5 9-2013 ss-secrets_of_successful_home_health_agencies
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5 9-2013 ss-secrets_of_successful_home_health_agencies
- 1. Secrets of Successful Home Health Agencies C. Sam Smith Evangelist Vice President - Business Development 2013 1
- 2. What are some specific characteristics that mean âsuccessâ to you? 2013- All Rights Reserved 2
- 3. 2013- All Rights Reserved 3 What are some of the characteristics of success for a home health agency? ď§ Being a member of the Home Care Elite? ď§ Higher Revenues? ď§ More Favorable Patient Outcomes? ď§ Lower employee attrition? ď§ Lowered deficiencies? ď§ No ADRâs? ď§ Happier employees? ď§ Fewer rejected claims? ď§ More varied service options? Characteristics that will lead to successâŚ
- 4. 2013- All Rights Reserved 4 ď§ OrâŚ.a 2013 exampleâŚ ď§ Ever increasing hospital referrals from new hospital clients because you have proven how your agency can aid in dramatic reductions in hospital readmissions rates because of your ability to manage, document and measure your Excellent Patient Care, leading to Positive Patient Outcomes, resulting in Reduced Hospital Readmissions? Characteristics that will lead to successâŚ
- 5. Todayâs Learning Goals 1. Aid in determining your agencyâs success benchmarks 2. Alignment of culture with vision in the journey towards becoming a Successful Home Health Agency 3. Understanding Learning Organizations 4. Creating and promoting a positive culture 5. Translating the secrets into actions which optimize level of effort, stability and profitability 2013- All Rights Reserved
- 6. âSuccess Secretsâ Secret #1 - Become a Learning Organization Secret #2 - Achieve Proficiency in Clinical Services Secret #3 - Compliance with regulations Secret #4 - Wisdom in Financial Matters Secret #5 - Diversification in Service Models Secret #6 - Intentional, Culturally Sensitive Environment Secret #7 - Servant Leadership 2013- All Rights Reserved
- 7. 7 #1 #2 #3 #4 #5 #6 #7 2013- All Rights Reserved The Organic View
- 8. SECRET #1 Become a Learning Organization 8 2013- All Rights Reserved
- 9. 9 âOrganizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole togetherâ -Dr. Peter Senge 2013- All Rights Reserved LEARNING ORGANIZATIONS ARE:
- 10. Characteristics Of Learning Organizations A.Systems Thinking B. A Shared Vision C. Understanding Mental Models D.Team Learning E. Personal Mastery 2013, All Rights Reserved 10
- 11. Systems Thinking 2013, All Rights Reserved 11 ⢠The idea of the learning organization developed from a body of work called Systems Thinking. This is a conceptual framework that allows people to study businesses (home health agencies are businesses) as bounded objects, like cellular organisms. ⢠Learning organizations use this method of thinking when assessing their company and have information systems that measure the performance of the organization as a whole and of its various components (metrics). ⢠Systems thinking involves all the characteristics that must be appear in an organization for it to be a learning organization. ⢠If some of these characteristics are missing, then the organization will fall short of its goal of being fully effective, or highly successful.
