HHVBP in 2025: What Home Care Agencies Need to Know

HHVBP in 2025: What Home Care Agencies Need to Know

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Erin Cahill: Welcome to CareSmartz360 On Air, a Home Care Podcast. I’m Erin Cahill, Account Executive at Caresmartz. Today, we’ve got a guest who’s part compliance guru, part quality care virtuoso, and 100% powerhouse: Annette Lee!

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Erin Cahill: Annette is the founder of Provider Insights Inc., where she’s been transforming home health and hospice agencies into champions of excellence. She’s a walking encyclopedia on everything, from regulations to real world strategies. But don’t let that intimidate you. She’s here to make it all refreshingly relatable. In this episode we’re looking ahead to 2025 and tackling the home health value-based purchasing (HHVBP) model.

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Erin Cahill: If HHVBP sounds like alphabet soup, don’t worry. Annette will decode it faster than you can say ‘revenue cycle management’. Get ready for tips, insights and maybe a laugh or two as she breaks down what agencies need to know to thrive in the quality focused future.

So, grab your headphones and let’s chart the course with Annette Lee, welcome to the Podcast Annette.

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Annette Lee: Thank you so much, Erin. I have never had an introduction quite like that before. I don’t know if I can live up to it, but I will do my best, and I love what you’re doing for your agencies and for the community as a whole, being able to share this information. So thanks so much, Erin, and to care smarts.

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Erin Cahill: Thank you so much. We really appreciate you being here. What? I will jump right into it. What are some proven strategies agencies can adopt to consistently deliver high quality, care, and score well under the Hhvp. Framework.

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Annette Lee: All right. Well, we are in performance year 3. So this is, I can’t believe it. But already, in the 3rd national year, I live in Iowa, where we were one of the 9 States. That also did the pilot for 5 years. So it feels like I’ve been doing this a long time. The best strategies that we see consistently over and over are education, education, and then

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Annette Lee: always with verification, making sure that what we’re talking about is sticking. It’s important. It’s always top of mind and having those key performance indicators for our entire team. So we can see that. Yes, this really did work. So, for instance, knowing that value based purchasing looks at both your oasis data and claims data and your patient

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Annette Lee: satisfaction scores through caps, we can kind of break those down into where your biggest pain points are never taking their eyes off the rest of them, but really trying to focus on those. So, for instance, the oasis measures.

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Annette Lee: making sure that the entire team that would touch an oasis has a good understanding not only of the oasis items themselves, but the measures, because sometimes you think that you’re scoring in a way that’s going to be positive, and it might not always give you what you think is going to be a thumbs up from the government. So, making sure they know what that improvement

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Annette Lee: looks like, and being able to give them that individual feedback, because otherwise we don’t really know where we’re falling short. So education, first,

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Annette Lee: second of all, know our own pain points. Where do we need to focus? And 3, rd that, I think, is really quite fun, is making sure that the entire agency is in on this. Every team member, not just the folks who touch the oasis, but our goals all over with the value based purchasing, because even the person who picks up the phone when you call the agency has an impact on things.

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Annette Lee: If their response to a patient or family member calling was well, just head to the er that hits our quality measures, or if we drop the ball and don’t follow up and don’t call back like we were supposed to. That’s going to hit our quality measures, not only for satisfaction and experience, but also, perhaps the hospitalization measure, perhaps the new discharge measure. So

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Annette Lee: those are my 3 favorite things, the education, the individual verification, and then finally getting everybody involved and getting some excitement around that that we really can make an impact, not only to our scores but to our patients.

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Erin Cahill: That’s great, and with the shift towards value-based care. How should agencies train their caregivers and staff to align with Hhbp. Objectives and enhance care outcomes.

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Annette Lee: Yeah, so again, kind of starting out with, where did these measures come from? How do we really know that we’re doing the things that we’re supposed to. So, for instance, the new, potentially preventable hospitalization measure for a million years.

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Annette Lee: we’ve always known that it is your Medicare population that hit the hospital stay within 60 days. That was our normal routine, acute care hospitalization measure. But now, since it’s

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Annette Lee: looking at both the acute stay and observation that’s huge and also ensuring that everyone again is part of the solution. Everyone is part of this process.

