The year 2023 will be different going forward for home health agencies or hospice services. This will be the first year of the performance of determining the value-based purchasing model.
Home health value based purchasing or HHVBP is the model where the differentiator is quality against the quantity of the care. It is a performance-based metric that considers the improvement of outcomes which largely depend on patient adherence and engagement.
When caregivers from home health agencies demonstrate compassionate and effective patient handling skills, especially for post-trauma care and senior patients who normally avail of home care, then the outcomes improve. A caregiver helps the patient fill the gap between the comprehension of their treatment and execution of the same through consistent monitoring, support, and encouragement.
Need for home care
Home health agencies are increasing in number as the aging population of the country is increasing and the health hazards of seniors living alone are a cause of worry.
Admitting them to hospitals for repeat episodes that can be managed through telehealth and remote patient monitoring will escalate healthcare costs. However, with telehealth and RPMs in place, clinicians can follow up and monitor the patients and when they feel that a patient needs consistent assistance from a caregiver that can be delivered in the comfort of their home, they are encouraged to go with a home health agency.
A caregiver will assist the patient as per the requirements. Numerous types of home care can be part of the program for patients depending on their treatment requirements.
Revenue change for home agencies
With a value-based model, home agencies must deliver quality care that can improve patient outcomes and improve their scores to maintain their revenue model. The Total performance score or TPS will comprise several parameters that can include acute care management, administration of oral medicines, patient hygiene maintenance, and therapy assistance in determining the overall measure for an agency.
Based on the score, the reimbursement model for agencies will vary. The above-average performance will benefit in saving up to 5% and below-average performance will lose out on the reimbursement of up to 5% maximum compared to a similar-sized agency.
Most agencies rely on value-based contracts that account for more than half of their annual revenue for the next 3-5 years. This means that value-based purchasing norms have to be ingrained and adjustments made accordingly for home care agencies to score above average to continue saving on the performance metrics.
Value-driven models are replacing the payment and reimbursement structure in healthcare in all segments. Improving a patient’s health outcomes is the result of the concentrated effort and skill of an agency and caregiver. This system is beneficial to all the stakeholders including patients, providers, insurance companies, healthcare units, and the government.
Steps that HHA can take to improve scores
Value-based payment models help agencies gain a reputation for their brand as the scoring system will inadvertently act as self-advertisement. Healthcare facilities and doctors are determined to provide trusted services and programs to their patients. If an agency keeps scoring high, then it will be rewarded for its consistent performance.
To scale to that level agencies need to understand patient-related risks and clinical documents. The staff has to be trained to handle EHR and RPM tools. Proactive measures and critical thinking when they need to connect with the hospital or clinicians are important. Here are some steps that will help an agency turn into a performer:
- Understand the HHVBP model and measures and train the staff so that they comprehend its importance
- If self-learning is difficult, hire a consultant who can train the staff
- Hire compassionate and skilled people who are determined to help patients in home care settings improve their outcomes
- Be abreast with information flow and changes that will affect the agency, especially from CMS concerning VBP requirements.
- Check for the updated version of the EHR software and determine if it is consistent with OASIS
Home health agencies play a pivotal role in reducing the costs of readmission for at-risk patients and also offer palliative care to seniors who are among the vulnerable patient population. At-home care for newborn babies with health conditions is also increasingly popular. Trusting their loved ones with a caregiver is possible only when an HHA scores in all parameters of safety and performance.