- 12. Seeing the systems in place around us 122013- All Rights Reserved Health Information Exchange System Home and Community Patient Health Info Patient Health Info Home Health HIE
- 13. Organic Systems 13 ⢠Seth Godinâs book: âTribesâ â The original organism for human endeavor is a tribe ââhuman beings banded together for a common purposeâ. Tribes evolve and survive. Speaking of Survival, Imagine: âhave you thought of your business being in business in the current or a different form 700 years from nowâ? âŚin 2712? ⢠The Swedish have such a business organization: It is called âSTORAâ : This is an example of a living organism-an ongoing tribe, a living company. Founded in 1302!* Living Company- Arie DeGeus ⢠Organic businesses - have spirit, they are âaliveâ! 2013- All Rights Reserved
- 14. 14 #1 #2 #3 #4 #5 #6 #7 2013- All Rights Reserved The Organic View
- 15. Shared Vision 15 ď§ The effective learning culture must be guided and disciplined by its shared vision and its collaboration ď§ Each member is expected to seek Personal Mastery of his or her role in the Operation, to become a Subject Matter Expert ď§ Knowledge is encouraged to be shared, not hoarded for personal advantage 2013- All Rights Reserved
- 16. A Shared Vision â are you up to it? 16 It is incumbent upon owners & managers to communicate, to dispense constant praise and encouragement towards: ⢠PERSONAL MASTERY for staff / both administrative and clinical ⢠TEAM LEARNING PRACTICES so all staff members can benefit. ⢠Benefits will manifest in: ⢠Quality patient care ⢠Repeated fine tuned and improved processes ⢠Procedural understanding ⢠Positive, productive inter-personal standards ⢠Mutually beneficial work objectives 2013- All Rights Reserved
- 17. 17 Secret #2 Proficiency in Clinical Services 2013- All Rights Reserved
- 18. 18 ď§ We must ensure that our staff members are achieving Personal Mastery ď§ Billing â all models (How frequently?) ď§ Skilled Health Services Employees: ď§ Patient Admissions ď§ Charting ď§ Case Management ď§ Therapy Deployment ď§ Regulatory Compliance ď§ Coding & RN Accreditation/Licensing Proficiencies
- 19. 19 ď§ We must ensure that our staff members are achieving Personal Mastery âin other areas of our business ď§ Financial Management â With ACOâs/Bundling of Payments, more important than ever ď§ Referral âRainmakingâ ď§ Data Application for Referral Generation- Report Generation ď§ Authentic Confidence in Approach to sources of referral business Proficiencies
- 20. 20 Secret #3: Compliance with Regulations
- 21. Compliance 6-7-2012 21 ď§Using up to date technology to: ďźProvide the teams with a methodology for time saving regulatory compliance ďźFollow the doctorâs orders ďźPerform the duties of skilled care of patients thoroughly ďźBill & accurately collect data to report those patient episodes ďźYour Technology Vendor should be a consultant. ďźWho, along with your state association, can enable you to stay ahead of new regulatory issues, and changes in standards
- 22. Compliance 6-7-2012 22 Is Your Technology Vendor your consultant? ďźAlong with your state association, can your vendor enable you to stay ahead of new regulatory issues, management ideas, and changes in reimbursement and clinical standards?
- 23. Secret#4 Wisdom in Managing Financial Matters 23
- 24. Agency expenses must drive revenues and growth 24 Key questions: ⢠Are the agencyâs costs and expenditures aligned with the agencyâs shared vision? ⢠âAm I either saving the company money, time and resources, or adding to its assets and revenue?â ⢠âIs what we are doing making us more profitable â by either increasing revenues or decreasing expensesâ? ⢠âDo we have sophisticated enough systems and measurements in place to accommodate bundled payment business models and diversified lines of business?â
- 25. Organization Name: Bluebonnet Health Services, Inc. Size: 400+ patients Population served: McLennan County, Metro Waco, TX Services provided: Home Health services with varied reimbursement models Exemplary in wisdom regarding expenditures: The market has two hospitals both with HHA subsidiaries. The HHA marketing challenge is to seek prospectsâ TOMA (Top of Mind Awareness). Expensive advertising: As sponsor of the Lady Bears basketball team, radio, TV, and onsite game-time advertising Results: Creates TOMA among the over 65 crowd who enthusiastically supports the Baylor womenâs basketball teamâaverage attendance over 10,000 per game. Census is regularly 50% higher than the hospital subsidiary HHAâs. VIGNETTE #2- AN EXEMPLARY HEHHA
