Overview
The numerous tables, charts, and metrics included on the Market Assessment page provide a detailed market analysis that you can use to make confident business decisions that support the development and execution of your company’s strategic goals.
Throughout this page you will notice that some columns are highlighted. In all Trella Health products, we use this highlighting to indicate metrics that have diminished counts because of the difference between the way that we compile our counts and the way that CMS reports the claims. In short, CMS assigns home health claims to a quarter of data based on the through date, not the start date. Trella Health counts claims based on start date. This means that for each new quarter of data, since some home health stays were started, but not completed, patients for those stays will not be in the counts.
So, why are we spending so much time on this? If you notice the image above, the entire column in the box on the right is highlighted. However, only the home health count is diminished. This is caused by a complex web issue that we are working on. Throughout this article, we will remind you whenever this issue shows up.
For a more complete description, see Why is the Latest Quarter of Home Health Metrics Lower and Highlighted?
In this article
- Overview Video - A Quick orientation to the page
- National Industry Trends tab
- State and County Trending tab
- Market Share tab
- Agency and Facility Compare tab
Overview Video
The following video includes a summary of the Market Assessment page, including the four tabs, some descriptions of each table, and a few references to ways to use the content on each tab.
National Industry Trends tab
Overview
The National Industry Trends tab has three sections.
- National FFS Post-Acute Admission Trends - A chart that provides a quick perspective on national admission trends for inpatient care, home health, hospice and skilled nursing facilities. You can hover over a column to see the actual counts for that column.
In light of the scale of the graph and the numbers involved, this chart provides a general perspective of admissions by quarter over the last eight quarters of available data.
- National Totals - this table includes benchmarks for enrollees and admissions with counts for the most recent four quarters and the previous 8 quarters of available data. (see below)
- Average National Medicare Reimbursement - the tiles show the national average cost per stay during the listed period for patients admitted to skilled nursing, home health, and hospice. (see below)
National Totals
The first table on the page provides counts of distinct enrollees and admissions for the different categories listed on the left. These counts are listed for the most recent four quarters (left box) and then for each quarter for the previous two years. More detail will be included below in the section Understanding the Metrics.
Understanding the Metrics
All of the metrics in this table are distinct counts of enrollees or admissions for the period listed in the column header. There is no complicated calculation methodology for these numbers, they are just counts.
Here are some details.
- Enrollees, both MA and FFS, are counted from the Master Beneficiary Summary File.
- For enrollees, the count in the most recent four quarters column is a separate count, not a sum of the four quarters listed. Enrollees are counted in every quarter that applies, and in the four quarters column.
- Mortalities (FFS and MA) are counted from the Social Security database.
- The last four rows, inpatient, skilled nursing, home health, and hospice are counts from the most recent Medicare FFS claims.
- Remember: Even though the column for the most recent quarter is highlighted, only the home health metrics are under-represented.
Usage
The national benchmarks allow you to understand national trends.
The two years of quarterly metrics displayed in the top graph and the first table show whether national admissions are growing or falling for Medicare FFS patients or for MA patients. This is a helpful baseline for comparison against state and county trends in the other tabs on the page, and can be used to compare against your agencies.
Average Medicare Reimbursement
The three tiles include the national average cost per stay for the three post-acute settings listed, skilled nursing, home health, and hospice. There are three different reporting periods for these metrics.
- Year to Date - The costs were calculated for the period from January of the most recent year of data through to the end of the latest quarter available. This provides the most current view of costs in the most recent calendar year.
- Calendar Year - The period for these costs is the most recent calendar year for which we have complete metrics. Since many businesses follow a calendar year for their financials, this allows a calendar year comparison.
- 12 Month Rolling - The period includes the most recent four quarters of available data.
In the following image, we show the reporting periods as if the most recent quarter of data available was April through June. Remember that CMS only releases data in quarter year chunks. The Year-to-Date metrics are counted from January to June of the current year (Year Two). The most recent complete Calendar Year is Year one in the image. The 12-month Rolling includes two quarters from each year.
At the top left of the section for reimbursement metrics there is a drop down selector that allows you to choose how the metrics in the section will be calculated. You can choose whether the metrics in the section are calculated from stays that start in the reporting period or from stays that end in the reporting period.
