Home Health Value-Based Purchasing: Top Three Lessons We Learned From the First Performance Year

It’s been a year since the first performance year (2023) under Home Health Value-based Purchasing, and there’s a lot to unpack! We spoke to leading home health agencies to understand what went right, what went wrong, and what they want to improve to get ready for the payment adjustments coming in 2025. Here’s the top three lessons we learned from the first performance year.

What Is Home Health Value-Based Purchasing (HHVBP)?

Home Health Value-Based Purchasing (HHVBP) was envisioned as a shift away from volume-based reimbursement and designed to provide financial incentives to home health agencies for improvements in quality of care. This would reward agencies with higher achieved or improved quality scores and reduce payments to agencies with lower performance scores. 

For most home health agencies, 2022 is the baseline year that 2023 and 2024 will be measured against, with 2023 being the first performance year, affecting payment adjustments in 2025.

What Are the HHVBP Measures in 2023?

Your score is broken down into three sections—35 percent of your score will be claims-based, 35 percent will be OASIS-based, and 30 percent will be derived from your agency’s HHCAHPS scores. Each measure type is then broken down further into different measures that carry different Total Performance Score (TPS) points. 

Your TPS scores will be added up and marked up to a maximum 100 TPS points. For example, if you hit the benchmark for acute care hospitalization in the Claims-Based category, you’ll get the full 26.25 points. But if you fall short on the ED visits measure, you’ll lose points from the 8.75 as appropriate. The higher your Total Achievement Score, the more likely you are to get a positive payment adjustment beginning in 2025.

Scoring will be measured in two different ways: Achievement Threshold and Improvement Threshold. The Achievement Threshold score measures your agency’s performance against everyone else while the Improvement Threshold score measures your performance during the performance year (2023) against your own baseline year (2022). CMS will use whichever of these two scores is higher. 

Luckily, you will have a couple different ways to understand your home health value-based purchasing performance throughout the year.

How to Understand Your HHVBP Performance

There are two primary ways to understand your performance. The first is the Annual Performance Report available beginning August 2024, which will give you a broader picture of how your agency did and what you can expect for that payment adjustment.

The second—and more immediately relevant to your agency today—is the Interim Performance Report (IPR). IPRs are released on a quarterly schedule, with the first release in July 2023. This report provides a look at the current benchmark, what the thresholds are for the achievement level, and your current performance so you know where you need to improve. 

What HHAs Are Saying About the 2023 HHVBP Performance Year

We spoke to our home health customers to find out what additional challenges they’ve been running into and what their experience has been like after the first performance year—so what did we learn?

Staffing concerns impacted initiatives.

Like everything else in home-based care over the past several years, staffing concerns have had a huge impact—including home health value-based purchasing performance initiatives. Many forward-thinking HHAs had plans in place to prepare for HHVBP well before 2023, but even they were sidetracked by staffing issues prevalent in the industry. Finding nurses to go out in the field and administer quality care is a persistent challenge, and many understaffed agencies have found it difficult to perform the deep dives into HHCAHPS results and hospitalizations metrics that they would have liked.

OASIS education and hospitalization reduction were the primary focus areas.

This is unsurprising given the weight of these metrics in the performance measures, but OASIS education and hospitalization reduction were the primary areas of focus for HHVBP improvement in 2023. Resources like our guides, “Best Practices to Solve Common OASIS-E Problems: Candid Tips from Top Auditors,” by Cindy Krafft and Terry Greenhalgh, or “Reducing Fall Risk to Prevent Rehospitalization and Emergency Department Visits,” can help you tackle these important metrics.

Agencies may not be reviewing the available reports from CMS.

If your team is not reviewing the data, your improvement program will be flying blind! The data can reveal ways to target several initiatives as efficiently as possible. Remember, you can get information from CMS on how to access your IPR here.

MedBridge is Your Partner for HHVBP

Home health value-based purchasing is going to be an ongoing challenge for years to come, but MedBridge is your partner for everything you need to be successful in 2025 and beyond. From best-in-class onboarding and training resources to expert-led outcomes improvement and OASIS education, our home health software has your back every step of the way.

Reduce Hospitalizations and Boost HHCAHPS scores

Our Clinical Procedure Manual supports excellence at the point of care with just-in-time training, accessible everywhere nurses go—even a patient’s driveway.

Get Nurses Trained and in the Field Faster

Our Skills and Competency Manager combines an online skills assessment checklist and engaging, evidence-based skills training to help improve quality of care and patient satisfaction, meet regulatory requirements, and reduce risk.

Improve OASIS Accuracy

Superior OASIS training and education yields superior results! Establish a strong foundation for accurate OASIS data collection and continually refresh knowledge with integrated training, assigning, and management tools.

Free Recorded HHVBP Webinar

Want a deep dive into the latest trends, HHVBP improvement strategies, and a Q&A? Check out our recent webinar on the subject, Home Health Value-Based Purchasing: Lessons Learned From the First Performance Year.