What is Value-Based Purchasing in Home Care?

The Centers for Medicare & Medicaid Innovation (CMS Innovation Center) implemented a pilot program, the Home Health Value-Based Purchasing (HHVBP) model, back in January 2016 to take place in nine states beginning in 2018. The program, according to CMS, is intended to incentivize Medicare-certified home health agencies (HHAs) to provide better patient care and outcomes at a lower cost by moving agencies away from the traditional fee-for-service model to an outcomes-based model.

Medicare-certified HHAs providing services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee compete on value in the HHVBP model, where payment is tied to quality performance, according to CMS. HHAs in these selected states will have their payments adjusted as follows: 

  • Maximum payment adjustment of 3% (upward or downward) in 2018
  • Maximum payment adjustment of 5% (upward or downward) in 2019 
  • Maximum payment adjustment of 6% (upward or downward) in 2020 
  • Maximum payment adjustment of 7% (upward or downward) in 2021 
  • Maximum payment adjustment of 8% (upward or downward) in 2022

Reward and reimbursement rates in one year are determined by a baseline year that’s two years old. An individual agency’s Medicare payment goes up or down based on its performance on specific measures, including clinical quality of care plus communication and care coordination. Efficiency and cost reduction, as well as patient safety and satisfaction also factor into payment calculations.

Whether the HHVBP model has had a positive impact on home health care is hard to determine, according to Home Health Care News. A July 2018 report on year one from CMS, cites Home Health Care News, found that HHVBP model showed no evidence of impact on patient experience measures and mixed results in terms of cutting costs. We’ll continue to look at the results of the HHVBP program and share the results with you. 

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Sources: CMS, Home Health Care News