Abstract
The Home Health Value Based Purchasing (HHVBP) Model program was introduced in 2016 as a pilot through the Centers for Medicare and Medicaid Services (CMS). The program devised a formula to incentivize Medicare-Certified home health agencies in the United States (U.S) to improve patient care quality, reduce hospitalizations, and improve patient experiences. The original model was piloted in 9 states (Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee) from 2016 to 2021. These states represented geographical areas across the nation where Medicare-certified “payment was tied to quality performance.” Participating agencies’ performances were evaluated using the Outcome and Assessment Information Set (OASIS) instrument to extract data related to patient outcome measures and claim-based measures. Data extraction of patient experiences came from HHCAHPS surveys. Conclusions drawn from the first 3 years denoted modest improvements in OASIS-based quality measures in patients in HHVBP participating agencies versus non-participating agencies. Nationwide expansion of HHVBP began in 2022, with the first full performance year starting January 1, 2023. This quality improvement project examines a Michigan-based home health care organization’s implementation of a focused OASIS-based measures process to improve patient outcomes impacting their HHVBP Model TPS scores within their designated cohort. Analysis of the executed plan revealed strategic implementation of measures to improve OASIS-based measures had a positive impact on clinician engagement with patients to facilitate improved patient outcomes. Improvement outcomes positioned the agency to be rewarded with a positive payment adjustment incentive in 2026 based on their CY 2025 performance.
Keywords
Introduction
The Home Health Value-Based Purchasing (HHVBP) Model was originally designed by the Centers for Medicare and Medicaid Services (CMS) to shift Medicare payments to providers from volume based to quality-based. The method of payment would reward agencies with higher reimbursement for improved patient outcomes and care efficiencies. CMS’s overarching goal was to enhance patient care quality, reduce hospitalizations, and lowering costs for Medicare beneficiaries nationwide. 3 The original HHVBP model provided financial incentives to home health agencies for quality improvements in patient care. A pilot of the model was conducted in 9 states: Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington. 3
A comprehensive review of literature and research related to the HHVBP model revealed positive results from the 5-year study within the pilot states. A cohort study conducted to compare outcomes for Medicare and Medicaid beneficiaries in the HHVBP states versus the 41 comparison states showed the HHVBP model states had greater patient functional improvements over the comparison states. 3 However, there was no statistically significant change in emergency department (ED) use or measures associated with patient experience. 3 A similar study conducted showed that each year post implementation, HHVBP was associated with a 1.59 (P < .001) percentage point increase in the Care Quality index and a 0.71 (P = .27) percentage point increase in the Patient Experience index. 4
The HHVBP model created competition within home health agencies to achieve higher reimbursements by demonstrating improved value according to clinical and patient experience-related quality measures. Based on a 2-year study evaluation of publicly available data through the Centers for Medicare and Medicaid Services, a small statistically significant increase was noted in patient care star rating for agencies participating in HHVBP; however, no effect was noted on patient experience ratings. 5 A study performed over a 3 year period (2016-2018) evaluated the impact of the model on quality, utilization, and Medicare spending in the 9 piloted states. Conclusions from the study evidenced a 1.2% reduction in Medicare spending and a modest improvement in unplanned hospitalizations. Greater improvements were realized in multiple OASIS-based quality measures in home health patients. 3
Another study conducted during 2016 to 2021 focused on key stakeholders’ perspectives of the HHVBP pilot in the 9 states. Conclusions from this study showed variations across stakeholders regarding awareness of and attitudes toward HHVBP implementation. 6 Some stakeholders viewed HHVBP policy as favorable, while others believed it would negatively impact their Home Health Agencies (HHAs) and patients. Synthesizing the experiences of stakeholders yielded critical insight into intended and unintended consequences of HHVBP policy. 6
Key results from the HHVBP pilot from 2016 to 2021 in the 9 participating states revealed improvements in quality metrics on average of 4.6% in their Total Performance Scores (TPS); a reduction in Medicare spending; an achieved cumulative savings for $1.38 billion to the program; reduction in unplanned hospitalizations; and notable improvements in patients functional outcomes (mobility/self-care). 3 However, there remain gaps in literature regarding outcomes scores specific to the Total Normalized Composite (TNC) change measures located in the OASIS instrument use to calculate HHVBP total performance scores in eligible home health episodes. The current quality project examines how a home health care organization improved their overall TPS scores through focal quality review of the OASIS-based measures defined in the HHVBP Model categories: Total Normalized Composite (TNC) in mobility and Total Normalized Composite changes in self-care.
