In January 2016, the Centers for Medicare & Medicaid Services (CMS) rolled out the Home Health Value-Based Purchasing (HHVBP) model in nine randomly selected states. Envisioned as a shift away from volume-based reimbursement, this pilot program was designed to provide financial incentives to home health agencies for improvements in quality of care to reward agencies with higher achieved or improved quality scores and reduce payments to agencies with lower performance scores. These metrics were based on their Total Performance Score, with a maximum positive and negative payment adjustment that rose year over year to seven percent in 2021.
According to CMS, the model “has resulted in an average 4.6 percent improvement in home health agencies’ quality scores as well as average annual savings of $141 million to Medicare,” and the success of the pilot has prompted a move to include more states in the model. Earlier this year, CMS announced that it would be expanding HHVBP beginning next year, while also increasing the maximum payment adjustment to eight percent. Now that CMS has proposed plans to expand the HHVBP model nationwide by the start of next year, value-based care is positioned to become the standard model in the near future. With the expansion potentially just six months away, what can we learn from the pilot to help us achieve quality outcomes moving forward? Here are five key takeaways that CMS has learned through this five-year pilot.
Performance Scores Are on the Rise
For the nine model states, the transition to value-based care not only didn’t hinder performance scores in the early transition to the pilot, it actually saw a notable increase. According to CMS, Agency Total Performance Scores (TPS) were “higher in the first four years (2016–2019) of the model, including 8 percent greater average scores than the comparison group in 2019. 1The TPS for agencies in HHVBP states were higher overall relative to the TPS calculated for agencies in the 41 non-model states.”2
HHVBP States Saw Reduced Total Cost of Care
HHVBP states saw a reduced total cost of care compared to the comparison group for a few significant reasons. The most dramatic decrease in cost was driven largely by reduced spending for inpatient and skilled nursing facility services, which led to a “cumulative decline of $604.8 million in overall Medicare spending for FFS beneficiaries receiving home health services during 2016–2019.”3 This included a “1.3 percent decline in average Medicare expenditures per day among FFS beneficiaries in HHVBP relative to the comparison group during and within 30 days following home health episodes.”4
Across the four years of the pilot, the overall reduction in total Medicare spending during and within 30 days following home health episodes for FFS beneficiaries receiving home health care in the model was $604.8 million, with an average annual reduction of $151.2 million.5
CMS Also Found Reductions in Unplanned Hospitalizations
Through the first four years of HHVBP, CMS continued to find that the model impacted claims-based utilization measures that apply to FFS beneficiaries receiving home health services. This included “declines of 0.19 percentage points in unplanned hospitalization rates among all home health episodes, which corresponds to a 1.1 percent decrease from average measure values pre-HHVBP implementation”.6
Patient Function has Increased While Maintaining a Positive Patient Experience
One of the most exciting developments from the first four years of the pilot was the improvements in quality of care and functional outcomes, both of which improved while not negatively affecting the patient experience. CMS indicated that there was a “pattern of positive effects of HHVBP on OASIS-based outcome measures used to calculate TPS, particularly a measure of discharge to the community and several measures of improvement in functional status, including the two new composite measures introduced in 2019.”7These effects not only showed improvements over time in functional status during home health episodes in HHVBP states, but also exceeded those found in non-HHVBP states.
Meanwhile, performance scores for the five patient experience measures that constitute the Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) surveys were “both high and consistent over time in both HHVBP and non-HHVBP states,”8 indicating that the transition to the model did not negatively affect the patient experience.
Agencies are Satisfied with the Model Overall and Have Maintained QI Programs
CMS interviews with participating HHAs indicated an increasing familiarity and positive feedback of the HHVBP model in each subsequent year they were participating in the model,1 and found that they were able to successfully integrate QI initiatives reinforced by the model into their existing QI programs. Because the model has continued the focus on quality improvement initiatives that most HHAs were already undertaking, by 2020 agencies were “less preoccupied with meeting model requirements and less concerned about the model’s potential financial impact than in previous years.”9 This increased familiarity with HHVBP and built-in QI considerations allowed agencies to continue to employ new strategies, including data analytics and training, to improve quality, staff retention, and upskilling initiatives vital to QAPI programs.
HHVBP is Coming—How Can You Ensure Your Agency is Prepared?
Now that CMS has proposed their plan to expand the HHVBP model nationwide at the beginning of next year, what can you do to prepare your agency for HHVBP? Whether you’re waiting to see how your state is impacted, or already operating under the model and just looking for ways to continue to streamline operations, here are some ways that MedBridge can help.
Create a home health Performance Improvement plan
Developing, implementing, and maintaining an effective QAPI program will be essential to both agencies that will be shifting to HHVBP and those already operating under the model. While most agencies already closely monitor their quality outcomes, targeted performance improvement projects require additional guidance and best practice recommendations for implementation.
You can find an example of this in our new guide, Your QAPI Roadmap: Getting from QA to PI, where we share specific clinician- and patient-focused strategies and resources to help your agency improve in eight key metrics that commonly appear on payer scorecards.
Reduce unnecessary visits and cost per episode with effective patient management
Providing the right care for the right patient at the right time is one of the most effective ways to provide effective, cost-efficient care, but keeping your patient engaged and activated in between visits is an ongoing challenge. By combining digital healthcare tools with patient education and clinical training, you can replace and supplement costly in‑person visits, develop standardized care pathways, and implement best practices to keep your patients engaged and healthy.
Our best-in-class HEP programs, evidence-based patient education, and Telehealth Virtual Visits tool provide low-cost touch points that engage the patient in care while reducing the need for in-person visits, reducing utilization while boosting outcomes by ensuring the patient knows how to effectively manage their own condition, preventing readmissions, and improving outcomes.
Provide efficient OASIS training
To succeed under the HHVBP model, agencies will need to ensure accurate and complete documentation, and help staff understand the impact it can have on quality measures. Effective training and management tools are two of the most effective ways to establish a strong foundation for accurate OASIS data collection.
MedBridge offers industry-leading OASIS education featuring our onboarding series that introduces the key concepts that frontline staff need to accurately gather and utilize OASIS data, as well as OASIS booster courses designed to reinforce training annually or remediate skill gaps with five- to ten-minute microlearning videos.
Boost clinical knowledge and provide refresher training with microlearning courses
Microlearning and just-in-time training are some of the most effective ways to educate your entire agency, and research shows that providing training in shorter segments increases learning engagement,10 allowing learners to conveniently refresh skills and quickly get up to speed on best practices.
Designed to fit between appointments and around busy schedules, MedBridge offers microlearning courses that enhance soft skills, documentation accuracy, and clinical performance with short, hyper-focused three- to five-minute courses to ensure care is uniform across your organization.
- 1-9 Pozniak, A., Turenne, M., Lammers, E., Mukhopadhyay, P., Slanchev, V., Doherty, J., & Green, L., et al. (2021). Evaluation of the Home Health Value-Based Purchasing (HHVBP) Model: Fourth Annual Report. Arbor Research: Ann Arbor, MI. Retrieved from https://innovation.cms.gov/data-and-reports/2021/hhvbp-fourthann-rpt.
- 10 Gerteis, J., Izrael, D., Deitz, D., LeRoy, L., Ricciardi, R., Miller, T., & Basu, J. (2014). Multiple Chronic Conditions Chartbook. AHRQ Publications No. Q14-0038. Agency for Healthcare Research and Quality: Rockville, MD. Retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf