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In the midst of the first full performance year for the expanded Home Health Value-Based Purchasing (HHVBP) model, providers are figuring out where they are succeeding and where there is room for improvement.
HHVBP continues to save hundreds of millions of dollars each year, according to the U.S. Centers for Medicare & Medicaid Services (CMS).
And the initial set of HHVBP scores — on the provider side — is influencing the operations of home health providers of all sizes.
“We are steering the entire company towards value outcomes,” Ananth Mohan, COO of Elara Caring, told Home Health Care News. “It adds to the complexity of how we do business, so you have to be sophisticated about it. With the midway point scores, it’s really geared us up and reaffirms that this is the way the world’s going to go.”
The HHVBP model, which CMS expanded from nine demonstration states to home health agencies across the country on Jan. 1, 2023, was implemented to incentivize home health agencies to improve the quality of care they provide to Medicare beneficiaries.
The goal of the model is to link Medicare reimbursement to the quality of care, rather than just the quantity or volume of services.
The way CMS does that is through quality measures and performance scoring. Those measures include patient outcomes, patient experience, process measures and timely initiation of care.
Each category has specific measures that contribute to the overall performance score. The performance period usually lasts a year. During that time, CMS evaluates the data that providers share, and, from that, a score is returned to providers that can negatively or positively affect their reimbursement.
After reviewing the scores Elara Caring received at the six-month point, Mohan is pleased with the early results. In particular, Mohan is encouraged in how the results have affected day-to-day operations.
“On the hospitalization front, the results made us think about being more programmatic,” he said. “It changed how we think about centers of excellence around certain diseases, how we think about which areas of the company where we’re more hospital-heavy. It’s also changed the way we think about things like remote patient monitoring. RPM is not incentivized today, so you’re essentially giving it away. But if you’re giving it away in this mode,l then it matters, because it drives outcomes.”
The Dallas-based Elara Caring is one of the largest home health, home care and hospice providers in the country, with about 200 locations across 17 states.
The HHVBP model has given Elara Caring insights into what is working and what isn’t working at different locations.
For instance, the midpoint check-in has reinforced the need for predictive tools.
“Otherwise, we’re always just looking backward,” Mohan said. “So, we built an in-house, custom predictive tool that our branches are able to use and see on a real-time basis what they’re good at and what they need to improve on. I continue to be impressed at how this resonates culturally with people. If you give them the right tools, they can make an impact. We’re seeing that.”
On the flip side, the early results have shown that reducing hospitalizations will be a “never-ending challenge.”
For patient satisfaction and OASIS scores, the simplified strategy is to see where improvements need to be made and to stay on top of them. For clinically-driven results, it’s a tricker task.
“Because acuity is going up,” Mohan siad. “Just when you think you’ve cracked it, you’re going to get sicker patients and you’ll run into situations you can’t expect. So, I’m not satisfied with where we are, but that’s probably all of us in the industry.”
A renewed focus on patient satisfaction
For other providers, the HHVBP results have reinforced a new focus on patient and customer satisfaction.
“If we’re knocking our patient satisfaction customer service out of the park from the moment we call our patients, our entire score can flourish,” Nicoleen Meyer, VP of clinical services at Accurate Home Care, told HHCN.
Accurate Home Care is a Minnesota-based home care and home health provider that operates in half of the state’s 87 counties.
As care in the home shifts to more value-based models, Meyer believes it’s critical to do everything possible to have top-tier customer service. It’s the baseline for any successful provider in a value-based system, she said.
“When your patient meets all their goals, they’re discharged from care and get that survey and think, ‘My gosh, my nurse was so great, I had such a great experience,’” Meyer said. “If they actually got better, are healthier, didn’t go back to the hospital — what you’ve done is reduced your hospitalization rates, improved your OASIS scoring and process measures and your whole HHCAHPS scores thrive because of that.”
Being a smaller provider, Accurate Home Care has to look for every advantage it can find. When Meyer initially looked through what would make up the total HHVBP performance scores, she immediately drew the line from patient satisfaction to quality scores.
“The other things are important too, but this one feels like low-hanging fruit,” Meyer said. “You don’t need a nursing degree to understand the importance of customer service.”
Providers spent years prepping for HHVBP, but now they’ll need to adjust.
Accurate Home Care, for instance, will be more focused on the OASIS process.
“OASIS, while it is intended to be objective and user friendly, it’s really anything but,” Meyer said. “It’s not a science, it’s an art. It may come down to the way our nurses are asking and answering the questions. Right now, there’s even more of a focus on educating our staff on these kinds of things in order to improve those scores.”
For Elara Caring, it goes back to hospitalizations and the difficulties in finding a good balance with programs as acuity in the home rises. Getting and evaluating risk scores, Mohan has found, doesn’t tell the full picture like it used to.
“You can get risk scores, but what we found was just risk scores weren’t enough,” he said. “You have to marry it with disease, at least in terms of how you develop pathways. We’ve evolved that. It used to be that if you’re high-risk, you’re in a high-risk program. Now it’s if you’re high-risk COPD, that looks different than if you’re high-risk cardiac.”
It’s still early, but the early HHVBP scores have already changed the way providers are operating.
“On the OASIS front, it accelerated the work we were already doing,” Mohan said. “On the hospitalization front, it made us get more programmatic, and on the patient satisfaction front, it made us operate on a real-time level versus leaving it all to chance.”