The Journey to Five-Star Quality of Care Ratings For Home Health

As the home health landscape shifts from fee-for-service to value-based care and hospitals continue to shrink their post-acute networks, the five-star rating system has become the standard aggregate metric for major referral sources when choosing post-acute discharge disposition for patients after an acute stay. At the same time, in January 2020, the public home health reimbursement program will shift from the current Prospective Payment System (PPS) to that Patient Driven Groupings Model (PDGM) which places a premium on hospital, or institutional, referrals over community-based referrals.

Home health agencies (HHAs) strive for the coveted 5-Star rating for many reasons, a rank that only 5% of HHAs nation-wide were able to achieve as of April 2018. Today the national average across HHAs is 3.5 stars, making a 5-Star agency really stand out. The benefit of carrying the rating system’s highest score is that it is a public and validated indicator for superior patient care delivery, something that all HHAs look to market in return for higher referral volume. Outside of the fee-for-service world, better quality measures can lead to higher reimbursement in the nine HHVBP states, and certain networks and health plans. Finally, higher star ratings attract and retain top industry talent which is often cited as the #1 challenge for HHAs today.

In this whitepaper, review the key opportunities and characteristics that come with superior quality of care star ratings. The document will also address an example case study with Well Care Home Health, and how innovative technology has helped them to be successful across the eight process and outcomes measures that earned them the 5-Star rating

John Banks Powell, VP of Post-Acute Strategies, obtained his Bachelor’s from UNC-Chapel Hill and his Master’s from Duke University. Powell spearheads CipherHealth's post-acute and bundled payment initiatives by partnering with providers across the care continuum. When Powell isn’t helping post-acute providers reach organizational goals, he can be found 30,000 feet in the air piloting planes.

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