Care episodes, in-home visits, OASIS outcomes, and payer reimbursement
Industry
Home Health Agency
Company size
Regional agency with 6 branches and about 40 clinicians and aides, with every branch staffing its own clinician in each discipline
Patient census
About 220 to 390 patients on service per month once the opening book is fully ramped, averaging about 290
Episodes
About 4,000 sixty-day episodes of care, roughly 2,000 per year
In-home visits
About 51,800 visits, roughly 25,900 per year
Annual reimbursement
About 6.0 to 6.2 million dollars per year in episode payments
Care model
Skilled nursing, physical, occupational, and speech therapy, home health aide, and medical social work
Caradell Home Health is a fictional regional home health agency created for synthetic BI analysis. The story is built around referrals that become 60-day episodes of care, the nurses, therapists, and aides who travel to patients' homes, the OASIS assessments that track outcomes, the payers who authorize and reimburse episodes, and the monthly census that ties it together. Everything is invented, and the kit contains no protected health information. Patients appear only as privacy-safe analytical segments, and OASIS is modeled as summarized outcome scores rather than item-level responses.
These are the operating questions this kit is optimized to answer first.
Active census rises through winter respiratory season and eases in summer, instead of following a flat line.
Skilled nursing and physical therapy carry most visits, and the mix shifts by condition: wound care nurse-led, ortho and neuro therapy-led.
Episode reimbursement traces to the visits actually delivered, from payer down to episode and visit detail.
Managed-care authorizations meet the visits recorded against them, so over-authorization is a real finding.
Clinicians carry weekly visit targets by employment type, and the busier branches run genuinely over.
Functional scores rise and hospitalization-risk scores fall from Start of Care to Discharge across the episode.