- 26. VIGNETTE #2- AN EXEMPLARY HEHHA Secret #5 Diversification
- 27. Secret #5 - Diversification 27 ď§ Step by step deployment of diverse home based services: ď§ Medicare, Insurance Authorizations, Hospice, Private Duty, Companion Care, Medicaid Contract Specialization, Chronic Care Specialties - cardiac care(CHF, COPD, Recovery and Monitoring, for example)âand the possibilities go on and onâŚ ď§ Seeking a diverse number of income streams ď§ Government reimbursement ď§ Private insurance ď§ Private pay from families
- 28. Exemplary in: ďź Diversificationâ A Shared Vision, Bounded Object, Systems Thinking ďź Culturally Sensitive, to employees, as servant leaders â Personal Mastery & Understanding Mental Models Organization Name: Mobile Personal Services, Inc. Size: 400-500 patients Population served: Metro Tampa, FL (Pinellas, Hillsborough, and Pasco counties) Services provided: Health services in homes, with varied reimbursement models: Medicare/Medicaid; Private Duty; Hospice; affiliated services as referrals Vignette #3: An exemplary Successful Home Health Agency - Diversification
- 29. 6-7-2012 29 Secret #6 Intentional, Culturally Sensitive Environment
- 30. 30 The environment is driven by Learning Organization tenets ⢠There is a ideological/spiritual connection/component. ⢠For sustainable growth, employees must have an ideological identity with the organization. ⢠Employees possess an obvious and open commitment to Learning and Achieving Mastery ⢠The organization encourages those who are inspired and who are learning and growing ⢠Service and servant hood are important values Secret #6 Intentional, Culturally Sensitive Environment
- 32. Secret #7 - Servant Leadership Servant Leaders ⢠Regularly translate & communicate the Present Reality to the Shared Vision ⢠Value advice and truthful advisers ⢠Are slow to speak and eager to listen ⢠Highly Value the aim of Personal Mastery in every work function ⢠Display Emotional Intelligence ⢠Understand the connection between giftedness and responsibility 32
- 33. Servant Leaders 33 ď§ âHuddle Upâ regularly. Operate with a regularly scheduled âtribunalâ - or - âhuddleâ ď§ Personally embodies the values to accomplish the vision ď§ Align his/her work in order to enable the staff ď§ Encourage open communication and provides an example of humility and humor with the organization members ď§ Make sure everyone is having fun!
- 34. CULTURE EATS STRATEGY FOR BREAKFASTÂŽ And all of these secrets are cultural standards that are vital to our aspiration of becoming a Successful Home Healthcare Provider The Secrets of Success! -ÂŽPeter Drucker âManaging in a Time of Great Changeâ
- 35. 35 To summarize⌠Do you have questions about: I. Success Benchmarks II. Learning Organizations III. Alignment of your culture with your vision IV. Action Steps V. What does culture eats strategy for breakfast mean? Have we achieved the learning objectives for today?
- 36. For more information on Learning Organizations and Dr. Peter Senge http://www.infed.org/thinkers/senge.htm The Fifth Discipline by Dr. Peter Senge Thank you for your attention today.
Hinweis der Redaktion
- What are some of the characteristics of success for a home health agency?Higher Revenues?More Favorable Patient outcomes?Lower employee attrition?Lowered deficiencies?Happier employees?Fewer rejected claims?Reductions in hospital readmissions rates because of your excellent patient care, and outcome management?
- We all have our own concepts of success.Please feel free to share these with our group today.What I am presenting today is what I believe is a cultural angle on the whole challenge facing home health agencies today. We must adapt a culture of learning, at every role and position within the agency in order to stay abreast of the ways our industry and our workflows and payments systems are dynamically evolving.
- There is much talk today about readmissions rates and how home health agencies can assist in the reducing hospital readmissions and how we can hopefully bring about a steady stream of patient referrals. Our discussion today suggests several major cultural adaptations for you to consider.Perhaps you already have adopted many of these measures.If so, I believe you are one step closer to measurable success in this market.
