Client Profile:

A home care and hospice provider in New England.


The LUPA rate for this agency was consistently above 12%, which reflected room for improvement in patient care and in reimbursement. A nursing and therapy staff shortage combined with high patient volume made it difficult to achieve proper visit utilization. The agency sought to increase patient satisfaction, quality scores, and revenue. Internal initiatives to address these areas proved impractical for the agency when competing with important day-to-day operations.


McBee proposed an episode management solution focused on improving visit utilization and reducing care variance. This involved regular discussions with field clinicians on plans of care and appropriate visit utilization.

In addition to front-loading visits, episodes showing low utilization were discussed with an agency manager before discharge, and missed visits were rescheduled within 48 hours.

Placing additional focus on low therapy utilization positively affected patient outcomes. Fall prevention and hospital liaison training were also focus areas.


The agency’s average LUPA rate was lowered from 12% to below 9%.  With an external focus on episode management, the agency was able to improve processes that resulted in better patient outcomes and satisfaction, as well as referral source satisfaction. The agency has achieved a Home Health Compare Star Ratings score of four on the five-star rating system.

The episode management initiative has also fostered stronger collaboration and communication on patient care among nurses, therapists, social workers, and home health aides.

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