Purpose of Model
CMS’s Innovation Center introduced the HHVBP model to support enhancements and efficiencies in the delivery of quality to Medicare fee-for service, Medicare Advantage (Medicare managed care), Medicaid, and Medicaid managed care beneficiaries receiving home health care services. 3 CMS defined the specific goal of the model as follows: “to provide incentives for better quality care and greater efficiency; to study new potential quality and efficiency measures for appropriateness in the home health setting; and to enhance the public reporting process.” 7 During the pilot period, participating agencies could receive a payment adjustment upward or downwards of 3% in 2018 with further adjustments upward or downwards of 8% in CY 2022. 5
To enhance quality care, CMS devised an incentive model HHVBP to improve clinical patient outcomes and patient experiences in the home health care setting. The programs emphasize “high-quality care and efficient use of resources to control health care costs and spending growth while still maintaining positive health care outcomes.” 5 The overarching goal of this model is holistically assessing a patient beyond a specific disease entity, functional status, or care setting to foster intersection of health care delivery and population health. 7
The pilot program was implemented from 2016 to 2018 and evaluated participating home health agencies performance in 12 composite indices defined in 3 major categories: OASIS-based measures, claims-based measures, and Home Health Care Consumer Assessment of Healthcare Providers and systems (HHCAHPS) survey-based measures. 4 Table 1 outlines the composite indices with maximum possible points and measure weights used to calculate an agency’s Total Performance Score (TPS) use to determine an agency’s annual performance against their home health agency cohort group. 5
Measure Scorecard.
Table 1 summarizes the composite indices with maximum points and measure weights.
In selecting the measures, CMS applied principles from their Meaningful Measures Initiative (MMI) to drive health equity in the Model’s quality measure set. This initiative was adopted by HHVBP as it includes measures that are broad, have high impact on care delivery and support CMS priorities to reduce disparities in home health via improved health outcomes, quality, safety, and cost efficiencies. 8 Additionally, CMS prioritized measures in the expanded model to align with data already submitted by home health organizations under the Home Health Quality Reporting Program (HHQRP) and Medicare claims submission process to minimize provider documentation burden. 7
Early data from the demonstration project did not identify any operational differentials between home health agencies participating in the demonstration versus nonparticipating home health agencies. Further, the study analysis did not evidence a significant impact of HHVBP on an agency’s quality improvement activities . 1 However, cumulative results from 2016 to 2020 showed the HHVBP Model was associated with significantly lowering unplanned acute care hospitalizations and Skilled Nursing Facility (SNF) stays, resulting in reductions in inpatient and SNF spending usage. 3 CMS posit, because of the original Model, there was a “4.6% improvement in Home Health Agencies (HHAs’) TPS and an average annual savings of $141 million to Medicare without evidence of adverse risks.” 7 Knowledge gained from this demonstration project propelled the U.S. Secretary of Health and Human Services to draft a proposal to expand the original HHVBP Model to all states to further reduce Medicare spending and initiate improvements in the delivery of quality care to Medicare and Medicaid beneficiaries. In October 2020, CMS’s Chief Actuary certified the expansion of the HHVBP Model with HHA payment adjustments. CMS announced the plans to expand the program nationwide in January 2021. The expansion to the remaining 41 states was actualized in 2023. 6 “The first full performance year for the expanded HHVBP Model is CY 2023, which began on January 1, 2023. CY 2025 [was] the first payment year, with payment adjustment amounts determined by CY 2023 performance. In a payment year, an applicable percent ranging from −5% to 5% applies toward Medicare fee-for-service payments.” 7 Financial incentives based on HHVBP Model performance were issued in 2025 to HHAs demonstrating higher quality and efficiencies in care
Performance Improvement Initiative
Objective: To examine the impact of implementing a focused quality review of the home health OASIS instrument’s functional status measures (Total Normalized Composite’s [TNCs]) change mobility questions (ambulation, toilet transferring, and bed transferring) and change in self-care questions (grooming, upper and lower body dressing, bathing, toilet hygiene, and eating) as defined in the HHVBP model. The Michigan-based organization used a focused Plan-Do-Check-Act (PDCA) methodology to improve patient care quality and outcomes to elevate their calculated TPS scores within their nationally designated cohort.
