How to Get to a Differentiated Value Proposition, Now and Tomorrow

Value is more than a buzzword in home care these days. Agencies know that payers, policymakers and consumers are all expecting it in the care they provide. But where should a hospice or home care agency start when thinking about how to demonstrate that value? How do you create a value proposition when there isn’t yet a roadmap for doing so?

It all begins with taking a step back and defining exactly who you’re trying to prove value to: Is it the payer? Is it a health system? Perhaps it’s a patient and their caregiver. Once you’ve truly defined your audience, the rest can start to fall into place. Agencies can then start to examine the MMA – what’s Measurable, what’s Monetizable and what’s Attributable to their efforts.

In the most recent episode of the Transcending Home Care podcast, Craig Solid, PhD, owner and principal of Solid Research Group, joined me to discuss how home care organizations can create a value proposition. We got into the details of how to think about proprietary versus public data sources, defining audiences, and finding your key allies and advocates.

Where’s the Data?

As I discussed with Craig, after you’ve figured out to whom you’re trying to provide value, the hard part can be getting your hands on the data that proves your case. Home care electronic health records (EHRs) are still evolving, and even the biggest platforms are still struggling with dashboards, KPIs and easy-to-use reports. Many providers still spend a significant amount of time manually compiling their own data when trying to develop their reports and value propositions.

Even under the best of circumstances, your own proprietary data can only get you so far. Hospice and home health EHRs can’t capture third-party events like rehospitalizations or the effects of medication drawdowns on Medicare Part D spending. These challenges will persist for some time to come while the home care community works to develop our collective capacity to demand integrated data sources with the help of tech companies and policymakers.

An Underutilized Available Resource

One source that Transcend sees as a potential for showing your organization’s unique value is available already: your Program for Evaluating Payment Patterns Electronic Report (PEPPER). PEPPER reports are a tool for ensuring claims submitted to fee-for-service Medicare are proper and in-line with regulations and oversight. While their main goal is to highlight outlier areas in billing patterns and to assist agencies with their organizational health and QAPI efforts, they also can be useful in proving an organization’s value to partners such as value-based organizations and Medicare Advantage plans.

PEPPER reports can be useful in demonstrating value in two ways to payers and value-based organizations:

• They highlight agreed-upon areas of outlier costs, and therefore value. Because these reports highlight areas that policymakers and payers agree are of interest, having good results to share can help an agency make their case in developing relationships with these entities. For example, hospice PEPPER reports highlight rates of Medicare Part D claims for patients at home, in an ALF and in a SNF. Being able to highlight low rates of Part D claims outside the hospice benefit can prove to a potential cost-conscious partner that your hospice has a robust medication reconciliation program in place and that you operate as CMS requests, covering “virtually all” conditions related to the terminal prognosis.
• They benchmark your program relative to other agencies. Having validation that your agency excels relative to others is a strong step in proving differentiated value. Being able to cite a source that shows your hospice live discharge rate for extended prognosis is lower than national, jurisdictional or state levels can be an enormous validator of your program’s worth. With proper context, it can tell a story about how you accept eligible patients and provide high-quality service through death.

In turn, using the statistics in these reports can help you develop a value proposition that, as Dr. Solid would say, is Measurable, Monetizable and Attributable. While PEPPER reports won’t be the only data points your organization should rely on, they can help paint a picture of an organization that strives to deliver high-quality care and better outcomes.

Keep Refining Your Value

The shift to value and all it entails will continue for the foreseeable future for home care agencies of all types. The data collection tools we have at our disposal are evolving, and so are the outcomes that we’re being held to by payers and value-based organizations. The trend is clear – the future will belong to those who can articulate a case for the unique value they can bring to a partnership.

If your organization needs help refining your value proposition or interpreting your PEPPER report outcomes, Transcend may be able to help. Reach out to us at hello@transcend-strategy.com to start a conversation about crafting a compelling story about your organization’s unique ability to deliver the best home care possible.