Your Right Hand for Clinical Excellence and Financial Success
Transform Utilization Challenges Into Achievements with Episode Management
Today, Medicare reimbursement is directly tied to performance across utilization, quality outcomes and patient satisfaction.
With the rollout of the Patient-Driven Groupings Model (PDGM) in 2020 and the nationwide expansion of Home Health Value-Based Purchasing (HHVBP) in 2023, home health agencies are under increasing pressure to deliver the right care, at the right time, with the right resources—with each episode of care.
The Challenge in Home Health
Many home health agencies are struggling with over- or under-utilization of visits resulting in:
- Rising LUPA rates
- Declining Periods per Episode
- Recertification rates below benchmarks
These issues don’t just impact care, they can directly reduce reimbursement and weaken performance scores.
Episode Management, Reimagined
McBee Episode Management Services help you take control of utilization, without compromising quality. We work with your clinical leadership to:
- Evaluate near real-time care patterns
- Optimize patient care plans
- Align utilization with best practice and reimbursement drivers
Support Beyond Reporting
This isn’t retrospective reporting, it’s near real-time, clinician-to-clinician collaboration. Our experts work alongside your team to:
- Identify missed opportunities in care planning
- Strengthen clinical decision-making
- Optimize workflow execution at the point of care
This structured approach helps support the delivery of efficient, patient-centered care that aligns with both clinical outcomes and financial performance goals.
Transform Utilization into a Strategic Advantage
Turn utilization into a catalyst for growth and performance.
- Elevate episode care delivery
- Advance quality and patient outcomes
- Minimize avoidable LUPAs
- Drive appropriate recertification decisions
- Maximize reimbursement opportunities under HHVBP
Request more information on our Episode Management Services
The McBee Advantage
The McBee Episode Management team combines clinical expertise with advanced performance analytics to help you deliver exceptional, patient-centered care. By leveraging key performance indicators (KPIs) and analyzing care delivery trends, we identify opportunities to help better align your clinical resources with patient needs, driving both quality outcomes and operational efficiency.
Our expert consultants guide your team in managing care across the full 60-day certification episode, while maintaining a strategic focus on the 30-day billing periods that directly influence your Periods per Episode (PPE*). We help you work toward improving functional scoring accuracy, reducing LUPA (Low Utilization Payment Adjustment) rates, optimizing appropriate recertifications, and proactively mitigating avoidable hospitalizations and emergency department visits.
At McBee, we understand that better outcomes start with better care planning. Our team works with your organization’s clinical leaders to evaluate individual care plans, assess team utilization, and strengthen execution through targeted reviews and coaching. The goal? A more confident, capable clinical team—equipped to consistently deliver high-quality, coordinated care.
Deliver clinician-to-clinician care plan reviews that facilitate appropriate utilization and clinical alignment
Help validate and improve the accuracy of functional impairment scoring
Strengthen collaboration and coordination across your care team
Reinforce regulatory compliance to drive high-quality documentation
Provide trend analysis to identify root causes and help reduce LUPAs
Help integrate best practices into your agency’s culture for lasting impact
Elevate awareness of how patient-centered care drives publicly reported outcomes, including:
- HHCAHPS Patient Satisfaction Scores
- Star Ratings on Care Compare
- Process Measures
- Outcome Measures
- Claims-Based Utilization and Cost/Resource Use Measures
See the ROI of Smarter Episode Management
24.29%
Average improvement in LUPA rate within first six months
* 24.29% Average Improvement in LUPA rate within the first six months, comparing 12 clients’ 12-month pre-McBee baseline LUPA rate to 6 months of post-McBee data as of August 2025.
6.29%
Average improvement in PPE within the first six months
* 6.29% Average Improvement in PPE within the first six months, comparing 9 clients’ 12-month pre-McBee baseline PPE to 6 months of post-McBee data as of August 2025.
3.67%
Average improvement in Recertification Rate within the first six months
* 3.67% Average Improvement in Recertification Rate within the first six months, comparing 9 clients’ 12-month pre-McBee baseline Recertification Rate to 6 months of post-McBee data as of August 2025.
Expert Guidance at Your Fingertips
Ready to get started? Contact us to schedule a consultation.
Frequently Asked Questions About Episode Management
Episode management can help provide the structure and clinical oversight needed to align care utilization with patient needs, helping agencies reduce LUPA rates, improve visit patterns and achieve more consistent performance against benchmarks.
Episode management helps enable agencies to proactively provide care delivery in alignment with PDGM and HHVBP requirements, to facilitate clinical decisions, utilization and outcomes that support both compliance and optimal reimbursement.
Low Utilization Payment Adjustments (LUPAs) can significantly reduce reimbursement and negatively impact financial performance. Under the current Medicare Home Health Prospective Payment System (PDGM), a LUPA occurs when a patient’s home health episode has a very low number of visits, falling below a specified threshold set by Medicare. When this happens, agencies are paid a per-visit rate rather than the full episode payment.
Episode management is the process of tracking care patterns and identifying the causes of both under‑utilization (LUPAs) and over‑utilization in each 30‑day payment period (or episode). The goal of this analysis is to support accurate reimbursement and efficient resource use.
Frequent causes include:
- Missed or cancelled visits without timely rescheduling
- Underestimating needed visit frequency based on clinical complexity
- Errors in functional or comorbidity coding
- Planning misaligned with patient risk factors or case‑mix grouping
Episode management can help bridge the gap between quality and efficiency by guiding clinicians in near real time, refining care plans and helping to facilitate resources effectively—driving better patient outcomes while strengthening financial results.
Episode management offers clinician-to-clinician collaboration and ongoing review of patient care plans, helping leaders uncover missed opportunities, standardize best practices and continuously improve care delivery processes.
McBee brings deep expertise in home health regulations and PDGM compliance. Our process gets the root of each episode and embeds sustainable improvements into agency culture. We help clients build proactive systems that align clinical care with reimbursement requirements.