A pragmatic guide for home health agencies that want to drive success by using key performance indicators and industry best practices.

1. Home Health Business
Improvements: Part 1
Wanda Coley, President & COO
Nick Seabrook, Managing Director

2. Learning Objectives
• Prioritize data to identify the key performance indicators that
drive success in home health
• Organize the key performance indicators into a daily dashboard to
effectively monitor your performance
• Strategies for sharing key performance indicators across the
agency

3. Overview
• Key Performance Indicator Overview
• Building an Agency Dashboard
• Keys to Managing KPIs
• Strategies for Success – Well Care

4. Key Performance Indicator (KPI)
• Definition
“The selected measures that provide visibility into the performance
of a business and enable decision makers to take action in achieving
the desired outcomes.”

5. Why are KPIs Important?
Performance Drivers
Provide Insight
Drive Decisions
Goal Setting

6. “If you can’t measure it, you can’t manage it.”
-Michael Bloomberg, former mayor of NYC
“If you can’t measure it, you can’t improve it.”
-Peter Drucker, “The Founder of Modern Management”

7. Operations KPI
• Census
• Referrals (By Referral Source, Marketer)
• Payor Mix – 57% Medicare*
• Productivity
• Days to Admission
• Outstanding Orders
• Turnover
• Employee Satisfaction
• Re-hospitalization within 30 days – 12.4%**
*Source - Simione Financial Monitor
**Source - SHP

8. Financial KPI
• Accounts Receivable (A/R) Balance
• Days Sales Outstanding (DSO)
• Days to Final Claim – 10-15 days
• Bad Debt – 1-2%
• Days Cash on Hand – 45 days*
• Profit Margin – 40%*
• Unbilled A/R
• Revenue vs. Billed vs. Paid
*Source - Simione Financial Monitor

9. Financial KPI
• Cost Per Visit*
• SN - $95
• PT - $98
• OT - $94
• ST - $123
• MSW - $193
• HHA - $52
• Administrative and General Cost*
• Clinical Supervision/QI – 8.3%
• Executive Team – 4.1%
• Office Support – 3.0%
• Intake – 2.7%
• Revenue Cycle – 1.3%
• IT - 1.3%
• Finance - 0.9%
• Medical Records - 0.6%
• Human Resources - 0.8%
• Fundraising - 0.3%
*Source - Simione Financial Monitor

10. Clinical KPI
• Productivity – 5-6 visits/day
• Case Mix – 1.074*
• Days to RAP – 5-7 days
• LUPA Percentage – 9.1%*
• Outlier Percentage – 2.9%*
• Therapy Utilization – 8.6 visits/ep*
• Average Visits Per Episode – 17.6*
• Average Length of Stay – 45 days
• Recertification Rate
• Supply/Drug/DME Utilization
• Outcomes
• Patient Satisfaction
• Star Rating
• Value Based Purchasing
*Source - SHP

11. Building an Agency Dashboard
• What Data?
• Frequency
• Daily
• Weekly
• Monthly
• Quarterly
• Annually
• Distribution
• Who?

12. Keys to Managing KPI

13. Keys to Managing KPI
Establish Goals
•Realistic goals
•Realistic timelines
•Trend Data
•Prioritize

14. Keys to Managing KPI
Identify Source
• EMR Reports
• Dashboards
• Third Party Reporting
• Home Health Compare
• VBP Interim Payment Reports
• CASPER Reports
• PEPPER Reports

15. Keys to Managing KPI
Monitor
•Who is reviewing what?
•How often?
•Who gets it?
•What manages?

16. Keys to Managing KPI
Analyze
Drill Down!
• Clinician
• Team
• Biller/Collector
• Agency/Service Area
• Referral Source
• Case Mix
• Day
• Time
• Write Offs

17. Keys to Managing KPI
Analyze
Drill Down!
• Case Mix
• Clinical Domain
• Functional Domain
• Service Domain
Score Average Case Mix Difference
C1 1.11
C2 1.17 5.2%
C3 1.31 12.6%
F1 1.14
F2 1.20 5.0%
F3 1.24 3.7%
Therapy
Visits
0-5 6 7-9 10 11-13 14-15 16-17 18-19 20+
Case Mix 0.63 0.78 0.92 1.07 1.21 1.36 1.54 1.72 1.90
Difference 15% 15% 15% 15% 15% 18% 18% 18%

18. Keys to Managing KPI
• Action
• Develop department scorecards
• Develop employee scorecards
• Monthly meetings with employees on variances from goals
• Create action plan

19. Well Care Health, INC Agency Overview
• Headquartered Wilmington, NC
• Serving the Carolinas
• Privately Held for over 30 Years
• Clinically Integrated Network ~Medicare Certified and Private Duty Services
• 11 Offices (3 Medicare Certified)
• 1,000+ Employees
• 5,000 Average Daily Census
• JCAHO Accredited and Deemed Status

20. Strategies for Success
• Strategic Planning
• 4 Disciplines of Execution
• Average vs Top 10%
• Financial, Clinical, Operational Benchmarks

21. Whirlwind Effect!

22. 4DX Philosophy
Focus on Wildly
Important Goals
Act on Lead
Measures
Keep a
Competing
Scoreboard
Create a
Cadence of
Accountability

23. More Goals = More Success
NUMBER OF
GOALS
(In addition to the
whirlwhind)
2-3 4-10 11-20
GOALS ACHIEVED
WITH EXCELLENCE
2-3 1-2 0
Your chances of achieving 2 or 3 goals with excellence are high, but the more goals you try to
juggle at once, the less likely you will be to reach them.

