Value-based care is a continuing focus in home health care, and 2022 brings another massive change as CMS completes its nationwide rollout of the Home Health Value-Based Purchasing (HHVBP) model, now in all 50 states.
Agencies in the nine states subjected to the HHVBP test demonstration that began in 2016 have already had several years to develop a clear understanding of what is needed in order to succeed under the HHVBP model, which incentivizes providers based on a series of outcomes. For many others informed in June 2021, that the program would be going nationwide, the model requires a more concerted approach to data collection, reporting and education, starting now.
As home-based care agencies continue to navigate the transition from fee-for-service to a system more focused on outcomes, there are several areas where they can look to adapt their operations during the second half of 2022.
Pre-Implementation and Education
Agencies that will be subject to the HHVBP program for the first time during performance year 2023 have the valuable opportunity to learn from those that have already adopted the new payment model. In addition to Department of Health and Human Services materials designed to help address home health agency questions, there are many other industry resources to help agencies adapt.
“We educate the industry on what to expect,” says Tammy Ross, senior vice president, professional services, for Dallas-based home health care software provider Axxess. “Now is the time to ensure an agency’s systems are in place prior to 2023 when many agencies will receive reimbursement adjustments for the first time.”
That does not mean agencies can sit back and let the changes take place around them.
“I think a lot of people hear ‘pre-implementation’ and think ‘I can take a break,’” Ross says. “That’s just not really true. Pre-implementation means this is when we get our processes in order. We define what to do from a quality perspective, and the things to pay attention to.”
Providers should seek and access educational resources in the form of communications, printed materials, webinars and more, to ensure agency partners are up to speed on what is needed under what timeframe.
Quality Measures and Reporting
One specific area where agencies will need to adapt is tracking and improving quality measures, starting with both the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and the Outcome and Assessment Information Set (OASIS) improvement scores.
Further, home health agencies can utilize their required Quality Assurance and Performance Improvement (QAPI) programs, which already underscore the importance of improving quality of life and quality of care, as well as services delivered in home-based care.
Providers should also scrub Certification and Survey Provider Enhanced Reports (CASPER) data as another means to identify areas of clinical improvement, and can look to implement OASIS clinical competency training and evaluations for both new and existing employees with an eye toward the outcomes as they relate to value-based care.
“Being able to score OASIS correctly will be key to showing outcome improvements,” Ross says. “If you go in and you score a patient incorrectly, it’s going to be really hard to show any improvement at the end of the episode.”
OASIS validation, including the competing factors that play into a patient’s outcome, can provide additional insight into areas of improvement. Assessing these factors, which may include anything from the patient’s family situation and home environment and his or her access to medication, can provide critical context around each patient’s social determinants of health that have a strong bearing on their clinical success.
Business Intelligence
While the data itself is critically important to HHVBP success, business intelligence takes the data a step further by providing operational insights in addition to clinical information. Making sense of data both at scale and on the patient level is critical for agencies to grow and to ensure quality at all levels of the organization.
To this end, providers will need to track numerous metrics relating to value-based care, both through its OASIS scrubber and clinical intelligence tools. Enhanced tools that provide quality assurance and caregiver comparisons can help agencies further pinpoint areas in need of improvement and can shore up performance during the HHVBP transition.
“We’ve designed a dashboard that we call ‘at risk’ to identify those patients that are likely not to develop a good outcome without the clinician’s involvement and interventions,” Ross says. “For agencies that have 3,000, 4,000 or 5,000 patients, you can’t look at every patient. What you want to do is identify those who need the most care.”
This article is sponsored by Axxess. All home health agencies will need to prepare for value-based care if they haven’t already begun the journey. To learn more about how Axxess supports the transition, www.axxess.com/value-based-purchasing.