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Annette Lee: We want the entire team to come together and really talk about when we see rehospitalizations. Was there an opportunity? Did we drop the ball again, starting from the person who answers the phone to the case, managers to the Lpns and Lvns to the home health aide, making sure that we’re talking as a team and really focused on those specific

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Annette Lee: measures that impact both our outcomes and the whole patient experience.

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Erin Cahill: Absolutely. And one of the cornerstones of Hhbvp, of course, is performance. Metrics. Can you walk us through the most critical ones? Agencies need to focus on and how to measure them.

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Annette Lee: Perfect.

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Erin Cahill: Athlete.

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Annette Lee: Absolutely so. I think that right now our kind of the the biggest ones are weighted heavier, but also they’re the newest. And so keeping these topics in mind when you’re planning, education is going to be a key for the beginning of this year to start this out right.

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Annette Lee: because, as of January first, st we have some major changes in the measures that are playing in value-based purchasing for us. So, for instance, the new sorry Pph. That I just mentioned the preventable potentially preventable hospitalization. I want some focus there. It is 26 plus percent

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Annette Lee: of our entire weighted score. And that’s if you do, caps. It’s even heavier if you are small enough that you’re not doing caps. So it’s huge. And the new discharged community claims based measure is also large. And it’s tracking. Did your patients end up back at the hospital within 31 days after you discharged? So the weight of them, and again understanding, the newness that these are the ones that we need to

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Annette Lee: give a little additional focus to.

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Annette Lee: That sort of strategy is huge, because again, it hits multiple points on these claims-based measures about the overall care that we provide because it’s looking at. Are we giving them enough service

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Annette Lee: enough tools, enough education, enough support that they’re calling us.

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Annette Lee: and that they are relying on us whenever possible to avoid that hospitalization. And we are their partners in that.

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Annette Lee: even after discharge. So strategies about looking at maybe making post discharge phone calls to patients

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Annette Lee: having them scripted, ensuring that it gets a clinical component. If there’s a need for one. If there’s been things like, you know. Have you been to the doctor recently? Were there any medication changes? You know? How are you doing? You’re feeling. Okay, any symptom changes. And so those are the things that I want handed off to a nurse to be able to call, and if needed, we’ll call back to Doc and get them back on service to avoid a rehospitalization even after discharge.

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Annette Lee: The other one that is very weighty is another new one called the discharge

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Annette Lee: function score that one is coming from the oasis, and this is the one that you’re hearing. All the hubbub about. The focus is finally on the gg’s.

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Annette Lee: And it’s not just the Gg’s, although that is the primary focus. Looking at. Where did the patient end up in those gg functional measures at discharge. But it’s also having to compare. What did these gg’s look like for your patient versus the universe? What did they expect?

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Annette Lee: But they have to ensure that this is based on patients that look similar. So there’s a multitude of other oasis items that go into this that give you that risk, adjustment that help them

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Annette Lee: project. What did they expect? So they’re looking at things like caregiver status. They’re looking at comorbidities. They’re looking at the Prior Gg’s. They’re looking at. Oh, gosh! There’s a whole litany

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Annette Lee: ensuring that they’re projecting the expectation correctly for you.

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Annette Lee: So gone are the days where you could just take a glance and say, Oh, well, I moved from a 2 to a 1 by discharge, so I know it’s appropriate. I know I’ve got a good measure. That is not what the discharge function score does.

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Annette Lee: I would have to know the whole universe. And so, therefore, this is an area where I need accuracy in my gg’s and accuracy in the whole oasis. That is a huge shift for us. So I would say, those 3 are our top metrics that we’re really honing in on right now.

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Erin Cahill: That’s really helpful. Thank you. What role do you see? AI and technology playing in helping home care agencies adapt to Hhvp, particularly in areas like areas like outcome tracking and quality improvement.