Understanding the Metrics
The dollar amount for each line of business listed is the national average for all stays during the named reporting period. This cost is calculated from every FFS claim submitted during that reporting period.
Usage
The costs in this section are benchmark averages for comparison against state and county averages. In addition, you can use the costs to compare with your agencies throughout the country.
State and County Trending tab
Overview
The State and County Trending tab provides a detailed view of markets at a state and county level.
What makes this page so powerful is that you have the ability to choose any number of states, and any number of counties for over forty different metrics trended by quarter over two years. That's a lot of options, but we will break them down.
Selecting Comparisons and Metrics
When you work on this page you have two different types of settings that control what you see in the table on the page.
- Select Comparisons - You can select any number of states or counties to add to the table
- Add Metrics - Then, for each selected state or county, you can choose which metrics you want to see.
Selecting Comparisons
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Click on the "Select Comparisons" button The following interface will open: |
National Benchmark - When you click on this row in the "My Lists" table, you will be able to choose the national benchmark for comparison in the right window.
Adding States - If you click on the "States" row in the "My Lists" table, you will see the states in the right window. (As shown)
Adding Comparison Elements - Click on any of the states in the right window to add them to the "Selected Comparison(s)" table below. (NY and PA are currently selected.)
Adding Counties - When you click on the "Counties" row in the "My Lists" table, you will see the following in the interface:
- You will need to click on the "States" dropdown to select a state.
- When you add a state to the dropdown, the counties in that state appear in the right window.
- Click on as many counties as you want to add to the "Selected Comparison(s)" table at the bottom.
Custom Groups - Notice in the "My Lists" table that there are entries like "CC test" and "GN Region List." These are custom lists that you or a user from the same company created. Selecting a custom list will populate the right table with options from the list.
Selected Comparisons - The bottom table will show the list of comparison items you have selected. Click on the trashcan icon to the far right to remove any listed item from the table.
Click the "Apply" button when you are done.
The table will refresh and display your selections.
Adding Metrics
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Click on the "Add Metrics" button The following interface will open: |
Search - To find a specific metric quickly, you can type a word that will find the metric. For example: "patient" or "ALOS."
Filters - The buttons at the top of the dialog box will limit the available metrics in the table below to match the filter. If you are focused on hospice metrics, click the "Hospice" button which will show you only hospice options.
Add Metric - Click on the plus button to the left of the desired metric. This action will add the metric to the "Selected Metrics" table on the right side.
Information - Click the button to open a definition of the metric.
Remove Metric - Click the "X" to the left of any metric in the "Selected Metrics" table on the right to remove if from the list.
Metric Order - You can change the order in which the metrics will appear in the table by clicking the up or down arrows to the right of any metric in the "Selected Metrics" table.
When you have completed your selections, click the "View" button at the bottom right of the dialog box.
The table will refresh to show you selected metrics in the second column of the table. All selected metrics will be shown for each comparison item you have also selected.
Something to keep in mind. If you choose 30 comparison items and 20 metrics, that will result in 600 rows of metrics being displayed in the table. With this many items, you might want to click the button at the top right of the table to export the contents of the table to an Excel spreadsheet so you can slice the metrics any way you choose.
Understanding the Metrics
- The first column includes the comparison items you have chosen. This will include the national benchmarks along with any states and counties you have chosen.
- The second column includes the metrics you selected. For every comparison item you chose, every selected metric will be displayed.
- Two most recent complete years - the next two columns include counts for each row for the two most recent completed years of data.
- Previous eight quarters - the remaining columns include counts for each row for the eight most recent quarters of data.
- Last column highlighting - Although the entire column is highlighted, only home health metrics are diminished in the most recent quarter. See Why is the Latest Quarter of Home Health Metrics Lower and Highlighted?
What about Metric details?
The easiest way to find the definition for any metric displayed in this table is to click on the "Add Metrics" button at the top of the page and click on the to the right of the listed metric. If any of the definitions don't make sense, call your customer success manager or email Support@TrellaHealth.com
Usage
This tab provides a ton of insights in the context of a lot of flexibility
- Flexibility - See the markets you want to see with national and state benchmarks for comparison
- Metrics - Over forty different metrics provide a detailed view of markets at the county level for home health and hospice
- Annual Counts/quarterly trends - Since the counts in the table show trends over two years you can see locations of growth.
