Boston Home Care Agency Reduces Hospitalization Readmissions to Well Below National Average

Prior to launching the Thriving at Home® approach and using AxisCare’s Hospitalization Tracking tool to track readmission rates, Dave Tasto and his team at Assisting Hands® – Boston Northwest were recording hospitalizations using ad hoc, time-consuming tracking at the client level. As Dave states,We did track hospitalizations at the client level but did not have a tool to report that data or a standardized way to even calculate our hospitalization rates, so the reporting was a huge missing piece.” 

When AxisCare released its Hospitalization Tracking feature, Dave’s team was one of the first to implement the feature, utilizing the data to track and iterate their readmission reduction strategies. 

Reduced Hospital Readmissions

Increased
Referrals

Improved
Client Satisfaction

The Challenge

Remaining in the home, colloquially known as “Aging in Place,” is a key goal for 9 out of 10 Americans, according to a recent survey by AAG. Hospitalizations are extremely challenging for both clients and their families, and the likelihood of the client returning after admission is about 1 in 5 within just 30 days (national average for Medicare patients, for the same diagnosis).

Dave and his team saw the crisis clients and families were facing and sought to change the script. They quickly realized that they needed a more structured system to improve effectiveness and a less time-consuming, more accurate way of tracking key indicators across multiple locations.

“In home care, we are in the business of preventing hospitalizations.”  – Dave Tasto, President/Owner

We sat down with Dave to learn more about his approach. Watch the interview below to learn how he is preventing and tracking hospitalizations. You will walk away with 2-3 actionable steps to do the same for your home care agency!

Play Video about Hospitalizations Case Study (1)

The Solution

Thriving at Home  Program Launched

Dave and his team instituted the Thriving at Home approach with their clients and families to equip them with knowledge, including home safety and fall prevention information, to begin to prevent common causes of visits to the hospital or emergency room. 

He also instituted Thriving at Home  Certification Training for his caregivers, preparing them with the interventions and appropriate escalations needed to address changes in condition, ultimately avoiding major causes of crises situations that could lead to hospitalizations. 

Organized Tracking with AxisCare Begins 

When the AxisCare Hospitalization Tracking Tool became available, the team at Assisting Hands – Boston Northwest applied the technology to each phase of care – from the initial intake of new clients to updating care notes on existing clients – in order to assess risk and track incidents and hospitalizations.

This newly organized data provided a way to monitor client conditions while effectively allowing for real-time communication with care managers and clients’ family members along with escalation to health care providers when necessary.

“We’re also receiving referrals from new partners who see our focus on hospitalizations in driving high client satisfaction and caregiver satisfaction as true differentiators in the area.”

Dave Tasto,  President/Owner

Hospitalization Readmission Tracking
About Dave

Dave Tasto is the President/Owner of Assisting Hands- Boston Northwest, a home care agency based out of Bedford, MA that provides award-winning home care to clients north and west of Boston. He is the author of Thriving at Home: A Handbook for Preventing Hospital Stays, a book aimed to help family caregivers identify and implement interventions to keep their loved ones healthy at home. Dave is also an Area Representative with Assisting Hands Home Care - helping grow the brand presence in New England

The Results

Utilizing both the Thriving at Home approach and the AxisCare Hospitalization Tracking feature, Assisting Hands – Boston Northwest has reduced hospital readmissions to well below the national average, which currently stands at 16%.

“We are regularly monitoring our readmission rates and are consistently tracking in the very low single digits,” says Dave. 

With data-driven decisions based on accurate tracking, Dave’s agency has seen improved client satisfaction rates and increased referrals, including new partners who see the focus on hospitalizations and driving high client satisfaction rates as true differentiators. Their office has also become as a “2022 Home Care Provider of Choice” in the Boston area. The satisfaction of caregivers who have received training and now benefit from having a true system in place, more regular shifts, and happier, healthier clients has also been a beneficial outcome that Dave contributes to the combined approach. 