Method
The first full year of the expanded HHVBP Model occurred in CY 2023. The organization presented Michigan Community VNA (MC VNA) is a for-profit home health care. Collaboratively, clinical and executive leaders designed and launched a quality improvement project initiative to improve their HHVBP TPS ranking from less than 25% to ranking in the 25th to 50th quartile within the first 6 months of CY 2025. The project was designed to actualize incremental improvement throughout CY 2025 with a goal of ranking in the 75th percentile by the end of CY 2025. This quality improvement project will illustrate the approach taken to implement a HHVBP Model improvement project using a focus Plan-Do-Check-Act (PDCA) method to improve specific Oasis-based functional composite measurements in the HHVBP Model. Moreover, it will examine the impact of the improvement process on patient outcomes and how the organization elevated their TPS statistics within the designated timeline.
This organization is in Southeast Michigan and holds an established home health/community service history dating back to 1898. MC VNA has a Care Compare publicly reported STAR rating of 4.5. The organization to date provides home health and hospice services in 2 agency locations within the state. Based on the cohort definition in the HHVBP Model, this organization classifies as a large-volume cohort.
The first reporting year for incentive funding through CMS’s HHVBP model was CY 2024. The performance year data used to calculate rankings for all HHAs was January 1, 2023-December 31, 2023. MC VNA received a TPS of 16.590 (see Table 2). The computed percentile ranking compared to HHAs in the large cohort (6, 984) was less than 25% in the TPS statistics for the HHA’s cohort grouping. This percentage indicated MC VNA’s performance was in the lowest (worst performing) quartile in the HHAs’ cohort. The final report indicated the agency would receive a negative TPS-Adjusted Payment percentage to home health claims in CY 2025.
MC VNA CY 2024 Annual Performance Report.
Table 2 summarized the organization’s Measure Scorecard from CY 2024 Annual Performance Report depicting MC VNA’s Quality performance scores and ranking based on the HHVBP composite measures used to calculate the TPS.
The weights for each measure may vary depending on the availability of measures within each measure category.
Your HHA’s Weighted Measure Points are calculated by dividing your HHA’s Care Points by the Maximum Possible Points and multiplying by the Measure Weight.
Your HHA’s Percentile Ranking is computed by comparing your HHA’s TPS to those of the HHAs in your HHA’s cohort.
Review and analysis of the 12 measures within the HHVBP Model indicated improvements were needed in all 3 measured categories: OASIS-based measures, Claims-based measures, and HHCAHPS Survey-based measures. Further analysis of MC VNA’s composite scores evidenced the greatest need for improvement in 2 areas: OASIS-based functional measures and HHCAHPS survey measures. The agency’s Clinical Leaders in conjunction with Executive Leadership developed an organization-wide plan to improve patient outcomes within the OASIS-based measures identified in the HHVBP model. The OASIS-based measures in the HHVBP model are specific to the Total Normalized Composite (TNC) Changes in Self-Care and Total Normalized Composite (TNC) Changes in Mobility (see Figure1). These measures directly relate to patient clinical care and have the greatest potential for improving patient outcomes by integrating best practice interventions into the clinicians’ plans of care for the patients served. Under HHVBP, payment adjustments are tied to performance on defined quality metrics, with OASIS-based functional indicators as key determinants of patient-centered outcomes including functional recovery and independence. Improving evidence-based clinical practices was the catalysis Leadership used in selecting the OASIS-based measures to launch the HHVBP improvement project. Elevating clinical care practices would not only improve the agency’s HHVBP measure scores; it would also have a direct impact on patient outcomes publicly reported through Care Compare home health STAR rating composite.
