1. +
Home Health Value-Based
Purchasing Plan: The Essentials
By Brandi McAlexander
Administrator

2. +
Why HHVBP?
(U.S Department of Health and Human Services Report to Congress:
Plan to Implement a Medicare Home Health Agency Value-Based
Purchasing Program, 2011)
 “The Medicare home health benefit provides an opportunity for
individuals who are generally unable to leave their home, and who
need skilled medical care for their illness or injury for a finite and
predictable period of time, to receive needed care at home. In
recent years, the Medicare home health program has grown
rapidly, both in program expenditures and the number of people
served. In fact in 2009, 3.3 million Medicare beneficiaries received
Medicare home health services, resulting in $18.9 billion in total
Medicare payments. At the same time, the Medicare Payment
Advisory Commission (MedPac), the OIG, the General Accounting
Office, and other stakeholders have raised significant concerns
with fraud and abuse in the Medicare home health benefit. While
the benefit is designed to encourage teams of skilled professionals
to provide patient-focused care to homebound beneficiaries, there
is growing concern that the existing payment system does not
provide the necessary incentives to provide such high quality
patient focused care.”

3. +
Now, the real Why…
 Required by the Accountable Care Act
 CMS hopes it will result in better delivery of care, better
outcomes and reduced costs
 CMS estimates that this model will result in $380 million in
saving with the reduction of unnecessary hospital readmissions
 Anticipated to be the most significant change to Medicare since
2000

4. +
An Important Question (not usually
asked or answered…)
Why are home heath agencies bearing the risk
and cost of being the ones to make the
quantum leap of up to 16% difference in
payment with VBP when we account for only
3.8% of all dollars spent on Medicare
recipient’s health care?

5. +
My multiple answers (but not the
only ones out there…)
 The U.S leads in the costs per capita for health care spending but lags
way behind in quality of care
 The U.S. population is aging at an incredible rate and soon more people
will be eligible for Medicare than other health plans
 Changes must occur rapidly to keep the financial solvency of the Medicare
System
 Home Health costs are much cheaper (sorry, make that more cost
efficient) than hospitalizations which accounted for 25% of Medicare
expenditures in 2014
 CMS wants to continue to drive health care away from institutions and
back into the community
 CMS expects major growth in our little corner of Medicare

6. +
Primary HHVBP Goals
Higher quality home health care
Less wasteful home health care
Home health care at the lowest possible cost

7. +
HHVBP Secondary Goals
 Moves Medicare HH towards rewarding better value, outcomes, and
patient-focused care instead of the volume of services provided.
 Aligns many of the Department of Health and Human Services (HHS) and
CMS’ efforts to improve coordination of care.
 Designed so that it is consistent with the National Quality Strategy to
promote health care that is focused the needs of patients, families, and
communities.
 Designed to make the health care system work better for doctors and
other providers.
 Supports future development in needed data, reporting, and payment
systems that will emerge as a result of changes in health care delivery
systems and quality measurement priorities.

8. +
HHVBP Model
 Final Rule published 11/5/2015
 Incentivizes Medicare HHAs to provide higher quality and more
efficient care,
 Tests whether a payment incentive of up to 8% significantly
improves provider performance (and tests whether a payment
disincentive of up to -8% weeds out the low performers),
 Tests the use of new quality measures in the home health setting;
and,
 Enhances the current public reporting process.

9. +
HHVBP Model
 The model includes all Medicare-certified HHA in
nine states:
 Washington
 Nebraska
 Arizona
 Iowa
 Tennessee
 Massachusetts
 Maryland
 North Carolina
 Florida

10. +
HHVBP Model
 Model began January 1, 2016 and runs through the end of CY
2022
 HHA payment adjustments tied to quality performance
 HHAs scored based on the quality of care delivered to all
patients receiving services compared to:
 Performance of their peers within their state, defined by the same
size cohort, and
 Their own past performance on the measures

11. +
HHVBP Model
Performance Years Calendar Year for
Payment Adjustment
Maximum Payment
Adjustment (up or
down)
2016 2018 3%
2017 2019 5%
2018 2020 6%
2019 2021 7%
2020 2022 8%

12. +
HHVBP Model
Quality Measures
 Each competing HHA’s total performance score will be
calculated from a set of measures already reported via the
OASIS and Home Health Consumer Assessment of Health
Care Providers and Systems(HHCAHPS) for all patients
serviced by the HHA, or determined by claims data, plus 3
NEW Measures where points are achieved for merely reporting
data.
 Payment adjustments based on agency quality measure’s
scores will be made to each HHPPS final claim.

