Value-Based Care: What It Means for Your Agency

Recent discussions about the expansion of the Home Health Value-Based Purchasing Model (HHVBP) signal major reforms on the horizon for home health operations and payment systems. Allow us to dive into what this means for the different industry stakeholders:

 

What Is Value-Based Care?

According to the Centers for Medicare and Medicaid Services (CMS), value-based care is the concept of “paying providers based on the quality, rather than the quantity of care they give patients.” Its goal is to improve clinical practice and patient outcomes.

Value-based care is a payment model that rewards providers when they help patients improve their health, reduce the impact of chronic disease, and live healthier lives. It has emerged as an alternative replacement for the fee-for-service model, which pays providers for the amount of services that they deliver. This has incentivized many providers to request more procedures, as well as manage more patients to improve profit margins. Cost for procedures increased and the home health industry was spending more to treat patients even though patient outcomes were not necessarily improving.

 

What It Means for Patients

Since value-based care incentivizes improvements in patient outcomes and the quality of care that patients receive, it triggers a shift in the mentality of home health providers in how they deliver care. Their new goal is to standardize healthcare processes through best practices. Using data and evidence, providers can determine which processes work and which don’t. This forms a foundational “care pathway” to help get best results for patients.

Patients benefit from this in terms of wellness, prevention, and less hospital readmissions. This quality-over-quantity payment model is all about being proactive rather than reactive. Preventive care reduces the need for more procedures and interventions, thus cutting healthcare costs for everyone. Patients staying well and healthy results in fewer hospital readmissions and trips to the emergency room.

 

What It Means for Home Health Providers

While value-based care is being adapted to improve patient care, we cannot deny the reality that it poses a challenge for care providers to optimize their business profitability under this new concept.

Aside from improving care delivery and outcomes, providers will simultaneously be challenged to improve their ways of documenting and reporting patient care and progress as these will be the main basis of payment. Value-based care reimbursements are calculated by using numerous measures of quality and determining the overall health of patients. Providers must report to payors on specific metrics and show improvement by tracking and reporting on hospital readmissions, adverse events, care plan follow-through, patient engagement, and more.

Value-based care compels providers to use evidence-based processes, engage patients, upgrade health IT, and use data analytics in order to get paid for their services. When patients receive more effective care, providers are rewarded.

 

Focus on Coding and Documentation

The transition for home health providers to value-based care is not easy because traditional business models have yet to catch up. There is a lack of complete and robust data, and the reality is that accurate diagnostic coding and quality reporting can be labor-intensive and time-consuming. These factors can be hurdles in providing the best care possible for patients.

Home health providers can align with the goals of value-based care and still optimize profitability by utilizing the right tools and partnering with the right solutions provider. These can help capture and process data to make them actionable insights that enable home health agencies to identify and prevent problem areas, and recognize opportunities for process improvement.

Coding and documentation are the languages of our healthcare ecosystem. If the documentation is incomplete or inaccurate, revenues under value-based contracts can be severely impacted, and worse, patients may not get the care they need. Proper documentation is not simply good practice; it is critical for value-based care.

 

The Bigger Picture

Value-based care is no longer a long-term goal. It is a clear and present push from both CMS and private insurers to align healthcare payments with better healthcare outcomes and most importantly, improve overall health and well-being.

The transition to value-based care may not be smooth, but if done correctly, it can benefit the entire healthcare ecosystem, including patients, providers, and payors alike. Simply put, everyone wins.