Home Health Value Based Purchasing Model Slightly Improved Spending, Care

Home health value-based purchasing was associated with lower utilization and spending and slight improvements in quality of care, an analysis published in the JAMA Health Forum found.

The researchers established two cohorts of home health patients. One cohort consisted of home healthcare patients who were in states with a CMS home health value-based purchasing and the second consisted of patients in the 41 comparison states.

The CMS intervention went into effect in 2015, so the study analyzed data from 2013 to 2015 as part of the pre-intervention period and data from 2016 to 2020 as part of the post-intervention years.

CMS implmented the home health value-based purchasing model in nine states in 2015: Arizona, Florida, Iowa, Massachusetts, Maryland, Nebraska, North Carolina, Tennessee, and Washington.

The study analyzed 16.5 million beneficiaries’ home health episodes during the intervention period, of which 22.6 percent were in home health value-based purchasing states and 77.4 percent were in comparison states.

States with the home health value-based purchasing model saw lower utilization, slower Medicare spending growth, and better quality of care in some areas.

The rate of home health episodes dropped slightly more for home health value-based purchasing states than for comparison states between the pre-intervention period and the post-intervention period.

In both cohorts, inpatient services consumed about one-third of Medicare payments and home healthcare services were the second largest factor.

In unadjusted analyses, unplanned hospitalizations became about equal during the intervention. Emergency department use grew similar between the two cohorts, with the home health value-based purchasing model witnessing an increase in emergency department use during the intervention. However, according to the difference-in-difference analysis, home health value-based purchasing organizations reduced unplanned hospitalizations by 0.15 percentage points or 1.0 percent.

Outpatient emergency department use increased in home health value-based purchasing states by 2.5 percent. Inpatient admissions dropped 1.1 percent in these states. Additionally, skilled nursing facility usage dropped 6.9 percent.

Unadjusted, the home health value-based purchasing cohort saw the average Medicare payments per day increase from $130.85 to $152.80. Among comparison states, the payments jumped to become about equal with the home health value-based purchasing cohort’s: from $127.69 to $153.84).

However, the difference-in-difference calculation showed that Medicare payments per day for traditional Medicare beneficiaries dropped $2.17 or 1.6 percent.

The discharge rate for home health value-based purchasing patients grew from 72.8 percent to 73.1 percent. The comparison cohort saw an increase as well, from 70.1 percent to 71.8 percent.

Outcome and Assessment Information Set (OASIS) measures saw slight improvements in home health value-based purchasing states.

As a result of these changes, the program added $190 million to Medicare’s average annual savings, post-intervention. The biggest distinguishing factor was the decline in inpatient services, which saved Medicare around $109 million annually. The drop in skilled nursing facilities utilization contributed around $40 million in annual Medicare savings.

“Agencies varied in their responses to HHVBP incentives, but overall, 4 of the 9 states showed evidence of savings,” the report found. “Determining whether agencies with specific characteristics were primarily responsible for the savings and quality improvement attributed to the HHVBP model remains a topic for future investigation.”

Home healthcare can be a key instrument in the value-based care toolkit for reducing costs. Payers like Humana have started acquiring value-based care home healthcare entities to expand these services. Since acquiring onehome, Humana has been extending its reach into new states to expand members’ access to value-based home healthcare services.

Appropriately measuring quality of care in this arena of care is essential, however. These new models call for strong home healthcare quality measurements.