Why Value-Based Care Is Forcing Home Health Providers To Train Differently

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Under the Home Health Value-Based Purchasing (HHVBP) Model, more reimbursement has to be earned.

With that in mind, it’s paramount that home health clinicians are well-trained in critical areas. As such, some providers are moving away from the older processes for training.

Broadly, under HHVBP, the main goal is positive patient outcomes. But for providers, it’s all about hitting the benchmarks that show the Centers for Medicare & Medicaid Services (CMS) that they’re doing an exemplary job.


“This is the first reporting year for [HHVBP],” Joseph Brence, head of clinical strategy at MedBridge, told Home Health Care News. “I would say value-based purchasing has three focus areas. Keeping the patient from seeking downstream services like emergency department care, or hospitalization. The second piece is really the satisfaction of the patient and caregiver. The third component is really based upon OASIS accuracy, specific to certain areas, including the functional improvements of patients.”

MedBridge is a Seattle-based clinical software company. It develops evidence-based solutions for health care organizations and professionals.

Part of seeing success under HHVBP means clinicians being properly trained in critical areas such as wound care and heart failure, so they can immediately recognize signs and symptoms that might lead to emergency department visits or rehospitalizations, which will adversely impact provider reimbursement.


“There are certain groupings of patients that are considered to be higher risk,” Brence said. “Those groupings would be patients with chronic conditions, individuals with things like heart failure, COPD, diabetes, those conditions themselves do oftentimes lead to additional emergency department visits. We also know specifically with wound care, that if an agency or a group of clinicians aren’t able to safely manage a patient’s wound, it often leads to additional adverse events, needing those levels of care as well.”

Brence also noted that with higher risk patient populations, the ability to achieve functional outcomes is a little bit more challenging compared to other patients.

Clinicians that can bring specific knowledge to table will be a value-add for their company and the patient. The problem is that some providers take the approach that all of its clinicians are generalists, according to Brence.

“This means that all of us sitting here might be nurses, but the agency is not investing in, for example, Amelia to become upskilled in wound care and Anna to be upskilled in chronic condition management, or heart failure management,” he said.

Plus, these providers tend to not utilize technology.

On the flip side, innovative, and mostly larger or mid-sized providers are beginning to build out specialty teams to focus on high-risk patient populations.

To accomplish this, providers are utilizing online learning that allows clinicians to complete skill training with more extensive programs focusing on specific areas, and streamlining the process.

ANgMar Medical Holdings ditches the pen and paper method

One provider trying to adapt to solve these very problems is ANgMar Medical Holdings, a Mansfield, Texas-based management company that has Angels Care Home Health and Hospice under its belt. The company operates across 10 states and has 80 locations.

ANgMar Medical Holdings recently transitioned to a digital skills checklist and online education for its clinicians’ training.

From the start, HHVBP has been top of mind at ANgMar Medical Holdings. Four of the states the company operates in were part of the original demonstration.

“We really took it, at that point in time, and made it a corporate wide effort,” Sheila Parker, senior vice president of clinical services at ANgMar Medical Holdings, told HHCN. “We incorporated all of the elements of all the different VBP models along the way, within our daily teaching and our monthly focuses. When it hit that it was going to a national forum, it wasn’t anything new to our offices. We’ve been talking [HHVBP] for a long time now.”

However, ANgMar Medical Holdings used to use pen and paper to perform nurse skill assessments, which Brence pointed out was common among providers.

“There was no visibility at the corporate level to see what the nurses were capable of doing, or what had been done,” Parker said. “That paper got sent out on all sorts of visits, came back, or sometimes didn’t come back. We had no idea, in that tracking, where that skills assessment was.”

This resulted in corners getting cut. Now, nurses at the company are using online education to train in those specific areas, according to Parker.

“It’s both being able to give them that opportunity to learn it online, and then having that opportunity to see and do a successful return demonstration with those skills as well,” she said.

Parker is also hopeful that online education will be helpful when it comes to retaining clinicians.

“One of the No. 1 reasons we were losing clinicians was the lack of educational training that they needed to have throughout their career in home health,” she said. “I’m really hoping that we do see improvement with the turnover.”

Under HHVBP, retention will be incredibly important.

“A provider that has a constant revolving door of new clinicians coming in, and then leaving, won’t be able to accomplish any of those goals within the value-based purchasing realm,” Parker said. “It takes a while for a nurse to be able to wrap their arms around what the OASIS is really asking us.”

Looking ahead, Brence believes that more providers will begin to take on this approach to training and specialized care.

“The majority of agencies that we talked to are now in this transition phase, really trying to get off the pen and paper, and on to technology,” he said.

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