How Home Health’s value-based buying model could further reduce nursing home utilization

As patients continue to seek ways to be cared for at home rather than in more institutional settings like nursing homes, an imminent nationwide rollout of the Home Health Value-Based Purchasing (HHVBP) model could reduce managed care relationships and move care away from NFCs.

Results from a five-year demonstration of HHVBP in nine states showed a 0.34 percentage point decline in SNF use per year among home care recipients.​​

This corresponds to a 6.9% decrease in mean metric values ​​compared to pre-HHVBP implementation, as previously reported in sister publication Home Health Care News.

An annual evaluation of the model acknowledged the decline of SNF, prepared and published in April by the Arbor Research Collaborative for Health and L&M Policy Research.

Brian Fuller, CEO of Integrated Care Solutions, a care management and coordination company, told Skilled Nursing News that the model’s main impact on the industry stems from fewer patients being eligible for a stay in hospital. nursing home if not as many are readmitted to hospital – one of the quality indicators of the HHVBP.

“It changed their care delivery patterns so that the frequency of patients going through the system went down and as a result there weren’t as many people being readmitted to hospitals, and there weren’t as many of patients eligible for a subsequent SNF stay,” Fuller explained.

HHVBP prevented this cycle from perpetuating itself at the same rate as in markets where the model was untested, he added.

“What these programs do, and I think that’s their intent, is they create this hyper-focus on quality metrics… It causes [clinical leaders] to rethink how they deliver care,” Fuller said.

The report also found an increase in visits from skilled nurses and therapies in the first few weeks of a home health episode, another key point for SNF operators, Fuller noted.

The process is called “frontloading” among home health care agencies, when a large portion of visits occur within the first few weeks of a 60-day home health care episode.

“We know from experience that starting care within 24 to 48 hours and loading that home health episode tends to create a smoother care transition and stabilize the patient,” he said. . “Home health has a lot of influence on the moment [patients] begin care, how they distribute visits during the home health episode.

Implementing HHVBP also resulted in $201.2 million in Medicare savings specifically related to SNF use between 2016 and 2020, according to the report. This is a drop of 4% in spending on SNF services on average.

If a nine-state demonstration can save $201.2 million in Medicare dollars that would normally be spent on SNF stays, a 50-state model could displace hundreds of millions — or billions — from institutional care facilities for years. coming. This could be an important macro-level consequence of value-based buying, if the trend continues into 2023 and beyond.

“The decline in overall Medicare spending due to HHVBP continues to be driven largely by reduced spending on inpatient and SNF services among home care recipients,” the report’s authors confirmed.

There was a 2.8% drop in average Medicare spending per day for inpatient services, which translates to savings of $546.8 million. The model is estimated to have saved Medicare a total of $949.2 million, according to the report.

The report also revealed that HHVBP plans have seen an increase in short-stay patients with heart failure, and more significantly knee and hip replacements, in turn leading to a decrease in the use of SNF. for these types of patients.

The authors specifically pointed to the three-day stay requirement as a factor in this shift of short-stay patients from NFS to home health, despite the lifting of the requirement due to the public health emergency (PHE ) from 2020.

Next year is expected to be a “performance year” for the expansion of the HHVBP model to 50 states, according to the Centers for Medicare & Medicaid Services (CMS), while 2025 will be the “payout year,” when participants at home health will receive a payment. adjustments based on performance quality measures.

For nursing home operators, such statistics could reshape the post-acute and long-term care landscapes, as policymakers and the Biden administration continue to advocate home care while seeking sweeping reform. of the SNF sector.

“Our findings that HHVBP reduced unplanned hospitalizations, ER use resulting in hospitalization, and SNF use align with policymakers’ intentions to incentivize HHA activities that reduce unnecessary use. acute care,” the authors said.

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