Staying on top of home health care rules and regulations is a full-time job. It can feel like another day, another complicated home health model to understand. With the Home Health Value-Based Purchasing (HHVBP) Model expansion effective this year, it’s crucial to clear up your questions on all things HHVBP.

In this article, we’ll be your guide to understanding HHVBP inside and out. From its fundamentals to the advantages it offers your agency, the implementation process and top-notch practices, we’ve got you covered.

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Article Roadmap

• What Is the Value-Based Purchasing Model?
• Impact for Agencies
• Primary Benefits
• Implementation Process
• Best Practices
• Next Steps

What Is the Value-Based Purchasing Model in Home Health?

The home health value-based purchasing model is a program designed to improve care delivery and minimize hospitalizations by incentivizing higher-quality outcomes with reimbursements. In 2016, CMS launched a pilot program across nine states with nationwide expansion starting in 2023.

Home health agencies will receive an increase or decrease in Medicare reimbursements by up to 5% using your baseline year scores and comparable agencies’ scores. The CMS calculates scores using three categories: OASIS-based measures, claims-based measures and HHCAHPS measures.

Impact for Agencies

When it comes to new CMS programs, it can feel like more models, more problems. A clear understanding of how value-based purchasing will impact your agency is essential to successful implementation.

Key Dates

First, you need to know when HHVBP will come into effect for your agency. There are three time periods to keep in mind:

Baseline Year: If your agency was Medicare-certified in 2018, 2019 sets the performance benchmark for home health agencies. Agencies certified in 2019 and 2020 will use 2021 as the baseline year, and those certified in 2021 will use 2022 as the baseline year. Metrics and scores from this year will measure achievement and improvement points against the performance year.

Performance Year: Grading is in effect from 2023, the calendar year where data collection contributes to calculating competing agencies’ performance using quality measures.

Payment Year: Cash in (or pay the price for) percentage adjustments for Medicare reimbursements in 2025.

Quality Measures

The value-based purchasing model combines three categories with varying weightage to calculate performance.

OASIS-Based: Five OASIS measures applied to the score are improving dyspnea, discharge to community, oral medication management and total normalized composite care in mobility and self-care. It accounts for 35% of the total score.

Claims-Based: Your agency’s ability to avoid acute care hospitalizations and unnecessary trips to the ER adds up to another 35%. Data is pulled from Medicare claims for admission and outpatient emergency department use without a correlating claim from an acute care hospital.

CAPHS-Based: Patient care and satisfaction is the final factor contributing 30% to your performance. The CMS takes information from HHCAPS surveys to determine patient care, communication between providers and patients, specific care issues, overall rating of the agency and willingness to recommend the agency.

Scoring

The three categories above combine to equal your agency’s total performance score. It consists of four values: scores from your performance year, the improvement threshold based on your baseline year, the achievement threshold using median performance from comparable agencies in the baseline year, and the benchmark, which is the mean of the top decile for comparable agencies in the baseline year.

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Primary Benefits

Adding another KPI to the already long list of CMS regulations can feel like discovering your teacher added two chapters to the test scheduled for the next day. Understanding the benefits of value-based purchasing in home health will help you gear up as you prepare for your first performance year. Besides the financial rewards, here’s how it can positively impact your agency:

Improve Patient Outcomes

What’s best for the patient is often best for your agency. Happy patients are also less likely to fill out negative responses on the HHCAPHs survey. Using evidence-based best practices, choosing referrals wisely and working in sync with other providers reduces hospitalizations, readmissions and medical errors.

Increase Employee Satisfaction and Accountability

Investing in training programs and incentives boosts performance scores and empowers your workforce.

Optimize Care Delivery

HHVBP’s expansion plans mean hospitals and home health agencies are in this together. Closer ties between hospitals and home health agencies reduce redundancy and ensure cohesive treatment plans.

Enhance Data Analysis

Establishing your baseline score helps you clearly identify areas for improvement. Access data from comparable home health care agencies to pinpoint ways to improve clinical and financial improvement.

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Implementation Process

Adding a new model to your operations is no spring picnic, especially when there’s math involved. Here’s how to navigate the process:

Understand Your Baseline

Prioritizing electronic health records means you likely have EMR or EHR software in place. Pull OASIS data to benchmark your scores against the model in the pilot program. Ask vendors for help with data from your baseline year.

Identify Improvement Areas

Once you understand where you stand, you can map out trends and identify problem areas. Use data to monitor program activities with room for improvement and perform root cause analysis and assessments to fill in the gaps. Focus on high-risk, high-volume issues.

Capitalize on Your Strengths

It’s unlikely your home health agency will score equally for every condition. Before you accept a referral, ask yourself whether you will improve that patient’s outcome. Perhaps your strength is treating COPD instead of chronic heart conditions. You may have clinical staff with more experience treating the former condition versus the latter or a better contingency plan. Focus on treating conditions where your agency excels, matching your expertise with patient needs.

Boost Survey Completion Rates

HHCAPHS data adds up to 30% of your total performance score. Unfortunately, human nature dictates patients are more likely to fill out the survey when they have a negative experience. Caregiver training to encourage survey completion and friendly reminders can help boost satisfaction scores.

Improve OASIS Proficiency

Doubling down for a round of OASIS assessments is no one’s idea of a good time. Train staff to consistently collect data at every assessment time point and understand the “look back” period. Remember that for accurate assessments, data can’t simply carry over.

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Best Practices

Achieving a solid value-based purchasing score goes beyond numbers; it’s about preparation. Like a professional sports team, a proper preseason can boost your performance. Consider these strategies for a successful first performance year:

Train Staff and Caregivers

Educating staff and caregivers on the impact of HHVBP helps your organization push toward its goals in unison. Additional training on patient education to complete HHCAPHS and how to assess patients for OASIS go a long way toward improving scores.

Invest in Software

A robust home health solution assists with OASIS assessments and HHCAPHS surveys, claims management and data analysis, making it simple to nail your baseline score and view trends.

Optimize Your Quality Assurance Improvement Program

Revamp your quality improvement plan to include HHVBP goals, align agency data with quality measures and review strategies for hospitalization rates, caregiver education and protocols.

Recruit and Retain the Right Staff

Rising caregiver turnover rates hamper patient satisfaction and waste time and resources on retraining staff. Hiring OASIS-certified nurses and experienced staff and providing opportunities for professional development will help you recruit and retain quality team members.

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Next Steps

Preparing for your first performance year under the Home Health Value-Based Purchasing Model is a daunting task. Luckily, you won’t have to go at it alone. Teamwork with home health software makes the dream work. Use our free requirements template to help you match your needs to the perfect software. Good luck!

How will the value-based purchasing home health model expansion affect your agency? Let us know in the comments!