- Patient Volume - Identify states and counties with the highest potential based upon counts of enrollees and admissions.
Strategies
The flexibility available to you on the State and County Trending tab allows you to customize the contents of the table to see exactly what you want. Let's consider a couple of strategies.
Lots of metrics for a single location
As you can see from the image above, we selected a single county in Pennsylvania in the "Select Comparisons" interface along with a bunch of home health metrics. Setting up the page in this way would allow you to do an extensive and detailed evaluation of a single market.
Lots of locations with a single metric
This is the opposite set up. We have chosen eight states from the "Select Comparisons" interface and a single metric, "Medicare Advantage Enrollees," from the "Add Metrics" interface. In this case, the comparison takes place between the chosen states.
Market Share tab
Overview
There are four tables on the Market Share tab. The following bulleted list is a summary of the tables. What is shown in each table will depend on the State and County choices you make.
- Totals - State or County - The metrics in this table are counts of patients for any selected states and counties for nine different metrics
- Market Saturation - State or County - This table is designed to show you a percentage of agencies in the chosen region. In other words, market saturation. Lots of details below.
- HHA Market Share - State or County - Displays all home health agencies that provided care for patients residing in the selected state or county.
- HOS Market Share - State or County - Displays all hospices that provided care for patients residing in the selected state or county.
A couple details:
- What is shown in each table will depend on the State and County choices you make.
- The metrics are calculated based on the place of patient residence. This has the following ramifications:
- In the HHA and HOS tables, the counts of patients are counts of patients in the region, not all patients treated by the agency. Patients who reside outside of the selected region will not be counted.
- You will have HHA and HOS agencies listed that are not located in the chosen region. Imagine an agency that serves many patients across state lines; those agencies will be included in the table. It is likely that you
State vs. County
The metrics under the Market Share tab are calculated for specific regions that you select. You can select a single state, or any number of states, or you can choose a specific county or multiple counties. The tables will show metrics for either states or counties, not both at the same time.
Selecting a State or States
| Action | What you will see |
| From the "Report Type" selections, click on the radio button next to "State." |  |
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Once you have selected the State Report Type, you will see the "States" selector. Click on the check box to the left of any state or states you want to include in the tables under the Market Share tab. |
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Selecting a County or Counties
| Action | What you will see |
| From the "Report Type" selections, click on the radio button next to "County." |  |
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Once you have selected the County Report Type, a states selector will be available. Click on the dropdown selector to open it. Click on the check box to the left of any state or states that correspond to the counties you want to view. Notice that we have chosen Pennsylvania (PA) and New Jersey (NJ). |
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Click the "Counties" selector to open it Then, click on the check box to the left of any county or counties you want to include in the tables under the Market Share tab. Notice that the selection in the image to the right includes counties from both of our selected states. |
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State or County Totals table
Examples:
For the next images, we selected a single state and a single county. If you choose multiple states or counties, the same rows of metrics will be included for each state or county you choose.
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State |
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County |
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The most recent column of quarterly metrics is highlighted to indicate that the counts in that column are diminished (See the note on highlighting in the page Overview) The only diminished metrics in this table are indicated by the boxes in the images above. |
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Understanding the Metrics
Use the following chart for a quick definition of the metrics in the table. Some of the definitions below are for rows of metrics some are for columns.