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Annette Lee: I was surprised how much AI was the hottest topic in town during the National Conferences this last year. That’s for sure. Everyone is thinking about it, and everyone has, you know, excitement and a little bit of concern and hesitation at the same time. But when it comes to those things you mentioned Erin, like looking at your performance improvement. Looking at specific measures.

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Annette Lee: I think it’s excellent. I think it will help us predict risk. I think it’s 1 of those things that can really show us. This is the type of patient that ends up back at the hospital. So therefore, this is the patient I need to do something more with. I need a care plan appropriately. But also I really need to ensure that this is also.

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Annette Lee: you know, top of mind if we have the opportunity to utilize it, to pull the data from our Emr. Look at the trends, look at the falls, look at the infections, but bigger picture focusing in on our value based purchasing measures as well. I think it’s you know. I think we’re on the cusp of something huge with it. That’s for sure.

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Erin Cahill: Yeah. How do compliance requirements specific to Iowa’s home health agencies align with or differ from, the national Hhvp framework? And what pitfalls should agencies in the State avoid.

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Annette Lee: So Iowa is lucky we don’t have any additional regulatory requirements in Iowa versus the Federal. So that is a great thing. So when we’re surveyed even by our State. It’s just looking at those Federal cops. So that’s nice.

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Annette Lee: But there are still additional barriers in Iowa and in other States similar to Iowa, where we have a high

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Annette Lee: a high percentage of duly eligible patients, meaning many of our patients in home health have medicare, but they also qualify for Medicaid

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Annette Lee: meaning. They have that social determinant of health, of poverty, and met the level in which they qualify for Medicaid. There’s other barriers happening when you’re looking at transportation and food, insecurity and you know, maybe health literacy. There’s a number of things that home health agencies

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Annette Lee: in our state are trying to bridge the gap.

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Annette Lee: One thing we can do is monitor. Our health equity reports in Ips Cms. Provided us that last fall, and one of those measures looks at? Are there differences in outcomes from your Medicare population versus your dual eligible population? So you’ll be able to see if you’re able to fill the gap, and if you’re hitting the mark with those patients as well.

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Erin Cahill: And looking ahead to 2025. What key trends or shifts do you predict for the home health value based purchasing model? And how should agencies prepare for them.

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Annette Lee: Well.

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Annette Lee: I think the big shift, obviously the new measures. But I think it’s also difficult, knowing that this is all on a bell curve. Right? This is all based on how we look compared to the rest of the nation. So, for instance, working with clients, we’d be like, okay, if you can get to 21 you’ll be meeting that that Median mark. You’ll be above the fold.

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Annette Lee: And then the next quarter’s report would come out, and they would be at 21 they would hit their goal, and the rest of the nation move to the right as well.

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Annette Lee: So, unfortunately, it is a moving target, and I expect to see a lot more of that in 25, as we’re all pressing to try to ensure that we’re not going to be penalized through value based purchasing, but instead striving for the performance reward. So that, I think, is a big piece of it is knowing that everybody is improving. So what we did 2 years ago, when this all started.

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Annette Lee: did not get you the same measure as what you got the year before, when you start getting all of your reports for last year.

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Annette Lee: So 23 cannot be what we did in 24. What we did in 24 can’t be what we do in 25. So again, we have to be more innovative. We have to ensure that we are again bringing the entire team with us and ensuring that there is again that whole culture of excitement about what can we do? I did have some agencies who decided to

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Annette Lee: really ensure that they were looking at individual nurses, scores, and individual case manager scores, and they actually rewarded them when we had positive growth in the value based purchasing measures when it was partly due to their outcomes and their scores, so they were highly motivated. Then, when they knew there was really something on the line for themselves as well as the patients and the agency.

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Annette Lee: So that worked well. That was something that I was pleased that people all got on board and got excited about it.

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Erin Cahill: Oh, that’s great. Yeah. Well, thank you so much, Annette, for sharing your expertise. Really appreciate having you here.

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Annette Lee: Okay.

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Erin Cahill: And to our lovely audience. Thank you for tuning in. I’m Erin Cahill for CareSmartz signing off.

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Annette Lee: Thank you, Erin.