Although gaps remain in the literature to fully substantiate the hypothesis that implementation of evidence-based clinical practices is derived from measure-based processes, there are limited empirical findings linking clinician education in OASIS data coding accuracy to improvements in patient-outcomes. In one study, the author asserted the OASIS instrument contained evidence-based questions to facilitate extraction of data from the patient to develop patient-centered interventions resulting in improved patient outcomes. 10 Another study evaluated how home health status changes were measured using the OASIS instrument, showed clinician education and training enhanced the clinician’s ability to interpret assessment items and produce reliable patient data to support evidence-based patient care planning in their clinical practice. 11 Similarly, one study explained how AI was used to enhance clinician accuracy in collecting OASIS data. The author emphasized how clinician education on the instrument’s measures improves patient data accuracy thereby improving implementation of evidence-based interventions to improve patient care outcomes. 12 Enhancing patients’ functional mobility and self-care management by the conclusion of a home health episode is associated with the advancement of high-quality and patient-centered care practices delineated in the Centers for Medicare and Medicaid Services HHVBP Model initiative.
Educating clinicians regarding the intent of OASIS questions specific to the measures TNC Change in Mobility and TNC Change in Self-Care will enhance clinician judgment and application of interventions tailored to the patient’s abilities resulting in care plan development to improve patient outcomes in practice. Elevating clinical care practices would not only improve the agency’s HHVBP OASIS-based measures scores; it would, also, have a direct impact on patient outcomes publicly reported through Care Compare Home Health STAR rating composite.
To mitigate the impact of this negative adjustment, the organization’s clinical and executive leadership prioritized enhancing this quality improvement project to optimize patient outcomes through targeted interventions. The quality improvement initiative was structured to remediate low performance measures, strengthen clinician data collection integrity, and adopt sustainable improvements in patient outcomes at the end of each care episode. Executive Leaders in the organization posit, incorporating tactics to support measurable improvements in patient outcomes would augment the quality indicators linked to the organization’s TPS rankings.
Clinical managers emphasized the importance of documentation accuracy by incorporating evidence-based clinician education to improve how clinical staff performed the OASIS-based assessment with their patients.
To address these challenges and improve the agency’s standing under the HHVBP Model, MC VNA initiated a comprehensive, evidence-based clinical education initiative aimed at elevating the accuracy and consistency of targeted OASIS-based data collection measures. Efforts were operationalized by redesigning current process flow to focally emphasized clinician engagement, and accountability, through systematic performance monitoring. The agency’s clinical leaders developed a HHVPB worksheet (see Table 3) designed to capture a patient’s functional mobility and self-care activities at service initiation and at the time of discharge from home health services.
MC VNA HHVBP Worksheet.
Table 3: The HHVBP Worksheet was implemented to track and summarize each patient’s episode from start of care to discharge projecting the probability of patient improvement in the composite measures of change in mobility and change in self-care. Data collected was used in the analytics process to determine the effectiveness of the organization’s implementation of evidence-based clinical practices to achieve the desired patient outcomes. linked to the HHVBP model. Improved outcomes would result in a stronger total performance score, yielding a positive payment adjustment and financial. incentive for delivering high-quality care to the organization.
The agency implemented the HHVBP worksheet to track and summarize each patient’s episode from SOC (step 1) to discharge (step 2) projecting the probability of patient improvement in the composite measures of change in mobility and change in self-care. Data collected was used in the analytics process to determine the effectiveness of the agency’s implementation of evidence-based clinical practices to achieve the desired patient outcomes linked to the HHVBP model. Clinical leaders asserted that incorporating this methodology would improve clinical care, clinical documentation, and patient outcomes. Further, the anticipated improvement would strengthen the agency’s TPS and position the agency to achieve a positive payment adjustment associated with the HHVBP Model’s financial incentives for delivering high-quality care to patients receiving home health services.