<2%

DAVE’S CURRENT READMISSION AVERAGE

VS

16%

*NATIONAL READMISSION AVERAGE

Actionable Steps

As Dave says about home care, “We’re in the business of preventing hospitalizations.” To replicate his success in tracking and lowering hospitalization and readmission rates at your agency, start by taking the following steps:

1.  Start by tracking all incidents and hospitalizations immediately

2.  Take proactive measures that can impact your rate of hospitalizations

3.  Update your intake process to capture prior hospitalization information

4.  Tailor your care plans to address potential causes of hospitalizations

5.  Train your caregivers to look for and flag causes for hospitalizations prior to a crises event

 

Industry-Leading Hospitalization Tracking

AxisCare is leading the way in hospitalization tracking.

Document and track hospitalizations, using real data to determine and prove your success at minimizing readmissions – separating you from your competition.

Documenting Hospitalizations
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We’re confident that once you try AxisCare Home Care Software, you won’t go back to the old way of managing your business.

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Wyoming

Supported: COMING SOON

Payers in Wyoming have selected CareBridge and AxisCare is completing the necessary development. We are planning on being fully compliant soon.


Illinois

Supported: YES

Illinois has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, Sandata Technologies) while allowing providers and MCOs to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Illinois’s contracted aggregator, which will allow agencies to easily send required visit information.

Minnesota

Supported: YES

AxisCare meets the state ‘s EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with HHAeXchange, Minnesota’s chosen aggregator, which will allow agencies to easily send required visit information directly to HHAeXchange. 

Michigan

Supported: YES

The Michigan Department of Health and Human Services has decided to go with an Open Model that allows providers to choose their own EVV system, as long as it meets federal EVV regulations. They are in the process of choosing an aggregator system that will accept data from all EVV systems.

AxisCare meets all state and federal EVV requirements, so providers may continue to use AxisCare as their EVV and management system.

Massachusetts

Supported: YES

Massachusetts has chosen an open model, but has not selected the aggregator.  AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution.  

Maryland

Supported: NOT AT THIS TIME

Maryland has chosen a closed model where AxisCare is currently not able to provide EVV data to the state.   Providers can choose to use AxisCare due to the many advantages but you must use ISAS to collect EVV required data.

 

Maine

Supported: YES

Maine has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, Sandata Technologies) while allowing providers to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Maine’s contracted aggregator, which will allow agencies to easily send required visit information.

Louisiana

Supported: YES

AxisCare meets the state ‘s EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with LaSRS, Louisiana’s chosen aggregator, which will allow agencies to easily send required visit information directly to LaSRS. 

 

Kentucky

Supported: CONTACT US

Kentucky has chosen an open model with Tellus serving as the aggregator.  AxisCare has not developed the integration with Tellus for Kentucky yet (AxisCare supports Tellus integration in other states), but if your organization is interested in using AxisCare, please contact us. 

 

Kansas

Supported: NOT AT THIS TIME

Kansas has chosen a closed model where AxisCare is currently not able to provide EVV data to the state.   Providers can choose to use AxisCare due to the many advantages but you must use AuthentiCare to collect EVV required data.

 

Iowa

Supported: YES

Iowa has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, CareBridge) while allowing providers and MCOs to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with CareBridge, Iowa’s contracted aggregator, which will allow agencies to easily send required visit information.

Indiana

Supported: YES

Indiana has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, Sandata Technologies) while allowing providers and MCOs to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Indiana’s contracted aggregator, which will allow agencies to easily send required visit information.


Idaho

Supported: YES

Idaho has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, Sandata Technologies) while allowing providers and MCOs to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Idaho’s contracted aggregator, which will allow agencies to easily send required visit information.

Missouri

Supported: YES

AxisCare meets the state’s EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Missouri’s chosen aggregator, which will allow agencies to easily send required visit information.


Hawaii

Supported: YES

Hawaii has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, Sandata Technologies) while allowing providers and MCOs to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Hawaii’s contracted aggregator, which will allow agencies to easily send required visit information.

 


Georgia

Supported: YES

Georgia has chosen to use an open vendor model in which the state sets the standards for EVV, and providers may either use their existing EVV system or choose one that best meets their needs.

AxisCare has developed a direct integration with Tellus, Georgia’s EVV aggregator, so providers may continue to use AxisCare as their EVV and management solution.

 

Alaska

Supported: CONTACT US

Alaska has chosen an open model with Therap serving as the aggregator.  Therap has not provided the detailed specifications yet, but if your organization is interested in using AxisCare, please contact us.

