By Jon H. Lemke, Ph.D.
Introduction by Anna Daly, MSN, RN
As Sotura Health is starting it’s journey working with healthcare professionals, AgeTech vendors and organizations focusing on aging populations we wanted to start by highlighting our strength in analytics using publicly available data for the aging population. In the analysis below, Jon starts his series of blogs analyzing US Home Health agencies and the results will surely surprise you! Follow along as we dig deeper in the coming months and just imagine how much more we can do if we add YOUR data into the mix! – Anna
When CMS released the Home Health Star Ratings from October, the first thing that jumped out at me was that Alabama and Mississippi stood out above all of the rest with 22% and 21% more stars than expected. The expected are from the following distribution of Quality Star Ratings across the nation, including Washington, D.C., and the territories of Guam, the Mariannas, Puerto Rico, and the Virgin Islands.
Alabama had a total of 452.50 observed stars and expected 370.41 (O:E = 1.22) and Mississippi observed 169.50 and expected 139.72 (O:E = 1.21). They were followed by Washington and West Virginia with O:E = 1.17, Maryland, Tennessee and South Carolina at 1.16, Virgin Islands at 1.15, Kentucky at 1.14, Louisianna and Pueto Rico at 1.13, and rounding out the top 10 states is Georgia at 1.12. Except for the state of Washington, the other 9 states in the top quintile are contiguous predominantly southern states. The territories on the Altantic side are comparable to this top quintile.
Alabama and Mississippi have 10.19% 5 stars, 45.22% 4.5+ stars and 66.24% 4+ stars, as compared to the 6.17%, 19.13%, and 34.91%, respectively, for the whole nation. These two states also had no 1 star quality ratings.
Even more impressive are the performances of Alabama and Mississippi on the specific measures used to determine the Quality Star Ratings. On the following table you will see the direct comparisons of Alabama and Mississippi quartiles to those of the rest of the nation. The Timely Initiation of Care is the only process measure and the rest are outcome measures from 2021, except for the Acute Care Hospitalizations which come from claims data and exclude the first six months of 2021 and instead use the last 6 months of 2020 and of 2021.
The Z-scores represent the standardized rank-based results comparing the observed mean ranks sums to the expected. Note these are not just greater than 2.0 they are greater than 6.0 for all measures (higher is better), except acute hospitalizations (lower is better). In these first six measures note the 1st quartile for Alabama and Mississippi is greater than the median performance for the rest of the nation. With significantly higher acute care hospitalization rates in Alabama and Mississippi, it should be apparent that one cannot expect closer attention to client’s health and well-being to result in fewer hospitalizations.
All of these analyses are based upon aggregate data. To understand how any agency relates to their impact on their clients and their opportunities for improvement, they have to study their own client specific data.
Note to close any gaps one must first understand and recognize best practices. This should initially lead to bigger gaps as those with best practices can make less dramatic improvements to enhance performance, while others may have to make more dramatic changes across a range of issues to achieve best practices. One cannot end this discussion without giving credit to the front line staff that interacts with their clients and truly make the difference.
Stay tuned for my next blog where I will take a broader look at Home Health Care across the entire nation.
-Jon