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 (Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington).

The original HHVBP Model leveraged the successes and lessons learned from other value-based purchasing programs and demonstrations to shift from volume-based payments to a model designed to promote the delivery of higher quality care to Medicare beneficiaries. The overall purpose of the HHVBP Model was to improve the quality and delivery of home health care services to Medicare beneficiaries with specific goals to:

Provide incentives for better quality care with greater efficiency
Study new potential quality and efficiency measures for appropriateness in the home health setting
Enhance the public reporting process.

The CMS has designed HHVBP Model to give Medicare-certified home health agencies (HHAs) incentives to provide higher quality and more efficient care.

HHVBP pilot program resulted in an average 4.6 percent improvement in HHAs' total performance scores (TPS) and an average annual savings of $141 million to Medicare without evidence of adverse risks. The evaluation of the original model also found reductions in unplanned acute care hospitalizations and skilled nursing facility (SNF) stays, resulting in reductions in inpatient and SNF spending. The U.S. Secretary of Health and Human Services determined that expanding the original HHVBP Model would further reduce Medicare spending and improve the quality of care. In October 2020, the CMS Chief Actuary certified that expansion of the HHVBP Model would produce Medicare savings if expanded to all states.

As part of the final rule for 2022, CMS is moving forward with expanding HHVBP Model to all 50 states.

HHVBP Implementation Timeline:

Based on the pilot program's success, CMS is expanding Home Health Value-Based Purchasing (HHVBP) to all 50 states, effective January 1, 2023. Pre-implementation for Home Health Care Agencies will begin on January 1, 2022, giving agencies time to prepare for the first performance year starting January 1, 2023. The CMS has capped the rate adjustments for the first payment year (2025) at 5%.

Impact on Home Health Agencies:

Home Health Value-Based Purchasing Model (HHVBP) adjusts the payment rate for the agency based on the quality of care delivered in 2023. For the year 2025, there will be a plus or minus 5 percent rate adjustment.

CMS assigns a Quality Score for the agency based on selected quality measures in three domains:

OASIS: Allocation of 35% weightage
Claims: Allocation of 35% weightage for claims for Acute Care Hospitalizations and Emergency Department visits within the first 60 days of patient care
HHCAHPS: Allocation of 30% weightage

The following is the list of quality measures used in calculating the score for the agency.

Home Health Value-Based Purchasing Model (HHVBP) - Quality Measures

Tips for Home Health Agencies to Prepare for HHVBP

HHVBP represents the most significant change to provide incentives (or penalties) to Medicare Certified Home Health Agencies to give higher quality and more efficient care. Home Health Agencies must review their processes to monitor quality outcomes and adjust as needed.

Data Analysis: Data Analysis for 2019 and the following years will be essential in preparing for HHVBP. Analyze 2019 data focusing on HHVBP quality measures to establish the baseline. Prepare the data for the following years, and compare the data with the baseline year to understand the trend.
Enhance Performance Improvement Plan: Based on the data analysis and trend, identify the quality measures that will require improvement. Review the current policies and procedures and make changes to make targeted performance improvements.
Education and Training: Education and training are one way for Home Health Agencies to stay ahead of the changes coming in 2023. Education and training will help home health agencies provide consistent patient care. Many national and state organizations are providing educational and training sessions for HHVBP. Engaging your clinical team in these opportunities will prepare the team to get ready for these changes.
Software Platform: The software platform will play a critical role in helping Home Health Agencies to meet the challenges of HHVBP. Agencies should check with their software vendors to understand their plans to accommodate HHVBP, make sure their program will meet the requirements, and adjust their processes accordingly

About CareVoyant

CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.

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For more information, please visit CareVoyant.com or call us at 1-888-463-6797.