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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
Source: National Council on Medicaid Homecare

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

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