The agency’s executive leadership team rendered approval of the proposed improvement project. Upon acceptance of the plan, executive leaders established a clear achievable organizational performance goal to achieve a TPS ranking within the 50th to 75th percentile of their national cohort by the end of the third quarter of CY 2025. Interventions were designed to support measurable improvements in OASIS-based quality indicators to methodically advance the agency’s overall performance toward the desired national ranking in their cohort group. Moreover, focal implementation strategies were aimed at strengthening clinician adherence to evidence-based care and enhancing clinical oversight. The process improvement project was launched in Quarter 1 of CY 2024 with analytical review and reporting of agency’s progression toward the established goal quarterly to the executive leaders throughout CY2024 and CY 2025.
Project Implementation
MC VNA’s clinical leaders devised an education plan to engage all members of the home health team in the implementation of the quality project to improve the agency’s performance metrics associated with the HHVBP Model. The HHVBP educational training modules were designed to educate field clinicians on their role in performing OASIS assessments with patients receiving home health services. Conduction of in-person and Zoom training occurred in Quarter 4 of CY 2023 with a planned implementation roll-out occurring in Quarter 1 of CY 2024. The training encompassed a generalized overview of the HHVBP Model, detailing the 3 major categories (OASIS-based, claims-based, and HHCAHPS survey-based) measures used to calculate a home health agency’s Total Performance Score. Similarly, information was provided on CMS’s overarching model goal to improve the quality of care for Medicare Beneficiaries via payment incentives, reduce net Medicare spending, to evaluate a home health agency’s quality performance measures compared to peers in the organization’s national size cohort, and to reward organizations in CY 2025 with a payment adjustment incentive upward/downward 5% based on their prior calendar year performance. 3 For this quality project, educational emphasis was placed on key concepts in the HHVBP Model impacting patient outcomes as defined in the composite measures: TNC Change in Mobility and TNC Change in Self-Care. Specific guidance was provided to clinicians to enhance their knowledge on how to assess a patient’s ability to perform each functional measure in the OASIS using CMS’s OASIS instruction manual.
Similarly, education on the purpose and usage of the HHVBP worksheet was provided to Clinical Managers (CMs), the Quality Assurance Reviewer (QAR), the OASIS Coder, and the clinical staff involved in collecting OASIS data. Formal implementation of the HHVBP Worksheet occurred in Quarter 1 of CY 2024. The CMs and QAR were charged with reviewing all OASIS for completion and accuracy. Any noted discrepancies were reviewed with the assessing clinician to ensure scoring of mobility and self-care activities were based on how safely the patient performed the task at the start of care. Clinical managers used the worksheet data to provide individualized education to clinicians as required to ensure documentation accuracy of functional activities of daily living (ADL) measures defined in the OASIS assessment document. Emphasis was placed on collaboration across services (skilled nursing, physical therapy, occupational therapy, etc.) to ensure that OASIS coding and the corresponding documentation thoroughly represented the condition of the patient at the assessment timepoints.
Moreover, clinician case conferences were conducted prior to the patient’s discharge timepoint to review discharge appropriateness and project patient outcomes in their functional mobility and self-care by the planned discontinuation of home health services. Data collected on the HHVBP Worksheet from the admission and discharge periods were used to analyze the organization’s progression toward their HHVBP goal, as well as guide remedial education with clinicians reiterating best practice measures to assess and measure a patient’s progress in mobility and self-care measures defined in the Expanded HHVBP Model.
At the initial implementation, the quality project required enhancement in the collaborations between the QAR and CMs in their review of OASIS documents. The Quality Assurance Reviewer was delegated the responsibility of generating the HHVBP worksheet at the SOC. The reviewer was charged with conducting an intensive focal review of the OASIS to ensure all documented answers accurately reflected the patient’s status at start of Care (SOC); and Clinical Managers were commissioned with receiving SOC reports from clinicians, reviewing deficits noted in OASIS documentation, and communicating with the assessing clinician to educate and provide guidance on revisions per the OASIS guidance manuals.
