Association of the Home Health Value-Based Purchasing Model With Quality, Utilization, and Medicare Payments After the First 5 Years

Abstract

ImportanceThe original Home Health Value-Based Purchasing (HHVBP) model provided financial incentives to home health agencies for quality improvement in 9 randomly selected US states.ObjectiveTo evaluate quality, utilization, and Medicare payments for home health patients in HHVBP states compared with those in comparison states.Design, Setting, and ParticipantsThis cohort study was conducted in 2021 with secondary data from January 2013 to December 2020. A difference-in-differences design and multivariate linear regression were used to compare outcomes for Medicare and Medicaid beneficiaries who received home health care in HHVBP states with those in 41 comparison states during 3 years of preintervention (2013-2015) and the subsequent 5 years (2016-2020).ExposuresHome health care provided by a home health agency in HHVBP states and comparison states.Main Outcomes and MeasuresUtilization (unplanned hospitalizations, emergency department visits, skilled nursing facility [SNF] visits) for Medicare beneficiaries within 60 days of beginning home health, Medicare payments during and 37 days after home health episodes, and quality of care (functional status, patient experience) during home health episodes.ResultsAmong 34 058 796 home health episodes (16 584 870 beneficiaries; mean [SD] age of 76.6 [11.7] years; 60.5% female; 11.2% Black non-Hispanic; 79.5% White non-Hispanic) from January 2016 to December 2020, 22.6% were in HHVBP states and 77.4% were in non-HHVBP states. For the HHVBP and non-HHVBP groups, 60.4% and 61.0% of episodes were provided to female patients; 10.0% and 13.6% were provided to Black non-Hispanic patients, and 82.4% and 75.2% were provided to White non-Hispanic patients, respectively. Unplanned hospitalizations decreased by 0.15 percentage points (95% CI, –0.30 to –0.01) more in HHVBP states, a 1.0% decline compared with 15.7% at baseline. The use of SNFs decreased by 0.34 percentage points (95% CI, –0.40 to –0.27) more in HHVBP states, a 6.9% decline compared with the 4.9% baseline average. There was an association between HHVBP and a reduction in average Medicare payments per day of $2.17 (95% CI, –$3.67 to –$0.68) in HHVBP states, primarily associated with reduced inpatient and SNF services, which corresponded to an average annual Medicare savings of $190 million. There was greater functional improvement in HHVBP states than comparison states and no statistically significant change in emergency department use or most measures of patient experience.Conclusions and RelevanceIn this cohort study, the HHVBP model was associated with lower Medicare payments that were associated with lower utilization of inpatient and SNF services, with better or similar quality of care.

Claims-Based vs Agency-Reported Patient Outcomes Among Home Health Agencies, 2013-2019

“…This study has limitations. First, we are not able to separate the associations identified from the introduction of star ratings for HHAs from other HHA quality initiatives, such as the 2016 pilot of the Home Health Value-Based Purchasing Model in 9 US states, which provided financial incentives for participating HHAs to improve quality of patient care . However, given the introduction of these 2 programs in the same years, we view the observed functional improvement in OASIS-based measures relative to claims-based measures even more salient.…”

“…First, we are not able to separate the associations identified from the introduction of star ratings for HHAs from other HHA quality initiatives, such as the 2016 pilot of the Home Health Value-Based Purchasing Model in 9 US states, which provided financial incentives for participating HHAs to improve quality of patient care. 32 However, given the introduction of these 2 programs in the same years, we view the observed functional improvement in OASIS-based measures relative to claims-based measures even more salient. Second, our data do not allow us to capture more recent changes in Medicare HHA reimbursements, such as the 2020 Patient-Driven Grouping Model or 2022 nationwide expansion of the Home Health Value-Based Purchasing Model, which might contribute to changes in HHA behavior and performance.…”

Disparities in Successful Discharge to the Community Following Use of Medicare Home Health by Level of Neighborhood Socioeconomic Disadvantage

“…In addition, our results suggest the possibilities that the initiatives the CMS introduced to encourage HHAs to improve care quality and health outcomes may affect existing health disparities. For instance, the HHVBP program financially rewards or penalizes HHAs based on their quality performance and will be expanded nationwide in 2023 (Pozniak et al, 2022). HHAs in disadvantaged neighborhoods could face more challenges in improving care quality and health outcomes under HHVBP.…”

VNS Health and HSS Partner to Reduce Length of Stay After Total Joint Arthroplasty: Implications for Home Care Providers

“…Medicare also established the Hospital Value-Based Purchasing (VBP) program and the Home Health Value-Based Purchasing (HHVBP) model. These are incentive programs for hospitals and certified home health agencies that are designed to improve patient experience and quality of care [4,6,16]. The VBP and HHVBP score hospitals and certified home health agencies on measures including patient safety, patient experience, cost, health care-associated infections, and mortality and complications.…”

“…Their scores are compared with those of other hospitals and home health agencies, as well as to their own scores from the previous year. Medicare may reward organizations for efficiency and outcomes [7,16]-thus encouraging providers from across the continuum of care to work together on enhancing patient safety, improving outcomes, and boosting efficiency [5].…”