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You Can’t Afford Not To… The Growing Necessity for Predictive Modeling in Home Care

Posted by fivebyfive on August 16, 2013

By Daniel Hogan – CEO, Medalogix – From the Home Health Strategic Management Newsletter

The institution of heavy fines in 2012 for hospitals with readmission problems has turned the existing success measures in healthcare upside down. The issue of readmission reduction has become a topic on par with the Y2K phenomenon of 15 years ago, only this issue will amount to something previously unseen in healthcare management. Part of that something is the recalibration of relationships between hospital systems and their post-acute partners, initiated by the 30-day readmission provision, which took effect in October of last year. In home health, we are in business with the hospital systems as they seek tools and technologies to remediate this potentially financially catastrophic reality.

We as home care providers can get a glimpse of what the future will bring at the hospital level by reviewing recent comments and projections from health leaders’ about our current health care landscape.

“This is really the tip of the iceberg in exploring this area, because while we see that 93 percent say [predictive analytics] is very important to the future of their organization, less than a third actually feel like they have what they need.”
-Jennifer Covich Bordenick, Chief Executive Officer, eHealth Initiative

“By doing a better of job connecting the dots of their big data assets, hospital management teams can start to develop the crucial insights that enable them to make the right and timely decisions that are vital to success today. And, better, timelier decisions lead to improved results and a higher level of quality patient care.”
-Russ Richmond, MD

In an effort to address this re-hospitalization reduction issue, readmission task forces are being formed in most hospitals across the country to evaluate tools including predictive modeling software, which provides measurable clinical-decision support. What are we doing on our end in the home health industry? Home care is estimated to be the source of 16.5 percent of all 30- day readmissions. As the decision makers in the hospital systems evaluate the opportunities to leverage their own data, they will look to their home care partners as contributors to this problem. If you aren’t prepared to stand up and demonstrate that your agency is part of the solution you may find your organization excluded from critical referral channels or care models of the future. Currently, hospital administrators are even considering drastic measures like establishing preferred provider lists that stand to exclude all but a few hand-picked agencies in each area.

While this may sound daunting, the truth is this presents a tremendous opportunity for post-acute providers. We have the advantage of positioning our organizations to become the solution hospitals are seeking. While predictive modeling software is not new to the hospital world, it has become hugely successful in helping post-acute providers reduce readmissions. Forward-looking home care companies have built focused marketing campaigns around innovative artificial intelligence analytics that more accurately identify at-risk patients as they are admitted to home care. More precise and customized risk assessments are allowing these providers to better deploy specialty programs like telemedicine interventions and telephone triage programs to reduce the number of return trips to the hospital.

Medalogix home care users reduced their 30-day rate of readmissions by an average of 35.9 percent in a one-year period. Their hospital partners took notice. More importantly, they’ve been able to quantify readmit rates by individual referring facilities and diagnosis related group (DRG). The readmit rates Medalogix users are representing in these costly DRG areas are hovering in the 2 percent range.

In this climate of eroding reimbursements, industry consolidation, and increased regulation and inspection it is even more critical for home care providers to demonstrate effectiveness in the pursuit of patients and viable partnerships. With the value our hospital partners place on these analytics and the improved clinical-decision support it offers, how can we expect to have a seat at the table if we can’t offer that same level of support? Home care agencies that hope to thrive in our new health care economy cannot afford to sit idly by while the business of health care evolves around us. Ninety-three percent of the physicians that sign our orders say advanced analytics tools are the future. We all need to prepare for that future right now.

   

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