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The Latest Homecare Stats
Home Healthcare Saves Medicaid Upwards of $1,500/Patient/Day
Hallmarks of Higher Performing PDN Providers
- Defined Performance Indicators for such factors as case level DL/OT/Missed Shifts/Unplanned hospitalizations
- Efficient use of Internal FTEs with activity documentation and emphasis on Per‐Diems in the field
- Medicaid MCO contracting above Medicaid FFS rates
- Cohesive relationships and support between Clinical and Operational team members
- Aligned goals for employees
- Low turnover of branch level staff
- Willingness to change
PDN Acquisition Opportunities
- Fragmentation with lower competition profile
- Barriers to entry /risk profile
- Increasing sector interest as a diversity play to offset Medicare centric models
- Favorable support from PPACA Medicaid expansion and ACO/Payer risk bundling
- Short‐term pricing pressure will lead to long‐term support
- Providers will need to be willing to share risk
- Providers will be willing to share risk with data and incentives
- Technology will be the key to both operational efficiencies/NI as well as the basis for new revenue growth
- Opportunities for PDN to serve as base for new revenue streams in Adult PDN, HME, Enteral Nutrition, Respiratory Support, School Nursing
- Continued opportunity to provide acute level of in‐home care in the best clinical and psychosocial environment for the benefit of the children and families we serve
Source: National Council on Medicaid Homecare
1/3
of pediatric healthcare costs come from only 1% of all children. Of those costs, up to 80% is hospitilization.*
Children with Medical Complexity
Although no standard definition exists for medical complexity, 4 cardinal domains characterize CMC/CCC (Children with Medical Complexity / Children with Chronic Complex Conditions), as follows:1. Chronic severe health conditions
2. Substantial health service needs
3. Major functional limitations
4 High health resource utilization
Emerging Delivery Models for Complex Pediatrics
• Providers as payers• Medical homes/care coordination
• Pediatric accountable care networks
• Other incentive‐based contract models
• CHA proposal to Congress
Source: National Council on Medicaid Homecare
*Graph Source: CHA Special Report: The Landscape of Medical Care for Children with Medical Complexity, Berry et al, June 2013
Clinical Profile of Home Health Users: Top 20 Most Common Diagnosis Related Groups (MS-DRGs) for Beneficiaries Discharged from Hospital to Part A Home Health Episodes, 2015
