activemandatoryepisode-based

Expanded HHVBP

Expanded Home Health Value-Based Purchasing Model

The Expanded Home Health Value-Based Purchasing (HHVBP) Model seeks to improve the quality and efficiency of home health care across the nation. It adjusts Medicare fee-for-service payments for Home Health Agencies based on their performance against a set of quality measures relative to their peers. The model aims to improve patients' experience, strengthen physical function, and address health issues before they require an emergency room visit.

Active since 2022-01-01

Innovation

Applies an applicable percent ranging from -5% to 5% toward Medicare fee-for-service payments based on an HHA's performance on quality measures relative to peers in a nationwide larger-volume or smaller-volume cohort.

The Problem

In a fee-for-service health system, Medicare beneficiaries who qualify for home health care often receive inadequate, uncoordinated care for their chronic health conditions, resulting in more visits to the emergency room, more admissions to the hospital, or more placements in a skilled nursing facility.

The Solution

Under the expanded HHVBP Model, HHAs receive adjustments to their Medicare fee-for-service payments based on their performance against a set of quality measures, relative to their peers’ performance.

Expected Outcomes

Decreased unnecessary emergency room visits, improved patient mobility, and reduced Medicare spending.

Model Goals

  • Provide incentives for better quality care with greater efficiency
  • Study new potential quality and efficiency measures for appropriateness in the home health setting
  • Enhance the current public reporting process

Patient Eligibility

Medicare beneficiaries who qualify for home health care.

  • Medicare beneficiary
  • Qualifies for home health care

Provider Eligibility

Medicare-certified Home Health Agencies (HHAs) in all 50 states, District of Columbia, and U.S. territories.

  • Medicare-certified HHA
  • Located in all fifty (50) states, District of Columbia, and the U.S. territories

Care Categories

Home Health Care

Chronic health conditionsPhysical function decline

CMS Benchmarks & Thresholds

financial

Original Model Annual Savings141,000,000
Expanded HHVBP Model Payment Adjustment Range-0.05% – 0.05%

operational

Original HHVBP Model Start Date2016-01-01
Expanded HHVBP Model Start Date2022-01-01
Pre-implementation Duration1
Expanded HHVBP Model First Performance Year2,023
Expanded HHVBP Model First Payment Year2,025
Expanded HHVBP Model Second Performance Year2,024
Expanded HHVBP Model Third Performance Year2,025
Expanded HHVBP Model Fourth Performance Year2,026
Expanded HHVBP Model Second Payment Year2,026
Expanded HHVBP Model Pre-implementation Year2,022

population

Number of States in Original HHVBP Model9
Number of States in Expanded HHVBP Model50

quality

Original Model Total Performance Score Improvement0.046%

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