In home health, what value-based payment models already exist?
One of the more successful APMs currently in place is the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented by the CMS Innovation Center on January 1, 2016. Originally implemented in nine states (MA, MD, NC, FL, WA, AZ, IA, NE, TN), all Medicare-certified home health agencies (HHAs) in those nine states competed on value where payment was tied to quality performance.
The original HHVBP Model was very successful, yielding an average annual savings of $141 million to Medicare with evidence of adverse risks, and demonstrating reductions in unplanned acute care hospitalizations and skilled nursing facility stays. On January 8, 2021, CMS announced its intent to expand the HHVBP Model nationwide. Subsequently, on November 2, 2021, CMS published the CY 2022 home health final rule establishing the end of the original model and the start of the expanded model. This final rule also established HHA eligibility criteria, payment adjustment rates, definition of cohorts, applicable quality measures, and payment methodology.
This nationwide expansion determined that pre-implementation would start January 1, 2022, without risk to payments until the first performance year, which recently began on January 1, 2023. HHA performance during 2023 will determine the payment adjustment incentive for the first payment year in CY 2025. As agencies navigate their first performance year, they must keep in mind the quality measures used in the expanded model are calculated using data from all Medicare and Medicaid payors based on OASIS, HHCAHPS survey, and claims-based measures.