- --Adaptable, agile, all working together within the cellular system -- like amoeba. The word amoeba comes from a Greek word meaning "to change." *The amoeba moves by continually changing its body shape, forming extensions called pseudopods (false feet) into which its body then flows. The pseudopods also are used to surround and capture foodâmainly bacteria, algae, and other protozoaâfrom the surrounding water. An opening in the membrane allows the food particles, along with drops of water, to enter the cell, where they are enclosed in bubblelike chambers called food vacuoles. There the food is digested by enzymes and absorbed into the cell. The food vacuoles then disappear. Liquid wastes are expelled through the membrane.Can you see the analogy?
- Agencies which teach and encourage shared vision and corporate learning, over time become true âlearning organizationsâ. In todayâs healthcare marketplace, the dynamics of the environment make the need for learning even greater than ever before.The learning organization concept was introduced by Dr. Peter Senge, of M.I.T.âs Center for Organizational Learning in Cambridge, MA, and author of âThe Fifth Discipline, The Art and Practice of the Learning Organizationâ. These tenets all have great influence in the shaping of an agencyâs culture. Letâs explore what each of these characteristics might mean to you as we look at aligning our culture with our vision and our strategy to bring about a Successful HHA.
- Continually expanding capacitiesCreating desired resultsNew, expansive thought patternsCollective aspirations are set freePeople are learning through systems viewpoints
- The idea of the learning organization developed from a body of work called Systems Thinking. This is a conceptual framework that allows people to study businesses (home health agencies are businesses) as bounded objects, like cellular organisms. Learning organizations use this method of thinking when assessing their company and have information systems that measure the performance of the organization as a whole and of its various components (metrics). Systems thinking involves all the characteristics that must be appear in an organization for it to be a learning organization. If some of these characteristics are missing, then the organization will fall short of its goal of being fully effective. The development of a Shared Vision is important in motivating the HHA staff to understand the shared vision of excellent, quality patient care as being the overriding cultural value can energize the tribe. In some agencies the agreed upon shared vision is often to succeed against a competitor; however, these are transitory goals. The shared vision should reflect a long term goal that is intrinsic within the company, such as the vision of excellent patient care. Understanding Mental Models. The assumptions held by individuals and organizations are called Mental Models. To become an effective agency which is growing as a learning organization, these models must be challenged. Individuals tend to espouse theories, which are what they intend to follow, and theories-in-use, which are what they actually do. Similarly, organizations tend to have âmemoriesâ which preserve certain behaviors, norms and values. In creating a learning environment for the effective Home Health Agency, it is important to replace confrontational attitudes with an open culture that promotes inquiry and trust. Unwanted assumptions, norms and misaligned values need to be discarded in a process called âunlearningâ. It is the responsibility of each agency to identify the flawed mental models of its members. These should be dealt with discretion and in a considerate, humble manner. The benefit of Team Learning is that staff members grow more quickly and the problem solving capacity and agility of the organization is improved through better access to knowledge and expertise. Team learning requires individuals to engage in dialogue and discussion; therefore team members must develop open communication, shared meaning, and shared understanding. (Tribunals aid in developing this capacity.) An individualâs commitment to the process of learning and professional proficiency is known as Personal Mastery.There is a competitive advantage for a Home Health Agency organization whose workforce learns and implements quicker than the workforce of other organizations. Individual learning is acquired through staff training and development, and credentialed formal education. However eventual learning cannot be forced upon an individual who is not receptive to learning. Effective agencies know the importance of the development of a culture where personal mastery is encouraged and practiced in each memberâs daily work-life. The effective HHA must employ agreed upon mechanisms to encourage individual learning to be transferred into organizational learning. **Many of the ideas that are contained in this presentation also have their root in âThe Fieldbook for Learning Organizationsâ- by Peter Senge and others
- This is a model Health Information Exchange diagram. It depicts a system that your agency could be within.
