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By: Connie Christopher, RN, BSN, Connie Christopher, RN, BSN, Director Care Transitions, FirstHealth of the Carolinas, Inc.

 FirstHealth Home Care, a division of FirstHealth of the Carolinas, a comprehensive not-for-profit health care system in the mid-Carolinas, has always kept the focus on high quality patient care and actionable data to drive performance improvement. With the advent of the five year Home Health Value-Based Purchasing Model Pilot in 2016, FirstHealth was already demonstrating consistently high outcomes.

Nine states are included in the Pilot and participation is mandatory. The Model is designed to provide incentives to Medicare certified home health agencies to provide more efficient and higher quality of care to their patients. The nine states include; Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee.

The five year Pilot will continue through 2022. We could see changes going forward related to the Model design. The current Home Health Value-Based Purchasing Model (HHVBPM) may even be replaced with a Post-Acute Value-Based Purchasing Model with a similar design in the future. Regardless of the particular model, it seems certain all of home health will be under some form of value-based purchasing before 2022. It is important to prepare.

“The current Home Health Value-Based Purchasing Model (HHVBPM) may even be replaced with a Post-Acute Value-Based Purchasing Model with a similar design in the future. Regardless of the particular model, it seems certain all of home health will be under some form of value-based purchasing before 2022. It is important to prepare.”

While FirstHealth Home Care has always been a quality driven agency, being included in the Home Health Model gave our efforts a more specific focus. The quality process does not vary but the content does. Below we have included some of the lessons we have learned from the first two years in the Model.

  1. Assess Your Current Performance

Like many, FirstHealth Home Care relies on an OASIS data scrubber. This invaluable tool is essential to identify strengths and opportunities and is the foundation of the quality process. It is important that the accountability for the review, reporting and results of the outcomes data is clearly identified. In our organization, the Patient Care Coordinators (PCC), who reside in the Quality Department, are responsible for all outcomes. Their responsibility also includes utilization of services and case management oversight. They have no direct reports. Each month they report to the Leadership Team a specific set of data and the current trends. Potential problems are identified early so that the appropriate action can be taken.

  1. Identify Priorities for Improvement and Implement an Action Plan

With so many measures included in the Model, it would be impossible to focus on all of them. Acute Care Hospitalization will always be a primary target for improvement, especially now given the increased weight under the HHVBPM for this measure in 2019. For example, the PCC reports that the hospitalization rate for the team is trending up but notes that the increase is basically related to some of our newer case managers. As a result, a simple but meaningful Action Plan is developed. The Team decides to have the Clinical Coordinator complete additional OASIS Walks, the PCC to do one on one Patient Conferences and develop a High Risk Patient Watch List specific for those case managers. The PCC will report back to the Leadership Team the following month. Accountability is clear and documented in the Leadership Minutes for follow up the next month. Quality Performance, in order for it to be consistent, has to be diligently monitored and accountability has to be clear. Once the Leadership Team has agreed to the plan, it is important to share the plan with those involved in terms of improving patient care. Give ongoing and continuous feedback to everyone involved throughout the process.

  1. Monitor Progress

Monitoring is one of the hardest things that we do. It takes time and designated resources. It is important to communicate your successes related to improvements as well as areas that still need focus with everyone involved. Engage your staff to be part of the solution. Have processes in place to hold staff accountable for their outcomes. For example, complete a 100% record review of all hospitalizations with a root cause analysis. Share the root cause analysis with everyone involved. Include the patient. Ask on resumption what led to the hospitalization. Be sure to keep your progress in perspective. Outcomes measures move slowly. Even a quarter may not be enough time to see the improvement you are looking for.

  1. Identify and Use Your Subject Matter Experts

Routine review of Quality Score Cards with individual staff is perhaps the best way to manage Oasis competency and identify subject matter experts. Share best practices from your subject matter experts. One of our nurses has consistently good hospitalization scores in comparison to her peers. When queried about her scores, she was able to explain how she makes the patient’s primary physician a partner at the beginning of the episode of care. She identifies both the patient’s goals as well as the physician’s goals for that patient and uses them to guide the plan of care. Her insights helped us to develop best practices related to hospitalizations.

  1. Performance Improvement is a Continuous Process

Ongoing performance improvement includes routinely reviewing the current status of your outcomes at least monthly and updating your action plan as indicated. Use your data to drive your actions. Continuous quality improvement is critical. Have processes in place to hold staff accountable for their outcomes.

Quality Improvement is a team sport designed to drive improvement in the delivery of patient care. It is a never ending process that if done correctly and consistently with true accountability will lead to success in whatever model lies ahead.

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