Innovative Financial Solutions for Home Health is pleased to announce the release of the newly revised and expanded Case-Mix Planner™ (CMP)—formerly known as the Resource Planner.

The CMP was originally designed—and has continued to evolve—to help home health agencies strengthen the connection between the patient’s needs identified through the OASIS assessment and the services and utilization incorporated into the Plan of Care.

That connection is essential. The OASIS helps establish the patient’s clinical and functional needs, but those needs must then be translated into an appropriate Plan of Care. At the same time, agencies need to understand the reimbursement and cost implications of the utilization being planned. This understanding can help agencies identify the most efficient approach to providing high-quality care to their patients (think HHVBP revenue adjustment).

The Case-Mix Planner brings those considerations together.

See the Expected Result Before the Visits Are Delivered

For each 30-day patient encounter, the CMP allows the user to enter the patient’s HIPPS code and the anticipated visits by discipline. The application then brings together:

• Anticipated Medicare reimbursement;
• The applicable LUPA threshold (and impact, if applicable);
• Planned visit utilization by discipline;
• The agency’s projected costs for the encounter; and
• The estimated financial result for the patient encounter.

The CMP makes these relationships visible while the Plan of Care is being developed—not after the visits have already been delivered and the financial results have occurred and nothing can be done about it.

It also calls attention to encounters that remain below the applicable LUPA threshold, allowing the agency to see the reimbursement and financial implications of the planned utilization before care begins, and also identifies the revenue lost should an unplanned LUPA encounter occur.

Why Encounter-Level Planning Matters

The financial impact of one Plan of Care may not appear financially material by itself. However, when the same utilization pattern is repeated across multiple patients, and multiple encounters, the cumulative effect can become significant.

A poorly constructed Plan of Care can cost an agency almost as much as or even more than the CMP’s annual license fee.

The CMP is not intended to reduce clinically necessary care or substitute financial considerations for patient needs. Care must always be driven by clinical need. The CMP’s purpose is to help the agency connect those needs, as identified in the OASIS with resource utilization projections via the Plan of Care while understanding the financial consequences of the decisions being made.

Visibility increases understanding.

Patient-focused care and financial responsibility are not competing objectives. The strongest agencies pursue both.

More Than Traditional Medicare

The current test version of the CMP is configured for traditional Medicare. A licensed application, however, can also be configured for other payers that reimburse under:

• A per-visit methodology;
• The PPS/PDGM-based methodology; or
• Medicare Advantage arrangements that follow Medicare’s payment methodology but reimburse at contracted or discounted rates.

The licensed CMP can also be configured to incorporate applicable HHVBP adjustments and other required reimbursement adjustments so that the appropriate expected revenue for each patient encounter is recognized.

The newly revised CMP also incorporates the Medicare payment rates included in the CY 2027 Home Health PPS Proposed Rule. The application will be updated as necessary following publication of the Final Rule.

See the CMP in Action

Agencies interested in evaluating the Case-Mix Planner may choose either of the following:

• A complimentary 30-minute demonstration; or
• Temporary access to a limited test version of the CMP.

The test version provides an opportunity to enter HIPPS codes, develop projected visit utilization and see how reimbursement, LUPA thresholds, costs and estimated financial results interact.

Limited-Time Founding Client Pricing

The standard annual license price is $3,750 per licensed user.

Agencies that confirm their CMP engagement and make payment by September 30, 2026, will receive a 25% Founding Client discount, reducing the annual license price to:

$2,812.50 per licensed user

Agencies that confirm their engagement and make payment after September 30 but by October 30, 2026, will receive a 15% introductory discount, reducing the annual license price to:

$3,187.50 per licensed user

To qualify for either discount, the licensing engagement must be confirmed, and payment must be received by the applicable deadline.

The discounted annual renewal price will remain in effect as long as the license is renewed continuously.

Move From Information to Understanding

Knowing a patient’s HIPPS code or anticipated reimbursement is useful. Knowing how that reimbursement relates to the patient’s Plan of Care, projected utilization, LUPA threshold and agency-specific costs is considerably more valuable.

Information alone rarely changes decisions. Understanding does.

Take the next step toward understanding how each Plan of Care connects patient needs, planned utilization and financial performance.

To schedule a complimentary 30-minute demonstration or request temporary access to a limited test version of the Case-Mix Planner™, contact Innovative Financial Solutions for Home Health before the applicable discount deadline.