Florida

Supported: YES

AxisCare currently provides direct integration with HHAeXchange and Tellus, so providers may continue to use AxisCare as their EVV and management solution.

 

Delaware

Supported: Coming Soon

Payers in Delaware have selected Sandata and AxisCare is completing the necessary development. We are planning on being fully compliant soon.

 

Connecticut

Supported: NOT AT THIS TIME

Connecticut has chosen a closed model where AxisCare is currently not able to provide EVV data to the state.  Providers can choose to use AxisCare due to the many advantages but you must use Sandata to collect EVV required data.

 


Colorado

Supported: YES

Colorado has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, Sandata Technologies) while allowing providers and MCOs to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Colorado’s contracted aggregator, which will allow agencies to easily send required visit information.


California

Supported: YES

California has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, Sandata Technologies) while allowing providers and MCOs to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, California’s contracted aggregator, which will allow agencies to easily send required visit information.


Arkansas

Supported: YES

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed integrations with HHAeXchange, AuthentiCare, and CareBridge, Arkansas’ contracted aggregators, which will allow agencies to easily send required visit information.

Arizona

Supported: YES

AxisCare meets the state ‘s EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Arizona’s chosen aggregator, which will allow agencies to easily send required visit information directly to Sandata.

Mississippi

Supported: YES

The Mississippi Department of Medicaid has decided to go with an Open Model that allows providers to choose their own EVV system, as long as it meets federal EVV regulations. They are in the process of choosing an aggregator system that will accept data from all EVV systems.

AxisCare meets all state and federal EVV requirements, so providers may continue to use AxisCare as their EVV and management system.

Montana

Supported: YES

Montana has decided to go with an Open Model that allows providers to choose their own EVV system, as long as it meets federal EVV regulations. They are in the process of choosing an aggregator system that will accept data from all EVV systems.

AxisCare meets all state and federal EVV requirements, so providers may continue to use AxisCare as their EVV and management system.

Wisconsin

Supported: YES

Wisconsin has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, Sandata Technologies) while allowing providers to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Wisconsin’s contracted aggregator, which will allow agencies to easily send required visit information.

Rhode Island

Supported: YES

Rhode Island has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, Sandata Technologies) while allowing providers to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Rhode Island’s contracted aggregator, which allows agencies to easily send required visit information.

West Virginia

Supported: CONTACT US

West Virginia has chosen an open model with HHAeXchange serving as the aggregator.  AxisCare has not developed the integration with HHAeXchange for West Virginia yet (AxisCare supports HHAeXchange integrations in other states), but if your organization is interested in using AxisCare, please contact us. 

Washington DC

Supported: CONTACT US

Washington DC has chosen an open model with Sandata serving as the aggregator.  AxisCare has not developed the integration with Sandata for DC yet (AxisCare supports Sandata integration in other states), but if your organization is interested in using AxisCare, please contact us. 

Washington

Supported: YES

Washington has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, ProviderOne) while allowing providers to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with ProviderOne, Washington’s contracted aggregator, which will allow agencies to easily send required visit information.

Virginia

Supported: YES

Virginia has chosen to use an open vendor model in which the state sets the standards for EVV, and providers may either use their existing EVV system or choose one that best meets their needs.

AxisCare has developed a direct integration with Tellus, Virginia’s EVV aggregator, so providers may continue to use AxisCare as their EVV and management solution.

Vermont

Supported: CONTACT US

Vermont has chosen an open model with Sandata serving as the aggregator.  AxisCare has not developed the integration with Sandata for Vermont yet (AxisCare supports Sandata integrations in other states), but if your organization is interested in using AxisCare, please contact us.

Utah

Supported: YES

AxisCare meets the state’s EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an export with UEVV, Utah’s aggregator, which will allow agencies to easily send required visit information. 

Texas

Supported: CONTACT US

Texas has chosen an open model with TMHP serving as the aggregator.  AxisCare has not developed the integration with TMHP for Texas yet, but if your organization is interested in using AxisCare, please contact us.

Tennessee

Supported: NOT AT THIS TIME

Tennessee has chosen a closed model where AxisCare is currently not able to provide EVV data to the state.   Providers can choose to use AxisCare due to the many advantages but you must use Sandata, Healthstar, and Time4Care to collect EVV required data.