Additionally, CMs increased case conference intervals targeting patients flagged with the following: high-risk for rehospitalization, multiple co-morbidities, and Social Determinants of Health (SDOH) deficits. It was determined that challenges in these elements might impede desired improvements in patient outcomes. Similarly, clinical managers established discharge planning review conferences with clinicians between 7 and 14 days prior to the patient’s anticipated discharge using the HHVBP Worksheet to review the scoring of measures at the SOC to have discussions with the clinician regarding the projected patient outcome score in each OASIS-based measure at discharge. This process aided in the determination of patient readiness for discontinuation of home health services.
Results
The first CMS report received after project implementation outlining MC VNA’s performance occurred April 2024. The April 2024 Interim Performance Report revealed a marginal increase in the organization’s TPS score at 17.314. The period CMS used to calculate the scoring was January 1, 2023, to December 31, 2023, for OASIS-based measures. MC VNA home health was still ranking in the <25th percentile against other agencies in their national cohort. Further, analysis revealed that the data used to calculate scoring still reflected dates prior to the implementation of project interventions to improve how patients were managed through their care episode. However, manual analysis of real-time HHVBP Worksheets and HHVBP data analytics reports for patients served in Quarters 1 and 2 of CY 2024, revealed MC VNA home health was on track to evidence statistical ranking in the 25th to 50th percentile in their agency’s cohort at the end of the second quarter of CY 2024.
The next iteration of CMS’s Interim Performance Report occurred in July 2024. Evidence of incremental improvement in OASIS-based measures was realized. The organization’s overall TPS was 21.026 placing them in the 25th to 49th percentile ranking within the agency’s national cohort. Although the ranking improved, MC VNA remained outside of their long-range internal goal to rank within the 50th to 75th percentile by the end of Quarter 3 of CY 2025. Based on the results, a deeper drill down occurred to look at specific measures underneath each Total Normalized Composite (TNC) out of alignment with performance points required to match or exceed CMS’s established achievement or improvement thresholds used to derive the agency’s weighted measure points driving the final TPS. Figure 1 provides a summation of the OASIS items under each TNC broad category. These items capture the patient’s ability to perform mobility and self-care activities at SOC/Resumption of Care (ROC) and the end of care (EOC). CMS rewards an agency’s efforts in improving a patient’s independence in their functional activities of daily living from the initiation of home health services to the EOC. It was important to note patients who evidenced stabilization or decline at the EOC. CMS considers these statuses at the EOC a negative patient outcome.
HHVBP OASIS-based composite measure.
Focal attention on underperforming OASIS-based measures at the time of clinician assessment coupled with a proactive approach to reviewing submitted OASIS documents for accuracy at the QA and clinical manager levels facilitated movement in a positive direction. Similarly, the agency’s clinical leaders noted that inclusion of OASIS education specific to the mobility measures, self-care measures and “GG” section pertaining to the patient’s functional abilities and goals, improved the accuracy of data collected on the OASIS instrument at SOC and discharge.
The modifications in strategies relating to expanding clinical education and QA review emphasis on elevating poor performing scores, yielded a positive incremental improvement in the agency’s October 2024 Interim Performance Report. The TPS was 23.982. The agency maintained its ranking in the 25th to 49th percentile within their national cohort. However, the agency achieved an overall improvement of 45% in the OASIS-based measures from the onset of this quality improvement initiative up to the October 2024 reporting period.
Building on the progress made at the end of Quarter 3 of CY 2024, the agency continued with their focus to improve their TPS score to rank in the 50th to 75th percentile. No further adjustments were made to the quality plan. In-depth analysis of the specific measures within the composites of change in mobility and change in self-care were evaluated to improve patient outcomes from SOC to EOC resulting in increases in either achievement or improvement points that translated into positive performance points for the agency. MC VNA’s January 2025 Interim Performance Report evidenced a TPS of 29.446. Although there was an incremental increase in the agency’s TPS score, they remained in the 25th to 49th percentile ranking within their HHA’s Cohort. Consistency in evaluation of clinical care and patient outcomes to foster improvements in the quality of patient care throughout Quarter 1 of CY 2025, yielded notable improvements in clinician assessment practices that translated into improved evidence-based patient care.