24. CONVENTIONAL THINKING 4DX PRINCIPLE
All of our goals are Priority 1. We can successfully
multitask and succeed at five, ten, or fifteen
important goals. All we need to do is work harder
and longer……
Many or our goals ae important, but only one or two
are wildly important. We call them WIGs. They are the
goals we must achieve. Our finest effort can only be
given to one or two wildly important goals at a time.

25. Key Performance Indicators
• Data Transparency
• Accuracy
• Actionable
• Timely
• Trends
• Why?

26. Sales
•Goals
• Admits per Marketer
• Conversion Rate
• Payor mix %
• Face-to-Face
• Achieve Goal 2 out of 3
Months
•Expectation
• 35-40 MCA Admits / Month
• 85% Referrals to Admission
• 75/25 PPS vs Non PPS
• <10% > 30 Days Post SOC

27. Sales Weekly Dashboard
Days in Month 8 of 31 MTD
Name
June MCR
Actual
July MCR
Goal
July MCR
Actual
Variance
Projected
MCR
Projected
Variance
Total
Admits
MCR % Pending
Non-Admits
MCR
Non-Admits
Total
Outstanding
F2F
Acct Exec A
28
32
8
-24 31 -1 10 80.0% -- 5 10
Acct Exec B
20
35
11
-24 43 8 16 68.8% 3 -- -- 5
Acct Exec C
33
40
18
-22 70 30 24 75.0% 6 2 5
Acct Exec D
17
28
3
-25 12 -16 14 21.4% 8 3 8 5
Acct Exec E
20
28
6
-22 23 -5 10 60.0% 3 -- -- 3
Acct Exec F
22
22
4
-18 16 -6 6 66.7% 9 -- -- 1
TOTAL 140 185 50 -135 195 10 80 62.5% 29 10 23 14
% Goal --> 70.0%

28. Competing Scoreboards
• Monthly Financial Review
• Senior Leadership
• Director of Operations at Branch Level
• Staff Meetings
• Distribute Weekly Dashboard
• Sales Activity
• Cash Collections vs Cash Goals by Payor
• Readmission %

29. Competing Scoreboards
• Marketing/Clinical Collaboration
• Pending > 24 Hours
• Trend Non-Admits
• Customer Relationship Manager - Playmaker CRM
• 20% Increase in Admissions
• Market Analysis

30. Intake
• Productivity
• Staffing Model
• RN, LPN 12-15 per day
• Administrative 15-17 per day
• Access to Hospital Portals and HIE
• Standard Office Hours vs. Flex Schedules
• Extended Intake Hours
• Cutoff Time

31. Intake
• Weekend Intake/After Hours Scheduling
• Same Day Insurance Verifications
• Timely Authorizations
• Monthly Report Write-Offs Due to Missing Authorization
• Currently centralized considering decentralizing to branch
• Face to Face Tracking
• Weekly Tracking Report by Liaison –Marketing Team and Operations
Leadership
• Weekly Cadence with Intake, Marketing and Clinical

32. Clinical Care Team Design
*400 ADC
Clinical
Assistant
LPN

33. Productivity
• Pay Per Visit Model
• Skilled Nursing
• RN = 5.5
• LPN = 6.5
• Therapy
• PT/OT = 5.5
• PTA/OTA = 6.5
• Staffing Model
• Discipline Mix 55/45

34. Bi-Weekly Productivity Report
Personnel Hire Date Goal Avg Visits Avg Miles Wgt Miles Variance Capacity
PT
PT, Tom 06/12/2017 5.50 5.07 75.54 5.08 (0.42) 92%
PT, Dave 03/26/2018 5.50 3.14 27.88 2.43 (3.07) 44%
PT, Alex 03/20/2017 5.50 3.50 25.86 2.75 0.02 50%
PT, Susan 03/27/2017 5.50 7.95 68.34 7.85 2.35 143%
PT, April 12/14/2015 5.50 5.79 51.22 5.43 (0.07) 99%
PT, Jaimee 06/20/2016 5.50 6.73 34.87 6.13 0.63 111%
PT, Daniel 08/22/2016 5.50 6.83 44.66 6.37 0.87 116%
PT, Robin 01/29/2018 5.50 6.25 87.52 6.44 0.94 117%
PT, Traci 06/20/2016 5.50 8.18 102.09 8.59 3.09 156%
Average for PT : 5.50 5.94 57.55 5.67 0.48 103%

