Boosting HHCAHPS Scores: Eight Methods to Enhance Home Health VBC Performance

Consumer Assessment of Healthcare Providers and Systems Home Health Care Survey (HHCAHPS) Basics

The Home Health Care CAHPS Survey (HHCAHPS) measures the experiences of people getting home health care from Medicare-certified home health care agencies.

Survey questions asked patients about their home health providers’ communication about their care, quality of care, and whether they would recommend the home health agency.

Beginning in 2016, HHCAHPS data became available on the Medicare Care Compare site allowing patients and caregivers to compare the experiences of other patients receiving home care from the local organizations that they are considering.

Organizations must contract with an approved HHCAHPS Survey vendor and administer and submit the survey on an ongoing basis. Individual scores are weighted to create an HHCAHPS star rating score of 1-5 with 5 being the highest score. The average score for HHCAHPS is in the 3-3.5 range showing average performance.

Survey results tie to Home Health Value-based Purchasing (HHVBP) financial performance as illustrated below. An organization's performance can result, when combined with their OASIS score and readmissions claims, in a monetary impact -5% penalty to +5% revenue boost.

How can an organization improve its HHCAHPS score?

In short, communication. With patients, with caregivers and between members of the care team. Here are several ideas to get you started.

1. Reinforce instructions – There is growing awareness of the challenges health literacy plays in the patient’s ability to understand and follow healthcare instructions, which are often provided verbally. Health literacy refers to an individual’s ability to understand healthcare information to make appropriate decisions. Patients may be overwhelmed, tired and/or uncomfortable with their condition and/or the activities required when they shift from the hospital back to home. They may not be able to concentrate during the visit.  

Even if they are alert and engaged, health literacy can pose significant challenges. The National Assessment of Adult Literacy (NAAL) study revealed sobering findings:

This same study shows that current health information is too difficult for average Americans to use to make health decisions. Even people with strong literacy skills can face health literacy challenges, such as when:

✓ They are not familiar with medical terms or how their bodies work.

✓ They must interpret numbers or risks to make a health care decision.

✓ They are diagnosed with a serious illness and are scared or confused.

 ✓ They have complex conditions that require complicated self-care.

Adults over 65, individuals with lower education and without insurance have even lower health literacy than those under 65, compounding efforts to manage their health.

Digital patient engagement platforms provide access to a wealth of personalized health information, resources, and educational materials.  

Chatbots use simple, easy-to-understand terminology, videos and fact sheets to educate and empower individuals to make informed decisions about their health and well-being, such as the need and timing for specific preventive care, how to prepare for a procedure and more. Many organizations have information on their websites or portals or have a subscription to a third-party education content vendor. Instead of supporting patient-initiated browsing, send a chatbot to proactively draw the patient’s attention to the topic. This increases patient understanding by reinforcing verbal instructions in writing post-visit.

2. Keep patients informed – How many times have staff reported showing up at a patient’s home and the patient does not answer the door? Build trust and the confidence to answer the door by digitally reminding patients of planned visits.  

Chatbots can replace manual phone calls saving staff time. They can efficiently remind patients of upcoming visits and how to prepare for a productive visit. These same chatbots can include the name and a picture of the staff person who will be coming and a brief bio so that when they are at the door, they are expected and welcome. Staff can also securely text patients to let them know if they are running earlier or later than expected, reducing anxiety.

3. Support secure care team collaboration - Simplify team communication and collaboration with convenient, HIPAA-secure chat. This can be helpful for staff to share information may not needed in a medical record but shows the team is coordinating such as:

• The patient has a dog that needs to be contained before the visit

• Where to park to not get a ticket

• The daughter is coming from out of town and expects to be at the PT visit on Friday

• The patient has a doctor's appointment on the day of the next home health visit and will be home after 2 pm, etc.

Patients and caregivers can see and appreciate it when their home health staff communicate as a team.

4. Send consents for e-signature before onsite visits – By definition, a patient is eligible for post-acute services when they are homebound, which implies a level of impairment that may influence the patient’s ability and the speed to read and sign consents at times.  

Instead of spending 15 minutes or more of an assessment reviewing and signing consents and having the patient feel rushed, send the documents digitally before the visit using a chatbot. The chatbot can walk the patient through each consent and form at a time and pace of the patient's choosing and that is convenient to them. Patients have expressed appreciation both for more time to complete the required forms and for the increased time and focus the clinician can then spend on them during assessment.  

5. Prevent readmissions and ED visits – Agencies are only authorized for a limited number of visits. How do you keep a pulse on how the patient is doing on the remaining days of the week? Sixty-one percent of ED visits are not urgent. How do you keep top of mind so that if the patient has concerns, they contact you before going to the ED or hospital for non-emergency needs? Staffing shortages and a lack of funding preclude staff from making more frequent phone calls for all patients, many of whom will not need the call.

Chatbots can be your eyes on patients between visits. A chatbot delivered as part of a scheduled automatic campaign provides critical check-ins with your patient population. Imagine a daily outreach asking the patient to rate how they feel that day and if they have any concerns that they need to talk with the staff. If yes, escalate the interaction to the office for a digital chat or virtual visit. Proactive communication keeps the agency top of mind and reinforces the agency’s high touch focus on the patient.

6. Save patient and staff avoidable trips – Issues and concerns can happen at any time. Sending staff to patient homes for unplanned trips is expensive and disruptive for staff when many times, a conversation and a visual inspection can resolve the need. Traveling to an ED or hospital is scary and disruptive to the patient and caregiver.

Home health agencies are now accountable for hospitalizations and ED visits while the patient is receiving services from home health. Agencies are increasingly adopting virtual visits, not as a billable service, but to potentially reduce the need to send staff to the patient's home between visits and after hours.

7. Assess the patient’s experience with your agency – Don’t rely solely on retrospective survey results as they don’t provide actionable information. Proactively manage patient satisfaction. Send a brief one-minute survey for the patient to provide feedback on their experience. QliqSOFT’s no-code flexible tools also allow organizations to modify surveys to meet specific agency-specific needs – say a specific score on the Care Compare website, such as talking about pain, is an opportunity for improvement. Agencies can easily modify the form to focus on the specific areas targeted for improvement to support their performance improvement initiatives.

8. Take action when patients express dissatisfaction – Ninety-five percent of consumers read online reviews before selecting a product or service and 94% say bad reviews made them avoid a business. In most areas of the country, patients have a choice of multiple agencies.  

There are well-established best practices for responding to both positive and negative reviews that can be applied to both survey responses and online surveys. Responding to both positive and negative views shows that you care about the customer experience.  

Involve your staff in investigating, addressing, and more importantly, preventing issues. The link between staff satisfaction and patient satisfaction is well-documented. Engaged and motivated staff provide a better patient experience and they tend to stay longer in their jobs.

When issues do occur, apologizing and addressing the issue that the patient shared may not only make your agency more appealing to potential patients, it may also translate into higher HHCAHPS scores.  

Patients needing care in the home may be scared and feel vulnerable, in addition to their physical symptoms. It may be hard for them to concentrate, understand, and act on healthcare instructions.  

Proactively communicating, educating, and reinforcing instructions are good for patients, target key metrics in the HHCAHPS survey, and are good for business. Digital communication platforms, such as QliqSOFT enable you to deliver a high-touch customer experience.