| Name |
Description |
| Column - State/County | The first Column indicates the state(s) or county(ies) for the metrics in the same row. |
| Row - Medicare FFS Enrollees | A count of all Medicare Fee For Service Enrollees for the selected region. Enrollees are not counted from claims, we get enrollee counts from the Master Beneficiary Summary File. |
| Row - Medicare Advantage Enrollees | A count of all Medicare Advantage Enrollees for the selected region. Enrollees are not counted from claims, we get enrollee counts from the Master Beneficiary Summary File. |
| Row - Home Health Admissions (FFS only) | This row includes counts of home health admissions of patients who live in the selected region for the period listed in the header. Counts for this row come from Medicare FFS claims. |
| Row - Skilled Nursing Admissions (FFS only) | This row includes counts of skilled nursing admissions of patients who live in the selected region for the period listed in the header. Counts for this row come from Medicare FFS claims. |
| Row - Hospice Admissions (FFS only) | This row includes counts of hospice admissions of patients who live in the selected region for the period listed in the header. Counts for this row come from Medicare FFS claims. |
| Row - Distinct Hospice Patients (FFS only) | This row includes counts of hospice patients who live in the selected region for the period listed in the header. Counts for this row come from Medicare FFS claims. |
| Row - Mortalities (FFS & MA) | This row includes counts of mortalities of any person enrolled in Medicare FFS or Medicare advantage whose place of residence was in the selected region and who died in the period listed in the header. Mortalities are gathered from the Social Security database. |
| Row - Hospice Mortalities (FFS only) | This row includes counts of people who died while receiving hospice service whose residence was in the selected region and who died during the period listed in the header. |
| Row - Mortalities (No Hospice) | This row includes counts of people who died who were not receiving hospice care at the time of death whose residence was in the selected region and who died during the period listed in the header. |
| Column - Recent Four Quarters | The counts in this column are for the most recent four quarters of data available. |
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Column - 20YY - QX Example: 2023 - Q1 |
The metrics in the remaining 8 columns are counts that are specific to the year and quarter listed in the header for the different metrics described in each row. |
Calculation - You can't subtract one mortalities metric from another to get a third metric that is not included in the table. Each mortalities metric is a unique count and other metrics are not necessarily subsets.
Usage
For the most part, the metrics in this table provide a broad baseline for understanding the market in the chosen region. e.g. Counts of enrollees or counts of admissions - these are large populations upon which many other more detailed metrics are based. There are a few other ways to think about the metrics in this table:
- Comparison - If you choose two states or two counties, you can make comparisons on large populations. For market planning this is a starting point for identifying potential at a macro scale.
- MA vs. FFS - Compare the market share for FFS and MA. Evaluate how changes in the payer mix will impact your targeting strategies.
- Trends - For each specific metric type in the table (row), you can view changes in the patient populations across 8 quarters of data. Knowing whether a patient population is growing or shrinking in a specific region, or in a specific line of business, can help with long term strategy.
- Broad and Narrow - The table provides counts for the broadest possible counts, enrollees and admissions, but also focuses more closely on specific lines of business and mortalities.
Market Saturation: State or County table
This table answers a specific question, in short, "What is the level of competition in the selected market?" In this table we do three things:
- First, we provide the number of agencies of each type in the selected region; home health, hospice, and skilled nursing. See the blue boxes in the image below.
- Second, we create a ratio of agencies to patients in the region for each line of business. The other boxes in the image below.
- Third, we provide the above metrics across 8 quarters.
Understanding the Metrics
In the example below, we only show metrics for home health. Hospice and skilled nursing metrics work the same way.
There are two metrics in this table.
- Agency Count (in the first row) - This is the count of home health agencies that treated patients who reside in the selected region.
- Agency Saturation (in the second row) - this is the saturation ratio for home health in the selected region (see Calculation, below)
In the above example, we have shown metrics for home health. The hospice and skilled nursing metrics are the same. We also only show a couple of quarters, when there are 8 quarters in the table.
Calculation
- The Agency Count is the count of agencies that admitted patients who lived in the the selected region. Simple addition.
- The agency saturation is calculated as shown in the image below.
To calculate the saturation metrics, we use two other metrics that are visible on the same page. The image above shows where you can find these two metrics.
- From the County Totals table, we use the count of home health admissions.
- From the Market Saturation table, we use the count of home health agencies.
The saturation metric is the number of home health agencies per patient. That is the equation on the far right in the image above. We divide the number of agencies by the number of admitted patients.
In the example above, 35 / 954 = .036 we round it to 0.04 home health agencies per patient.
Something to keep in mind
Captain Obvious would remind you that there are always going to be more patients than agencies. IF we turned the equation from the image upside down, we would get the number of patients per home health agency. The calculation would work like this: 954 / 35 = 27.3 patients per home health agency.
Usage
The Challenge
It is easy to imagine 27.3 patients per home health agency. We don't ask ourselves, "What is that .3 of a person?" We understand that it is an average per agency.
