‘Bring It On’: Home Health Executives Embrace HHVBP Expansion

When the U.S. Centers for Medicare & Medicaid Services (CMS) first released its home health proposed payment rule for 2022, its nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model was recognized as a potential game-changer for the home health industry.

While HHVBP has been heralded for its ability to improve quality of care and bolster annual Medicare savings, only select states have been able to take part in the demonstration since its 2016 implementation.

Now that this might change, leaders across home health are weighing in on how HHVBP may help or hurt their businesses. So far, the expansion plan has received a warm reception from the industry, though some believe that providers should have a bigger piece of the savings pie.

To get a better understanding of this acceleration of value-based care, Home Health Care News asked nine executives for their insights on the HHVBP expansion.

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Related: “HHCN+ Report: Breaking Down the Home Health Value-Based Purchasing Model”

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The expansion of HHVBP connotes a level of confidence in and expectation of home health that we should embrace. Not everyone is going to do well, but this should bend the curve toward better outcomes, patient experience and greater cost savings that can be attributed to home health agencies.

VNSNY has significant capabilities in care management and predictive modeling that can provide more tailored and effective interventions to patients who are at risk. Delivering value in a risk-based environment is what we do every day in our value-based arrangements with managed care plans. If we can operate in a Medicare environment with similar measures and incentives, it will benefit everyone, especially our patients.

Nothing is perfect right out of the gate, though. Home health agencies should be able to share savings generated from reducing readmissions; agencies should be evaluated regionally instead of nationally; there should be a stronger risk-adjustment model; and patient stabilization should be recognized, given the age and acuity of patients.

— Dan Savitt, president and CEO, Visiting Nurse Service of New York (VNSNY)

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At BAYADA, we are fortunate to have participated in the original HHVBP pilot across more than 20 branch locations in five states. We have performed well in the pilot, and collective feedback from our teams revealed an overall positive experience, supporting the nationwide expansion of this model.

For the home health industry at large, the natural response from providers will be to assume that, if you perform well in the star ratings, then you will also perform well in HHVBP. Through our pilot experience, we discovered that these quality reporting programs are not directly correlated with one another. We have instances where a service office performed exceptionally well in the star ratings but did not receive a proportionate payment adjustment from the HHVBP scores. Agencies will need to take this into consideration when developing quality improvement initiatives and should anticipate potentially mixed messaging across the various reporting programs.

Additionally, agencies will need to consider how to balance the rollout of HHVBP with the ongoing challenges of the public health emergency, as well as increasing demand for services paired with growing labor costs and competition for talent. This may lead to a limitation in resources in some markets and should be considered when preparing for HHVBP while also addressing these other priorities. As with any new program, we will closely evaluate the performance measures and methodology and will be prepared to put our teams in the best position to succeed. If HHVBP is finalized as proposed, we say “bring it on.”

— Anthony D’Alonzo, senior vice president of clinical strategy and innovation, BAYADA Home Health Care

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Home health value-based purchasing will not fundamentally shift our business, but it will cause some changes to what we do. We’ve already seen a lot of this change happening in states where VBP has been in place as part of the CMS demonstration project, but now it will happen on a national scale. Agencies will spend even more time and money working to improve the VBP numbers and capture that extra revenue. The interesting thing will be what happens as the overall tide rises. What is a good rehospitalization number now will not look good in five years. Because this rising tide will lift everything, that also means that VBP numbers will continue to rise. I think there will come a time when some agencies tap out and either exit the business or decide that it’s not worth chasing VBP money and accept a smaller payment for results that aren’t as good.

In terms of our business, we’ve seen some areas that we have identified as serious focus points during the measurement period so that we can hopefully end up with the winners once financial incentives are put into place. We have made some big changes to start factoring in this need and anticipate continuing to do so as we move forward into this new world.

— Beau Sorensen, chief operating officer, First Choice Home Health & Hospice

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We believe the expansion of the Home Health Value-Based Purchasing Model is another positive step toward better aligning the incentive of home health providers with patient care and satisfaction. As we’ve experienced, when performance is measured, performance improves. In addition to reducing CMS’s overall Medicare spend, the HHVBP model provides those agencies that outperform clinically the opportunity not just to participate in more Medicare incentive but do so in a more cost-efficient manner, leading to improved provider results and, most importantly, patient care.

We also see that the expansion of this program could contribute to the consolidation of providers across the industry, as those that have the clinical expertise to perform well under HHVBP will likely have access to additional funds for M&A opportunities. Overall, we view the model as a positive for the industry and welcome the opportunity to more closely align value and payment.

— John Gochnour, chief operating officer, The Pennant Group Inc.

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HHVBP will challenge all home health providers to align personalized care plans with close attention to the potential for improvement within an efficient amount of visits and interventions. Patients with higher levels of acuity and/or limited community resources will naturally require a higher amount of visits and the care of multiple disciplines. Thus, caring for sicker and socio-economically disadvantaged patients could result in a payment reduction. We are committed to providing the highest quality of care possible for all of our patients in Southeast Michigan. We hope that SDoH will be considered by CMS and that we will not be penalized for providing for the nation’s most vulnerable patients. Some agencies may choose or be forced to not serve this population. American Advantage Home Care Inc. will always be here for these patients.

— Cleamon Moorer, CEO, American Advantage Home Care

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We applaud HHS’s decision to expand the HHVBP model. Incentivizing pay for quality and value is the right move, as consumers deserve high-quality care in their home. Our focus has always been on providing patients with the highest quality care at the right time, in the right place. We look forward to what’s ahead for the industry as home care continues to grow as a high-quality, high-satisfaction and low-cost alternative of care.

— Scott Powers, chairman and CEO, Elara Caring

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The HHVBP model represents a validation that companies like Aveanna will be rewarded for their investments in clinical innovation, technology, and high-quality, cost-efficient care. We believe that CMS values the benefits of home health care and is demonstrating their conviction through their support of the HHVBP model. This model promises our patients better outcomes and our payers lower costs. Furthermore, the HHVBP model allows providers like Aveanna to continue to invest in outcomes that make a difference in the lives of our patients. This is a true win-win scenario. Value-based care is the wave of the future, and we believe at Aveanna that we are well-positioned to optimize our performance and our care in this environment.

— Jeff Shaner, chief operating officer, Aveanna Healthcare

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The key value for HHAs with HHVBP is the definitive finding that using high-quality home health services brings Medicare savings by reducing hospitalizations and nursing home use. That is a “dynamic value.” As a result, home health should get favorable reception on policy reforms along with an improved embrace from managed care entities that are also looking for positive patient outcomes and cost savings.

— Bill Dombi, president, National Association for Home Care & Hospice (NAHC)

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Within the nine demonstration states, there have been winners and losers. States with the highest degree of success studied the requirements and performed additional education for their staff.

Outcomes was the impetus behind the creation of the OASIS assessment. Yet despite industry efforts to educate clinicians in the process, clinicians continue to struggle. For several agencies, star ratings showed significant declines. This indicates there may be unaddressed OASIS education that needs doing.

CAHPS scores are another item used in tabulating wins and losses with HHVBP. Creating environments that will boost patient- satisfaction scores will be important, and engaging patients and families toward an organized discharge will be an invaluable asset.

With so many other changes to our business models over the past two years, HHVBP will now take front and center stage as we move into this payment model.

— Arlene Maxim, senior clinical officer, Axxess