13. +
HHVBP Model
Quality Measures
 24 Quality Measures for Performance Year (PY)1-2016
 Six process measures from existing OASIS data collection
 Eight outcome measures from existing OASIS data collection and
two outcome measures from claims data
 Five HHCAHPS consumer satisfaction measures
 Three New Measures
 Points are achieved for merely reporting data
 Submitted through the HHVBP portal
 These will change across time

14. +
HHVBP Model
Process Quality Measures (from
OASIS)
 Care management (timeliness of admission/SOC)
 Flu vaccine data collection
 Flu immunization received
 Pneumococcal vaccine received
 Reason pneumococcal vaccine was not received
 Drug education on all medications

15. +
HHVBP Model
Outcome Quality Measures (from
OASIS)
 Improvement in Ambulation/Locomotion
 Improvement in Bed Transferring
 Improvement in Bathing
 Improvement in Dyspnea
 Discharge to Community
 Improvement in Pain interfering with Activity
 Improvement in Management of Oral Meds
 Prior functioning ADLs and IADLs

16. +
HHVBP Model
Outcome Quality Measures (from
Claims data)
 Acute care hospitalization within 60 days
 Emergency department use without hospitalization within 60
days

17. +
HHVBP Model
HHCAHPS Quality Measures
 Communication between providers and patients
 Care of Patients
 Specific Care Issues
 Overall Rating of Agency
 Willingness to recommend the agency (Would Definitely
Recommend)

18. +
HHVBP Model
Proposed New Quality Measures (3)
 Flu vaccine coverage for HHA personnel
 Shingles vaccine ever received by patient
 Advance care planning

19. +
HHVBP Model
Scoring
Each HHA’s total score will be based on two separate factors:
 How it’s quality measures compare to other agencies within it’s
state
 Whether it’s quality measures have improved over time

20. +
HHVBP Model
Scoring
 CMS will use each agency’s 2015 quality measures as the base year to
compare its initial measures.
 2015 state medians = thresholds
 2015 state average of top decile = benchmarks
 2015 agency scores = baseline
 As the program continues, CMS will determine if the agency’s quality
measures have improved from the previous year and how each agency
compares with other home health providers in it’s state
 Each quality measure will be scored equally to create the agency’s Total
Performance Score (HH Compare “Star” Rating).
 Agencies will be notified annually in late summer of their total score, and
their “quality-adjusted” payment rate will increase or reduce the Medicare
PPS payment amounts they will receive for that year.

21. +
HHVBP Model
Scoring – Achievement Points
Percentile Ranking At/above Benchmark = 10 points
91st – 100th 1-9 Points in Between
81st – 90th 1-9 Points in Between
71st – 80th 1-9 Points in Between
61st – 70th 1-9 Points in Between
51st – 60th 1-9 Points in Between
41st – 50th Below Achievement Threshold = 0
points
31st – 40th
21st – 30th
11th – 20th
1st – 10th (9X(HHA Performance Score-
Achievement Threshold/Benchmark-
Achievement Threshold)+ 0.5))

22. +
HHVBP Model
Scoring – Improvement Points
Actual Measure Score
76% At/above Benchmark = 10 points
74% 1-9 Points in Between, Based on Current Score
(75% 2015 Benchmark)
72% 1-9 Points in Between, Based on Current Score
70% 1-9 Points in Between, Based on Current Score
68% 1-9 Points in Between, Based on Current Score
66% (65% Agency 2015 Baseline Score)
64% At/Below Agency Baseline = 0 points
62%
60%
58% (10X(HHA Performance Period Score –HHA
Baseline Period Score/Benchmark-HHA Baseline
Period Score)- 0.5))

23. +
HHVBP Model Timeline
 Baseline Year: 1/1/2015-12/31/2015
 Model commencement: 1/1/2016
 2015 Achievement thresholds and benchmarks available: 4/2016
 1st Quarterly performance report and 1st new measure submission:
10/2016
 Quarterly performance report and new measure submission:
1/2017, 4/2017, 7/2017, 10/2017
 1st Annual payment adjustment report: 7/2017
 1st annual payment adjustment: 1/2018-12/2018

