Presented by Rich Chesney at Carevoyant 2015. To understand how the healthcare delivery landscape is changing for home health and hospice and provide self-assessment tools to gauge future growth and opportunities.

1. October 22 2015
Carevoyant Users Conference

2. AGENDA
 Purpose
 Speaker Background
 Environmental Context
 4 Survival Test questions
 Home Health
 Hospice
 Implications/Conclusions

3. PURPOSE
 Understand how the healthcare delivery landscape is
changing for home health and hospice
 Provide a self-assessment tool for organizations to
gauge the prospects for future success in home health
and hospice
 Outline next steps for organizations based on results
of tool

4. SPEAKER BACKGROUND
 Over 20 years in home care
 35 years of experience in planning and marketing
 MBA from the Sloan School of Massachusetts Institute
of Technology
 President, Healthcare Market Resources,

5. HEALTHCARE MARKET RESOURCES
 Leading market research firm serving post-acute
 Helps home health agencies, hospices and SNF’s better
understand their market, competitors and referral
sources
 Clients use our data in strategic/market planning,
benchmarking, sales targeting and key account
development
 Referral data on hospital, SNF’s and MD’s

6. CHANGING LANDSCAPE
 Reduced margins
 Rebasing
 Case mix creep adjustment
 Differentiated reimbursement
 Shift to “managed care”
 Sequestration

7. CHANGING LANDSCAPE
 Pay for Value, not Volume
 Demonstration projects
 Accountable Care Organizations-Population Health
Management
 “Capitation” thru voluntary and mandatory bundled
payments
 Performance Incentives/Penalties

8. CHANGING LANDSCAPE
 Narrowing provider referral lists
 Hospitals
 SNF’s
 Physicians
 More data transparency & differentiation
 Re-admission rates
 STAR ratings
 Increased regulatory scrutiny
 Drive unnecessary care and costs out of system

9. FOUR QUESTIONS
 Organic Growth
 Post-Acute Networks
 Reimbursement Impact
 Efficiency

10. QUESTION 1 HOME HEALTH
 Can we grow organically?
 How mature is my market?
 How concentrated is my market?
 Is there an opportunity to shift post-acute site of care
mix?
 Can we increase revenue per patient-less LUPA’s, higher
case weight & more re-certs

11. QUESTION 1 HOSPICE
 Can we grow organically?
 How mature is my market?
 How concentrated is my market?
 What is median LOS for my market?
 What is my market’s non-cancer mix?
 What is my market’s site of care mix?
 What is utilization amongst underserved population?
 Can my hospice use palliative care to capture patients
earlier in the disease process?
 What is managed care penetration?

12. QUESTION 2 HOME HEALTH
 What is my role within post-acute networks?
 How big is the post-acute market?
 How dominant are captive agencies at their own
facilities?
 How will proposed bundle payments for joint
replacements affect referral patterns in my market and
at specific local hospitals?
 How does your organization compare to its competitors
to be asked to join these network(s)?
 Will hospitals monitor referrals of owned MD’s?

13. QUESTION 2 HOSPICE
 What is my role within post-acute networks?
 How big is the post-acute market?
 How dominant are captive agencies at their own
facilities?
 Where do the hospitals in your market stand on
bundled payments, ACO’s & value-based purchasing
metrics-mortality rates, re-admission rates and per
beneficiary spending?
 Is there inpatient & palliative care capacity to limit end
of life expenditures?

14. QUESTION 3 HOME HEALTH
 What is impact of reimbursement changes on my
agency, market and competitors?
 Shift in weighting for therapy cases
 Dual eligible demonstration project
 Limits on re-cert rates
 Cost re-basing & sequestration
 IMPACT Act
 Value-based purchasing for Home Health
 ICD-10 Coding Transition

15. QUESTION 3 HOSPICE
 What is impact of reimbursement changes on hospice?
 Two tiered rates beginning 1/1/2016 under and over 60
days for routine home care(RHC)
 Added reimbursement in last 7 days for professional visits
to RHC patients
 Compare LOS mix versus competitors to estimate impact
 Hospices over the cap most affected(-5.4%) margins ; current
profits could be being re-directed to prior yr repayment plans.
 MedPAC recommendation to move hospice to managed
care

16. QUESTION 4 HOME HEALTH
 Is your agency cost efficient?
 Does it benchmark performance against local
competitors?
 Does it optimize visit levels by HHRG by discipline
 Does it analyze why LUPA’s occurred?
 Does it have practices in place to optimize episode
management
 Frontloading chronic disease, joint replacement and surgical
aftercare patients
 Appropriate use of nursing in therapy cases?
 Evaluation of therapy need based on clinical triggers

17. QUESTION 4 HOSPICE
 Is your hospice cost efficient?
 Compare visit levels per patient per week by discipline to
competitors
 New quality measure as visits in 2 days prior to death
 Visits correlate to patient satisfaction levels, particularly
near end-of-life(EOL)
 Preponderance of short-stay patients

18. IMPLICATIONS
 Need to get a passing score(3 out of 4) to have a chance
to survive long term
 Cannot rest on laurels; bar will get higher
 Failing scores seriously need to consider HARD
options
 Merger
 Sale
 Phase-out
 Passing scores or the prospect of one means you need
to making changes NOW

19. CONCLUSIONS
 Value-based purchasing is here to stay across ALL
segments
 Hospitals will dominate post-acute landscape
 MD’s and insurers will focus on pre-acute or community-
based referrals
 REFERRAL LISTS WILL SHORTEN
 Hospices and HH agencies will need to differentiate
themselves with outcomes/data
 Low barriers to entry will prompt large post-acute
providers and short-term acute hospitals to add captive
HH and hospice capacity

20. FREE OFFER
 Start the process by answering Question 1 or 4
 Need to understand the maturity of your market by
understanding utilization level of home health and/or
hospice
 Need to understand if appropriate visit level are bing
performed by HHRG
 Hand business card and indicate on the back as to
which report you want

22. CONTACT INFORMATION
 Rich Chesney
 President, Healthcare Market Resources
 1133 Dundee Drive, Ste. 100, Dresher, PA 19025
 rchesney@healthmr.com
 215.657.7373
MARKET DECISIONS BASED ON DATA, NOT
PERCEPTIONS