Evaluation of progression toward the agency’s goal of ranking in the 50th to 75th percentile within their HHA’s cohort was realized with the CY 2025 Annual Performance Report. Table 4 captures CMS’s scoring calculation period from January 1, 2024, to December 31, 2024, for OASIS-based measures. The report shows the agency’s TPS score of 35.136 with ranking in the 50th to 74th percentile within their cohort. Further, the weighted measures column in the report reveals not only improvements in the OASIS-based measures, but there was correlational improvement in the HHCAHPS Survey Based measures used to evaluate a patient’s experience during an episode of care. Ultimately, these measures contribute to the calculation of the agency’s TPS. Similarly, the report evidences the need for the agency to devise a focal plan for the Claim-based measures that evaluate the utilization rate of specific services (i.e., hospital readmissions) that may indicate quality of care concerns with the agency. 9
CY 2025 Annual Performance Report.
Table 4 summarizes MC VNA’s scores reported in the CY 2025 Annual Performance Report calculated by CMS for the reporting period January 1, 2024−December 31, 2024. The report reveals the percentile ranking for the organization as compared to other home health agencies in their Cohort.
The weights for each measure may vary depending on the availability of measures within each measure category.
Your HHA’s Weighted Measure Points are calculated by dividing your HHA’s Care Points by the Maximum Possible Points and multiplying by the Measure Weight.
Conclusion
MC VNA’s improvement project yielded positive results with goal attainment. Through this process, the agency realizes the need to continue their strategic focus to further advance their quality standings in their national cohort. An area noted for additional improvement was consistency in scheduling and executing clinical case conferences. This was an identified challenge for the clinical management team as day-to-day operational responsibilities at times impeded the conduction and documentation of case conferencing designed to enhance patient care management from the field staff. In the current project plan, adjustments were made to the case conference schedule to strengthen communication and ensure timely review of patient cases. Setting conferences to occur twice monthly, 1 conducted via phone or Zoom and the other integrated into the monthly clinical staff meetings facilitates streamlined information sharing and supports the need for greater consistent data review.
The performance improvement goal established by MC VNA’s executive leadership prior to the implementation of the process improvement initiative was achieved in the designated timeline. Analysis of the executed plan revealed strategic implementation of measures to improve OASIS-based functional status measures had a positive impact on clinician engagement with patients to facilitate improved patient outcomes in the areas of mobility and self-care from care initiation to discharge from home health care services. Further, there was a correlational improvement noted in how patients responded to their experience during their home health care episode attributing to the results outlined in the agency’s CY 2025 Annual Quality Report. Based on the reported HHA’s TPS score compared to the agency’s national peer cohort, MC VNA is receiving a positive payment adjustment incentive in 2026 based on their CY 2025 performance.
MC VNA will continue with the established improvement plan throughout CY 2026 based on intel regarding updates to the Expanded HHVBP Model for HHA performance for the CY 2026 applicable measures set to determine payment adjustments applicable in CY 2027. The model for 2026 removes 3 HHCAHPS survey-based measures, adds new OASIS-based measures (bathing, dressing), incorporates measures derived from the OASIS GG section data, and the Measure Specifications: Medicare Spending Per Beneficiary (MSP-PAC) measure. Recalibration of measure weights will occur to align with CMS’s vision to focus on improving patient care quality and efficiency. 9 Table 5 provides a snapshot of the HHVBP quality measures by performance year. Employing strategic tactics to enact continuous quality improvement in evidence-based clinical practice to guide positive patient outcomes, may stimulate further exploration into how home health care organizations can collaborate to support innovative development of patient-centered quality initiatives throughout the home health care industry.
HHVBP Quality Measures by Performance Year.
Table 5 provides a summation snapshot of the HHVBP Model quality measures implemented per performance year. The information captures when measures were added or deleted in each category providing a visual for strategic implementation of internal organizational measures to improve patient outcomes. The “X” in the measure set refers to the specific indicators CMS uses to calculate your Total Performance Score (TPS) in the performance year.
Footnotes
Acknowledgements
The author thanks Vicki Welty, CEO of Michigan Community VNA (MC VNA) for granting permission to develop and implement the quality improvement initiative at the home health care agency; identify and share the organization’s results in this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.