35. Episode Management
• Utilize Episodic Tool
• Admission and Recert Review
• Patient Name
• HHRG
• Utilization
• Projected Revenue, Cost, Profit per Episode
• Weekly IDC
• Center for Clinical Excellence
• Code Record within 48 Hours of SOC
• Monthly Coding Scorecard

36. Clinical Benchmarks
• Average Revenue Per Episode
• Average Visits Per Episode
• Average Cost Per Visit
• Profit Per Episode
• Utilization
• Recertification Rate

37. OASIS Accuracy
• OASIS Expertise Clinical and Performance Improvement Teams
• OASIS Walk
• Utilize SHP OASIS Alerts
• Clinicians Manage Alerts
• 98% Alert Resolution
• Monthly SHP Scorecard by Team by Clinician
• Distributed Clinical and Sr. Leadership by 10th of Month
• Monthly PIP – Team and Clinician
• Monthly Outcomes and HHCAHPS Review by Sr. Leadership

38. LUPA Management
• LUPAs= 10%
• Educate Clinicians and Marketing
• Weekly LUPA Meeting
• 7 or Less Visits Projected
• Premature Discharge
• Therapy Down Codes
• Make Up Missed Visits
• Hospitalizations
• Diagnosis Driven

39. Avoidable Readmissions
How important are Quality Star Ratings?
What’s your readmission rate?
Days to SOC from Referral Date?
Direct Admit to SNF
*Population Health & Clinical Integration Team

40. All-Acute Readmission Rate (SHP) - Team Rankings
Rank Team Clinical Manager Mar-2018 Apr-2018 May 2018
1 A CM A 9.0% 8.9% 8.0%
2 C CM C 10.3% 9.0% 8.2%
3 D CM D 10.0% 11.8% 12.0%
4 F CM F 11.9% 15.0% 12.8%
5 G CM G 12.8% 12.0% 13.0%
6 B CM B 12.0% 10.9% 13.3%
7 Goal - 14.0% 14.0% 14.0%
8 E CM E 15.8% 18.0% 19.2%
9 I CM I 18.7% 19.0% 19.5%
10 H CM H 19.0% 18.5% 19.8%

41. Operational
• Days Sales Outstanding
• Monthly AR Aging Review
• Cash goals
• Weekly Revenue Cycle Stand Up
• Revenue Cycle Calendar
• Clinical and Billing Collaboration

42. Operational
• OASIS submitted prior to billing final claim
• Submit RAPs and Final Claims Daily
• Claims Billed vs. Unbilled
• Orders Management
• Claim Denial Management
• Timely Visit Completion- Weekly Report Incomplete Visit Documentation
• Electronic MD Signatures
• Pre Claim Review Proposed Illinois, Ohio, NC, Florida, Texas
• MBI

43. PEOPLE
•Turnover Goal = 25%
• Chief People Officer
• Recruitment & Retention Strategy
• Nursing Challenge
4 Day Work Week
Salaried On Call Nurses
LPN Clinical Assistants

44. Human Capital Scoreboard
Current Month Jun-2018
Fill Rate (Total) percentage of open positions
Rank Recruiter Goal Apr-2018 May-2018 Jun-2018
1 A 10.0% 9.4% 9.4% 6.1%
2 B 10.0% 16.5% 16.9% 9.5%
3 C 10.0% 0.0% 0.0% 12.3%
4 D 10.0% 20.0% 15.8% 12.4%
5 E 10.0% 23.3% 23.8% 21.6%
Fill Rate (31+ Days) percentage of open positions over 30 days
Rank Recruiter Goal Apr-2018 May-2018 Jun-2018
1 A 8.0% 6.8% 3.6% 4.2%
2 B 8.0% 13.5% 20.8% 4.7%
3 C 8.0% 0.0% 0.0% 9.2%
4 D 8.0% 17.9% 12.7% 10.3%
5 E 8.0% 22.6% 13.1% 17.9%

45. Offers Extended
Rank Recruiter Apr-2018 May-2018 Jun-2018
1 A 9 13 23
2 B - - 12
3 C 16 13 11
4 D 13 15 9
5 E 8 6 8
Offers Accepted
Rank Recruiter Apr-2018 May-2018 Jun-2018
1 A 7 11 19
2 B 11 15 8
3 C 9 12 7
4 D 3 4 6
5 B - - 5

46. Monitor, Measure, ACT
Measure
Trend
Drill Down
PIP- Agency,
Team, Staff
Member
Establish
Agency
Goals

47. Questions?

48. Contact Info:
Nick Seabrook
Managing Director, BlackTree Healthcare Consulting
NickSeabrook@BlackTreeHealthcare.com
Wanda Coley, MBA
President & COO, Well Care Health, Inc.
WColey@wellcarehealth.com