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The Results Are In – The HHVBP Model Annual Report Shows Continued Progress

Findings show that the HHVBP Model has led to marked improvements in quality of care, patient safety, and patient experiences.


August 10, 2023 – The Home Health Value-Based Purchasing (HHVBP) Model has been at the forefront of healthcare discussions as a transformative model designed to improve the quality of home health care services. The model showed so much potential in its early years, that CMS expanded the model nationwide starting in 2023.

The HHVBP model, now known as the Expanded HHVBP model, links financial incentives with performance and creates a healthcare delivery system that values quality over quantity. In this blog, we will delve into the most recent HHVBP Sixth Annual Report released by CMS, and then take a further look at how Performance Year 1 of the Expanded HHVBP model is progressing, before diving into the implications for the future of home healthcare and home care under this value-based payment model. 

HHVBP Model Results – Impact and Improvements

The HHVBP Model has shown promising results since its inception. The most recent Annual Report released by CMS shows nothing to the contrary. 

Over the six years of the original Home Health Value-Based Purchasing (HHVBP) Model, a significant reduction was observed in the growth rate of Medicare spending for Fee-For-Service (FFS) beneficiaries receiving home health care. Furthermore, substantial improvements were noted in several quality of care measures in the nine states that initially adopted HHVBP, compared to the 41 states that did not. 

Key factors driving the favorable impact on overall Medicare spending included decreases in unplanned hospitalizations and Skilled Nursing Facility (SNF) usage. Hospitalizations, the most significant expenditure for FFS beneficiaries receiving home health services, saw reductions under the HHVBP model. Overall, there has been a cumulative reduction of $1.38 billion in overall Medicare spending for FFS beneficiaries receiving home health services during 2016-2021. This number is staggering and shows the true potential of the HHVBP model for reducing overall healthcare costs

Despite the reduction in healthcare spending, the Sixth Annual Report also showed that Total Performance Scores (TPS) for those participating in the model were also 6% higher on average than the control group. The TPS values are important as they serve as an indicator of HHA performance. For each of the six years under the original HHVBP model, the TPS for agencies in HHVBP states were higher relative to the TPS calculated for agencies in the 41 non-model states.

Despite these promising signs, the HHVBP Model revealed persistent inequities involving underserved populations. The reduction in unplanned hospitalizations and overall outcome improvements were not observed at similar levels for Medicaid patients or among Hispanic patients. In addition, racial and ethnic minority beneficiaries were found to be more likely to reside in areas served by lower quality HHAs.

Addressing these inequities and obtaining health equity as this model expands nationwide will require careful planning. Individuals deserve to live comfortably at home with quality care despite their race, ethnicity, and where they reside. One solution could be the implementation of additional quality improvement initiatives that focus on reducing such disparities. That is something CMS will need to carefully consider as the Expanded HHVBP model progresses. 

Based on the Sixth Annual Report, in the six years since its launch, the HHVBP Model has led to improvements in patient care quality, patient experiences, and cost of care. It has also led to a reduction in hospital readmissions, which is one of the primary objectives of value-based healthcare. It will be interesting to see if these trends hold true nationwide with the Expanded HHVBP model.

The Current State of the Expanded HHVBP Model

The Expanded HHVBP Model is currently in Performance Year 1. But how is it faring and are we seeing similar results to the original model with this nationwide expansion? The answer to that will become evident when the First Annual Report is released publicly by CMS in 2024. That doesn’t mean that HHAs are in the dark about their performance until then.

Currently, CMS provides home health agencies with quarterly performance reports called Interim Performance Reports (IPRs). This is a critical tool for driving improvement. For the 2023 performance year, IPRs will be available quarterly starting in July 2023. Each IPR offers insights into an agency’s performance and includes the following data: 

  • OASIS-based performance measure data collected by HHAs through the OASIS assessment process and then routinely submitted to CMS via iQIES
  • Claims-based measures derived from Medicare fee – for – service (FFS) claims data submitted to CMS for payment purposes
  • HHCAHPS Survey-based measures from patients’ responses to a set of standardized questions

Overall, the IPR will provide feedback to HHAs on their interim, risk-adjusted measure performance scores and an interim Total Performance Score. Agencies will also learn about their improvement, achievement, and care points relative to the performance of other HHAs in their cohort, as well as information to help them understand how quality measures are contributing to their TPS. 

This kind of benchmarking is crucial in a value-based care environment, as it allows agencies to gauge their performance and identify areas for improvement. With these reports, agencies have a robust and comprehensive tool for evaluating their performance. This enables them to implement data-driven decision-making and work towards continuous quality improvement. 

While the IPRs are not available publicly, we look forward to the release of the first Annual Report in 2024 and as always, you can expect a comprehensive analysis from the team at XtraGlobex. 

Looking Forward – The HHVBP Model's Promise for the Future

So, why does all of this matter? Simply put, the Expanded HHVBP Model marks a significant step forward in the evolution of home healthcare. By linking financial incentives to quality performance, it creates a catalyst for continuous improvement that includes better health outcomes, lower costs, and higher patient satisfaction. 

The Expanded HHVBP Model will undoubtedly continue to shape the home healthcare landscape. It stands as a testament to the power of value-based care and serves as a guide for future healthcare initiatives. Looking forward, we see the Expanded HHVBP model serving as a template for future VBP models. Homecare seems like the next obvious frontier for value-based payments and the success of VBP models in home healthcare can eventually seep into the next sector.

Advocates Perspective

The Expanded Home Healthcare VBP Model is a huge step forward for value-based payment models in the United States. Based on a 9-state pilot that consistently saw better HHA performance scores, higher patient satisfaction, and lower healthcare costs that HHAs not participating in the model, CMS decided to expand the model nationwide. This Expanded HHVBP model is a bright spot for VBP models and has the potential to not only revolutionize the home healthcare industry, but also the homecare industry. As the aging population in the United States increases, more individuals are going to be in need of non-medical homecare services that allow them to remain living comfortably and independently at home. The Expanded HHVBP model may be a precursor to VBP models in home care. Only time will tell, but we will keep a close eye on future developments. 


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About the Author

Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).

His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.

mandy sahhar

About the Co-Author

Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.