It is not so easy to grasp 0.04 agencies per person. What is four hundredths of an agency? Difficult.
So let's look at a comparison that will show how easy it is to use the metric without wrapping our mind around the details of the math.
Equation on the left - In our example above, there were 35 home health agencies and 954 home health admissions in selected region. The saturation ratio is calculated in the equation on the left.
Equation on the right - Now, let's pretend that the region we selected has 74 home health agencies instead of 35. The saturation ratio would be calculated as shown on the right.
What we see is that a region with more agencies has a higher saturation ratio. More agencies means more competition. Whether you are considering growth or an acquisition, the smaller the saturation ration is indicates less competition in the region you are viewing.
Trends
As new agencies join the fray or merge or close down, the number of agencies in a selected region will grow or shrink. The table shows counts and saturation ratios over 8 quarters in order to identify trends over a two year period.
This is only one of several factors to take into account when analyzing market opportunities.
Market Share State or County table
Overview
The HHA Market Share and HOS Market Share tables will display metrics for all home health agencies or all hospices that admitted patients who reside in the selected region.
Some brief observations
- The table is very wide. You might need to scroll the table left and right to see all columns.
- Since the list includes every agency that treated patients from the region there are a few ramifications to keep in mind
- The table has the potential of including a huge number of agencies. To work with that much data you might want to click on the
at the top right to export the entries to a spreadsheet.
- The table is sorted by the most Recent Four Quarters Admission Count by default.
- There will be a lot of agencies included from other regions; even far away. Imagine a patient who lives in Minnesota who is visiting their son in Oklahoma and receives care at the son's house. That agency will be reported for the county in Minnesota based on the patient's residence.
- The table has the potential of including a huge number of agencies. To work with that much data you might want to click on the
- Since the table in the image above shows home health metrics, the most recent four quarters and the most recent quarter will have diminished counts. This is why those columns are highlighted.
Home Health vs Hospice
The Market Share tab includes separate tables for home health agencies and hospices for the selected region. The metrics in the two tables are identical, except, of course, that one shows home health agencies and one shows hospices.
One more thing. The highlighted columns in the hospice table should not be highlighted. The highlighted columns indicate diminished counts that only applies to home health metrics.
Understanding the Metrics
The following image shows a partial view of the Market Share table for home health. We have cut out six quarters of data from the middle to make the image easier to read.
As mentioned above, the metrics in the two Market Share tables are identical for the home health and hospice table.
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Column |
Description | |
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HHA/HOS NPI Patient Location |
Each row shows metrics for the agency listed in the first column. The second column is the agencies NPI, and the third column is the region from which the metrics are drawn. | |
| Recent Four Quarters | Admission Percentage | The percentage of home health admissions who resided in the selected region who were admitted to the listed agency during the most recent four quarters of data. |
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Admission Count |
The count of patients from the selected region who were admitted to the listed home health agency during the most recent four quarters of data. | |
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20YY - QX 8 double columns |
Admission Percentage | The percentage of home health admissions who resided in the selected region who were admitted to the listed agency during the quarter listed in the header. |
| Admission Count | The count of patients from the selected region who were admitted to the listed home health agency during the quarter listed in the header. | |
| % Change Admits | For the listed agency, the percent change between the most recent four quarters compared to the previous four quarters. | |
| Market Share Change | The change in market share for the listed agency between the most recent four quarters compared to the previous four quarters. | |
Usage
This table is treasure trove of market share data. Here are the largest nuggets:
- Top Competitors - The table is sorted by admission counts highest to lowest by default. This means that the agencies with the most patients are right at the top of the table.
- Comparison - Find your own agency in the list, and you can compare your agency against the top agencies easily.
- Trends - For every agency, you can scroll right and left and see quickly which agencies are growing and which are losing patients over eight quarters. You can also see whether the same agency's market share has grown or diminished over the past two years as well.
- Admits/Market Share - The last two columns provide the percentage change in admits and the percentage change in market share for the last year against the previous year. At a glance you can see which agencies have grown, and by how much.
Agency and Facility Compare tab
Overview
The Agency and Facility Compare tab is the most focused and detailed section of the Market Assessment page. Under this tab you can choose which benchmarks and home health agencies or hospices are included in the tables. Then, you can choose from among about forty different metrics to display for your chosen agencies or hospices. The page includes a table of home health agencies and a table of hospices.