South Dakota

Supported: CONTACT US

South Dakota has chosen an open model with Therap serving as the aggregator.  AxisCare has not developed the integration with Therap for South Dakota yet, but if your organization is interested in using AxisCare, please contact us. 

South Carolina

Supported: NOT AT THIS TIME

South Carolina has chosen a closed model where AxisCare is currently not able to provide EVV data to the state.   Providers can choose to use AxisCare due to the many advantages but you must use AuthentiCare to collect EVV required data.

Pennsylvania

Supported: YES

Pennsylvania has implemented an open model in which the state sets the standards for EVV, and providers may either use their existing EVV system or choose one that best meets their needs.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also integrated with Sandata and HHAeXchange, Pennsylvania’s two EVV aggregators, which allows agencies to easily send required visit information.

Nebraska

Supported: YES

AxisCare meets the state’s EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Tellus, Nebraska’s chosen aggregator, which will allow agencies to send required visit information.

Oregon

Supported: YES

AxisCare meets the state’s EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an export with eXPRS, Oregon’s aggregator, which will allow agencies to easily send required visit information. 

Oklahoma

Supported: CONTACT US

Oklahoma has chosen an open model with AuthentiCare serving as the aggregator.  AxisCare has not developed the integration with AuthentiCare for Oklahoma yet (AxisCare supports AuthentiCare integrations in other states), but if your organization is interested in using AxisCare, please contact us. 

Ohio

Supported: YES

Ohio has chosen to implement an open vendor model in which the state selects a single aggregator (in this case, Sandata Technologies) while allowing providers to continue using their existing EVV systems as long as it meets federal EVV guidelines.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with Sandata, Ohio’s contracted aggregator, which will allow agencies to easily send required visit information.

North Dakota

Supported: CONTACT US

North Dakota has chosen an open model with Sandata serving as the aggregator.  AxisCare has not developed the integration with Sandata for North Dakota yet (AxisCare supports Sandata integrations in other states), but if your organization is interested in using AxisCare, please contact us. 

North Carolina

Supported: YES

North Carolina has implemented an open model in which the state sets the standards for EVV, and providers and MCOs may either use their existing EVV system or choose one that best meets their needs.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also integrated with Sandata, HHAeXchange, and CareBridge, North Carolina’s EVV aggregators, which allows agencies to easily send required visit information.

New York

Supported: YES

New York has implemented an open vendor model in which the state selects a single vendor while allowing providers to continue using their existing EVV systems as long as it meets federal EVV guidelines.

New York has chosen to work with three EVV aggregators: eMedNY, HHAeXchange and CareBridge.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have developed integrations eMedNY, HHAeXchange, and CareBridge which allow agencies to easily send required visit information.

New Mexico

Supported: NOT AT THIS TIME

New Mexico has chosen a closed model where AxisCare is currently not able to provide EVV data to the state.   Providers can choose to use AxisCare due to the many advantages but you must use AuthentiCare to collect EVV required data.

New Jersey

Supported: YES

New Jersey has implemented an open model in which the state sets the standards for EVV, and providers may either use their existing EVV system or choose one that best meets their needs.

AxisCare meets state EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also integrated with HHAeXchange and CareBridge, New Jersey’s two EVV aggregators, which will allow agencies to send required visit information.

New Hampshire

Supported: YES

New Hampshire has decided to go with an Open Model that allows providers to choose their own EVV system, as long as it meets federal EVV regulations. They are in the process of choosing an aggregator system that will accept data from all EVV systems.

AxisCare meets all state and federal EVV requirements, so providers may continue to use AxisCare as their EVV and management system.

Nevada

Supported: CONTACT US

Nevada has chosen an open model with AuthentiCare serving as the aggregator.  AxisCare has not developed the integration with AuthentiCare for Nevada yet (AxisCare supports AuthentiCare integration in other states), but if your organization is interested in using AxisCare, please contact us. 

Alabama

Supported: YES

AxisCare meets the state ‘s EVV requirements, so providers may continue to use AxisCare as their EVV and management solution. We have also developed an integration with HHAeXchange, Alabama’s chosen aggregator, which will allow agencies to easily send required visit information directly to HHAeXchange.