- --Adaptable, agile, all working together within the cellular system -- like amoeba. The word amoeba comes from a Greek word meaning "to change." *The amoeba moves by continually changing its body shape, forming extensions called pseudopods (false feet) into which its body then flows. The pseudopods also are used to surround and capture foodâmainly bacteria, algae, and other protozoaâfrom the surrounding water. An opening in the membrane allows the food particles, along with drops of water, to enter the cell, where they are enclosed in bubblelike chambers called food vacuoles. There the food is digested by enzymes and absorbed into the cell. The food vacuoles then disappear. Liquid wastes are expelled through the membrane.Can you see the analogy?
- Tribes are an organic way of alignment of like-minded people working together collaboratively for a common goal or shared vision. Exemplary Visions for agencies that could be shared are:An authentic desire to provide quality patient care is an excellent example of a shared vision. To follow Learning Organization Principles & Direction is a shared vision.The effective agency is a living organism, a tribe, whose culture must be guided and disciplined by its shared vision and its collaboration. Each member is expected to seek Personal Mastery of his or her role in the tribal organism. This recognizes the skilled nurse, the aide, the social worker, the billing and administration personnel, the ownership and management, as being highly proficient and ever-learning, ever-growing-in-knowledge and proficient in their assigned duties. The age old âguildâ interrelationship between the master and the apprentice is a guiding principle in an effective home health agency. Knowledge is highly valued, but is not hoarded for personal advantage. However, those of the tribe who possess knowledge are held in high esteem by their colleagues and are considered Subject Matter Experts.Teaching and learning is encouraged between team members and between care givers and patients.
- Leaders are very aware that they must constantly praise and encourage the members of the tribe to continue learning, initiating and growing in personal mastery. The agency without a focus primarily on quality patient and member care, empowering its employees/members to act as âcare agentsâ in the field, are not able to achieve anything similar to the effectiveness of those HHAâs that do.Owners and managers who are unable and unwilling to be open and to submit to this shared vision/teamwork oriented concept and agree to grow towards operating in this way are acknowledging that they will accept something less than becoming highly effective as an agency.
- Skilled Nursing Proficiency is a non-negotiable cultural norm of the effective HHA. Successful agencies know that skilled staff members working in the areas of patient admissions, charting, case management, therapy deployment, regulatory/billing & compliance, and RN accreditation are necessary in order to become more and more effective in operation. The highest professional standards for skilled nursing care, nursing licensing, and knowledgeable, well-designed workflows and well-trained administrative staff are high return targets for each HHA. Decisions regarding software platforms and operating systems for the agency should include methodologies for tracking and maintaining the necessary ongoing training necessary for always current professional nursing licensing. Effective tribal agency leaders have a constant eye on the professional standards maintained by the nursing staff.
- The most important reason for choosing a software platform is to provide a methodology for maintenance of regulatory compliance in skilled care of patients, and billing & reporting those patient episodes. In the current environment the home health industry is regulated by our primary payment source, the Center for Medicare Services. The effectiveness of the agency in billing and overall compliance is directly attributable to the accuracy achieved in preparation of the Outcome and Assessment Set documentation (the OASIS). Also the 485 summary report to be signed by the Physician in charge of the patients care must be accurate and in compliance. The technologically superior and constantly improving updated software platform* is the driver for this accuracy and completeness in the effective HHA. Because of the sophistication of operational platforms, maintaining the home health agency on paper forms, while still possible, is now impractical and counterproductive. The time required in generating paper charts and billing submission documents in order to maintain regulatory standards for OASIS and 485 submissions is clearly cost prohibitive.
- *Note: Axxessâ AgencycoreÂŽ is the leading state-of-the-art Point-of-Care and Operations based software platform in the US. A rapidly growing number of prominent and effective Home Health Agencies utilize AgencycoreÂŽ to enhance their ability to achieve highly effective and productive operations. No other platform available in the marketplace today can compare to Axxess in the enablement of highly effective agency operations.