Your first step is to set up the page to show the agencies and metrics you want to see.
The Home Health Comparison/Benchmark table and the Hospice Comparison/Benchmark table work identically, so we will show the process on the hospice table.
Select Comparison and Metrics
| When you click on the Select Comparisons button, a dialog box will open that will allow you to select hospices and/or state and/or county benchmarks. |
Since the process for adding hospices and benchmark are slightly different, we will show each process separately.
State Benchmarks
You can add as many state benchmarks to a table as you want.
The Add/Edit Comparisons dialog box is shown in the following image.
In the "My Lists" box, click on States. A list of states will appear in the right box
Click on any states for which you want to view benchmarks In the Comparison table
If you want to delete a comparison item from the table, click on the trash can icon at the far right.
Click the "Apply Button when you are done.
County Benchmarks
You can add as many county benchmarks as you want, and you can add counties from different states.
In the "My Lists" box, click on "Counties." The options on the right will change to add the "States" selector.
Click on the "States" selector and click on the state of your choice. The counties from the selected state will appear in the "Search Results" box on the right side
Click on any counties for which you want the county metrics to be included in the table.
Hospices
You can add as many hospices to the table as you want. If you want to add hospices from more than one location, you will need to go through the process below for every state/county from which you want to include hospices.
Click on "Hospice Agencies" in the "My Lists" box. This will change the options to the right to include a "States" selector. Click on the State(s) selector.
With the "State(s)" selector open scroll to your state and click on the radio button to the left of the state. The county options will change in the selector to the right.
Select the county or counties from which you want to select hospices.
After selecting a state and county/counties from the selector, click on the "States" selector to close it.
??? - IF your company has created custom lists of hospices, they will appear in the "My Lists" box. You will be able to select a custom list and then select hospices from that list.
When you have closed the selector, you will see the following options:
Click on any hospices you want to add to your table.
You will need to repeat the State/County selection process to add additional hospices.
Click the "Apply" button when you are done.
Add Metrics
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Click on the "Add Metrics" button The following interface will open: |
Search - If you know the name of the metric you want to add, start typing the name in the search field to find it quickly.
Filters - For categories of metrics, you can click on one of the helpful filters to limit the list below to the category your choose.
Add Metrics - Click on the "+" sign to the left of the metric you want to add to move it to the "Selected Metrics" list on the right.
Definitions - To examine details about a specific metric, click on the "i" for more information.
Delete - to remove a metric from the table, click on the "X" to the left of any metric in the "Selected Metrics" list.
Metric Order - You can switch the order in which the metrics appear in your table using the arrows to the far right of the "Selected Metrics" box.
Click on the "Apply" button when you are done.
Understanding the Metrics
Using the "Add Metrics" tool, you can add about forty metrics to either of the tables under the Agency and Facility Compare tab. There are two ways to view the definition of each metric.
- If you view the image above, we have clicked on the
in the header for % Readmitted: 30 Days. The definition for the metric appears in the long skinny black box above the header name.
- If you open the "Add Metrics" tool and click on the
to the right of any metric, you will see a definition as shown in the image below.
If you need or want additional details about any specific metric, please get in touch with our customer success manager or send your question to Support@TrellaHealth.com
Usage
This table allows an enormous degree of customization focused on allowing you to make detailed comparisons between hospices or between home health agencies along with state and county benchmarks. You can focus as broadly or narrowly as your want and include individual specific metrics or many metrics.
Don't forget that you can export this table to Excel.
Comparison Strategies
Basic - For comparing your agency with the competition:
Click the "Select Comparisons" button
- Add the appropriate state benchmark
- Add the county benchmark (or benchmarks if your agency serves more than one county)
- Add the top agencies under the same counties
- Add your agency or agencies from the appropriate county or counties
States - If you are working an expansion strategy, you can add any number of states with a selection of metrics that will allow you to make broad comparisons.
Regional analysis - To make an in depth analysis of a region, you can add all counties in an area of any size, even adding counties from additional states that are adjacent. Add the matching state benchmarks, and you can identify the best locale for growth by viewing numerous metrics.
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