Executive Summary
Community Nurse Home Care (CNHC), a certified Home Health Agency in Massachusetts, faced the challenge of meeting the ambitious goal of becoming a 5-Star agency in both Quality of Patient Care and HHCAHPS (Home Health Consumer Assessment of Healthcare Providers and Systems). To address this, they partnered with Strategic Healthcare Programs (SHP) to harness real-time data tools, foster a quality-driven culture, and enhance staff engagement. The result? CNHC achieved consistent 5-Star ratings in multiple reporting periods.
Introduction
CNHC, based in Fairhaven, Massachusetts, serves 20 cities along the Southcoast region. With a mission to deliver exceptional home health care to their patients, they set out to ensure that their quality of care is accurately reflected in the publicly reported star ratings. Navigating the intricate metrics of Quality Measures and HHCAHPS, CNHC aimed to establish itself as a benchmark for excellence in home health care.
The Problem
Despite their commitment to high-quality care, CNHC faced challenges reflecting their performance in public ratings. The agency had set an ambitious target to consistently reach 5-Star ratings in both Quality of Patient Care and HHCAHPS. This required real-time tracking and proactive management of clinical data, patient satisfaction, and quality metrics.
Key hurdles included:
- Lack of real-time data insights to monitor quality and patient satisfaction trends.
- Challenges in education and engagement with staff on the importance of quality measures and star ratings.
- Need for actionable insights to identify areas requiring improvement and implement corrective strategies.
With these complexities at hand, CNHC recognized the need for a comprehensive, data-driven solution to achieve their goals.
The Solution
To tackle these challenges, CNHC partnered with SHP, a leader in healthcare performance analytics and benchmarking. Together, they created a structured, robust strategy to establish a quality-driven culture and leverage SHP’s cutting-edge tools. Here’s how the solution was implemented:
Data-Driven Monitoring with SHP Tools
SHP Clinical Scorecard
CNHC utilized the Clinical Scorecard to track performance on publicly reported quality measures in real time. The Scorecard report allowed them to focus on specific teams, clinicians, and diagnoses, identifying opportunities for improvement, then drilling-down to individual patient examples to determine the underlying cause of issues.
HHCAHPS Scores and Benchmark Report
Benchmark comparisons against state and national averages helped CNHC identify where to focus their performance improvement efforts, and sentiment analysis helped them address negative patient comments to continually improve satisfaction.
Hospital Utilization Suite
By tracking hospitalizations with SHP's suite of Hospital Utilization reports, CNHC conducted root cause analyses to prevent avoidable readmissions and design tailored quality improvement plans.
Star Ratings Preview Report
The Star Ratings Preview report allowed them to preview upcoming star ratings and individual quality measures scores, enabling CNHC to proactively address performance gaps well in advance of public reporting.
Cultivating a Quality-Driven Culture
To ensure lasting success, CNHC prioritized the establishment of a culture focused on quality and teamwork:
- Quality measures and patient satisfaction were integrated into new staff orientation, ensuring every new hire understood their role in achieving agency goals.
- Frequent updates and in-person educational sessions served to train clinicians on areas requiring improvement and to celebrate successes.
- Mandatory biannual meetings reviewed star ratings, agency objectives, and current projects, fostering a shared commitment to progress.
OASIS Review Program
The OASIS (Outcome and Assessment Information Set) Review Team was pivotal to the success of SHP’s implementation. By leveraging SHP’s alert management tools:
- OASIS reviewers conducted detailed chart reviews to verify data accuracy and compliance.
- Reviewers maintained onsite collaboration with clinicians, offering real-time guidance for accurate patient scoring.
These efforts resulted in significantly improved quality measure scores and compliance, directly influencing publicly reported star ratings.
Results
With teamwork, SHP’s advanced analytics tools, and a quality-driven culture, CNHC achieved remarkable results:
- CNHC secured 5-Star ratings for both Quality Measures and Patient Satisfaction in multiple reporting periods for April 2019, July 2019, April 2020, July 2022, October 2022 and more recently in January 2023, April 2023 and July 2023.
- Real-time monitoring helped identify and resolve performance gaps quickly, ensuring consistent quality outcomes.
Our results showcase how a coordinated strategy with SHP can bring consistent 5-Star outcomes. The ability to track and act on real-time data has transformed our operations and empowered our team to deliver their best.
Conclusion
The partnership between CNHC and SHP underscores the value of leveraging advanced analytics and cultivating a quality-driven organizational culture. By integrating real-time data, staff education, and proactive problem-solving, CNHC successfully reached—and maintained—its ambitious 5-Star goals.
Looking ahead, CNHC intends to sustain its momentum by continuously innovating and refining its strategies with SHP as a trusted partner.
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