24. +

25. +
Lead the way!
For your patients, for your
organization, for your staff, for
your job and for the future of
health care

26. +
TTD
 Take a deep breath and know once you have this battle won,
there will be another one (or more) to wage…
No pressure BUT you need to start now

27. +
TTD
 Educate yourself
 Read everything you can get your hands on (from reputable
sources)
 Look for government-sponsored and free webinars (there probably
won’t be much for a while)
 Share what you learn with your management team and your
clinicians
 Utilize NAHC and state-groups for both networking and information

28. +
TTD
 Ensure your staff are proficient in OASIS
 This is a very complex data set with questions and answers
formulated by the government that do not follow the nomenclature
which is taught in universities.
 Ensure your staff UNDERSTANDS which OASIS questions impact
your agency’s HHVBP score and why they are soooooo important!

29. +
TTD
 Analyze your organizational structure - does it need to be left
alone, tweaked or wiped clean & started from scratch?
 Will the individual field staff members have the desire, motivation,
time and enough agency-sponsored education to truly manage their
cases under HHVBP?
 Does a Clinical Director/Clinical Manager system better meet your
agency’s needs?
 Does it work with your current census? How will growth will impact
processes.

30. +
TTD
 Ensure you have access to and track the items which make up
your HHVBP score
 CASPER Reports
 OBQI Reports
 HHCAHPS Reports
 New Measures Reports from HHVBP Secure Portal (if in a pilot
state)
 Internal Reports
 Data Analytics
 Do you need an Electronic Medical Record?

31. +
TTD
 Incorporate HHVBP into your Quality Management Program
and Program Evaluation
 One of the few areas that “administrative simplification” is possible
 Success will be easier to achieve with team effort vs. your blood,
sweat & tears only
 The standardized tools are very useful for planning and managing
change

32. +
TTD
 Get intimate with your agency and state statistics
 Where are you furthest away from your state’s median and
threshold scores?
 Where can you make the most change (improvement) in your
scores the quickest?

33. +
TTD
 Outside of the box
 Reach out to your QIOs and Intermediary
 Do they have any initiatives you can get involved in?
 Do they have any advice or guidance?
 Do they have any education or resources for your and staff?
 Reach out to your referral sources
 Remember the measure about readmission rates? Hint: They
have the same goal

34. +
TTD
 Out of the box, cont.
 Creatively borrow (AKA: don’t reinvent the wheel)
 Ideas: Start a group of home health professionals from diverse
areas using a meeting app once a month to share, discus and learn
from each other
 Policies/processes/education:
 YouTube – many training videos are now available in the public
domain
 Policy Searches – some teaching center hospital system have
placed their policies in the public record

35. +
Questions
&
Discussion

36. +
Resources
 Federal Register, HHVBP Final Rule, https://www.federalregister.gov/articles/2015/11/05/2015-27931/medicare-and-medicaid-
programs-cy-2016-home-health-prospective-payment-system-rate-update-home
 U.S Department of Health and Human Services, Report to Congress: Plan to Implement a Medicare Home Health Agency
Value-Based Purchasing Program, 2011
 National Association for Home Care & Hospice, CMS Issues Proposed Rule:2016 Home Health Payment Rates and Value-
Based Purchasing Pilot, http://www.nahc.org/NAHCReport/nr150706_1
 Medicare.gov/Home Health Compare, Process of care and outcome quality measures; Rate Calculations; National quality forum
endorsement; What is the patient experience of care survey?;Measuring agency performance; Patient survey star ratings;
Measuring agency performance, https://www.medicare.gov/Home HealthCompare/Data/
 CMS.gov, Home Health Value-Based Purchasing Model, https://innovations.cms.gov/initiatives/home-health-value-based-
purchasing-model
 Baxter, R, Home Health Value Based Purchasing: What You Need to Know – Part One, https://www.alayacare.com/blog/value-
based-purchasing
 Ability, HH Value-Based Purchasing: Are you using the latest data?, webinar 5/2016

37. +
Contact Information:
Kathy Harden
kharden58@gmail.com
772-532-0567