- Generosity with patients and with staff brings about the joy of working, of having fun with oneâs co-workers and the patients in the field. Cost containment managed wisely means being generous with patients and the pay scale for agency staff, because these factors drive greater returns, more referral generation and more expansive revenues. Cost containment is non-negotiable; however, the effective HHA is wise in strategically deciding on how costs are linked to productivity. Additionally, effective agencies utilize productivity and performance metrics as motivational drivers towards greater productivity. Personal productivity and team productivity can effectively be managed in an open facilitative manner, appropriate to the adaptive, learning organization based tribal culture.
- KEY QUESTIONS:Just what is it that we do well?Monitor heart patients? care for diabetics?helping folks get ambulatory again after surgery?Companion care efficiencies? Hiring of great care givers?Therapy processes?
- Since its founding in 1991, MPS has been an agency that takes advantage of all opportunities.Now MPS operates as a state licensed and Medicare licensed agency. Home health episodes are originated for all types of patients. They are operating under state authorized Medicaid programs, standard Medicare programs, insurance authorized Managed Care programs, HMOâs, private pay/private duty programs, and home services plans.MPS also participates in The Signature Network, a program whereby the agency recommends trusted partners for all sorts of home owner services, plumbing, construction, air conditioning, lawn and garden maintenance, housekeeping, pest control, painting, and house cleaning. The agency garners referral fees from the Signature Network for referral of their patients to these partnering companies.Nurse Mary Beth is the DON at MPS. She had established herself as a productive DON. She went to the owner of the agency and explained that she would like to have âtreadmill deskâ so she can exercise while she is at work, doing QA and patient records work. MPS owner/administrator, Lisa Tabbert assisted her in getting the treadmill installed by offering to furnish a truck to transport it. Now Mary Beth is a happy DON, walking on her treadmill 3 miles a day.
- The effective agency is always creating, initiating, evolving. This creative action and initiation has the effect of causing others in the market to react. Most HHAâs are not aware of tribal organic operational culture, so tribal cultures can move stealthily within their local markets, to quietly and forthrightly accomplish their goals and objectives, and move closer to their shared vision. In doing so, they are lethal competitors. Tribes have strong, visionary, focused and competent leadership. Effective âTribal HHAâsâ are focused on âthe whyâ behind what they do, so that every member acts in accomplishment of the shared vision of the tribe. For effective HHAâs it has to do with excellence in patient care. Tribal organisms are quick to identify the mental models (or flawed assumptions) that are not aligned with the agencyâs vision. Left unattended, flawed mental models can harm an agencyâs shared culture, and can in turn do harm to its ongoing business success. The effective HHA acts and initiates based on its best knowledge and shared learning. Because effective agencies are learning organizations, and every member is encouraged to act in accordance with a shared vision, creative solutions and methods are constantly being tried and implemented. Like a tribe in the wilderness, it constantly adapts and is agile as a team. An effective HHA recognizes its organic nature, in that tribal culture is the fundamental unit of human activity. Everyone knows and understands his or her role and is expected to do his or her job because each member is committed to achieving an ever growing sense of personal mastery and is fulfilled in his or her role. He or she is being encouraged to grow in their role, and is praised when they achieve new attributes. This mastery and the encouragement of leaders can assist each member in making their assigned work become âfunâ.Letâs have fun! âHaving funâ and achieving positive feedback at work creates a work environment in which members enjoy participating. Once organic concepts and learning organization cultural standards are implemented in the HHA, more effective workflows in operations result, because the team members are enjoying their work and working together towards a common goal. Why not try these concepts? You might become more effective! Not only that, you might begin to have fun at work.
- Have you considered how to determine your own success benchmarks, by understanding the characteristics of successful agencies?Have you begun learning how to better align your culture with your vision in the journey towards becoming a Successful Home Health Agency?Do you have a better understanding of the characteristics Learning Organizations?Do you see how this can become a way to promote a positive culture?Can you begin translating these secrets into actions which optimize your organizationâs level of effort, stability and profitability?