1. Home Health Value Based Purchasing: Coaching for Success Presented By: Jennifer Gibson, RN, HCS-D, COS-C Axxess Consult and Technology

2. Review key elements of Home Health Value-Based Purchasing (HHVBP) Discuss rationale for performance improvement Review key steps of performance improvement process Review key strategies for improving performance measures Today’s Objectives

3. Healthcare Improvement Goals

4. Affordable Care Act legislation required CMS to implement a HHVBP system Tying quality to payment will: – improve the beneficiaries’ experience and outcomes – incentivize quality improvement and efficiency – lead to a more sustainable payment system HHVBP Background

5. Home Health Pay for Performance Demonstration conducted from 2008 to 2010 found modest quality improvement in certain measures President’s 2015 and 2016 Budgets proposed VBP be extended to skilled nursing facilities, home health agencies, ambulatory surgical centers, and hospital outpatient departments HHVBP Background

6. Shifting focus of payment Focus is QUALITY of care given Outcomes based incentives Why HHVBP?

7. CMS plans to change payment models for 30% of traditional Medicare fee-for-service payments by end of 2016 and 50% by end of 2018 Also plans to tie 85% of all traditional Medicare payments to quality by 2016 and 90% by 2018 HHVBP FAQ’s

9. Home Health Value Based Purchasing Model began January 1, 2016 in 9 states Is scheduled to continue through December 31, 2022 Payment will be adjusted according to quality for participating states HHVBP FAQ’s

10. All Medicare certified home health agencies in these 9 states are MANDATED to participate in HHVBP.

11. Competition Within States

12. HHVBP Payment Adjustments

13. 6 National Quality Domains

14. What are agencies graded on?

15. Clinical Quality of Care Care Coordination and Efficiency Person and Caregiver Centered Experience New Measures HHVBP Quality Domains

16. HHVBP Starter Measures Quality measures for the first year of HHVBP Model 6 Process Measures + 10 Outcome Measures + 5 HHCAHPS Measures + 3 “NEW” Measures 24 TOTAL MEASURES

17. What guiding principles did CMS use to choose these starter measures? Capture the complexity of Home Health Agency Services provided Flexibility to include IMPACT Act measures Balance of process, outcome, and patient experience measures Ability to measure cost and value Measures for appropriateness or overuse Promote infrastructure investments HHVBP Starter Measures

18. Predominantly drawn from OASIS and HHCAHPS Emphasize measuring patient outcomes and functional status Appropriateness of care Incentives to measure quality data National Quality Strategies (NQS) Improve health outcomes, quality, safety, efficiency of care of patients Best practices HHVBP Measure Objectives

19. Focus = Outcomes Payment tied to quality/outcomes Must be able to PROVE quality care is being delivered Patient’s perspective/patient experience Keeping elderly and vulnerable populations healthy Coordination of care: patient, family/caregiver, other disciplines/team members, physician What’s The Big Deal?

20. Clinical Quality of Care (Outcomes) M1860 Improvement in Ambulation/Locomotion M1850 Improvement in Bed Transferring M1830 Improvement in Bathing M1400 Improvement in Dyspnea FACT: CMS pays for loads of therapy services! Where is the proof that this therapy is helping?

21. Clinical Quality of Care (Process) M2015 Drug Education on All Medications Provided to Patient/Caregiver during all Episodes of Care FACT: Mediation errors are a leading cause of hospitalizations and re-hospitalizations.

22. Population Health (Process) M1041 Influenza Vaccine Data Collection Period: Does this episode of care include any dates on or between 10/01-3/31? M1046 Influenza Immunization Received for Current Flu Season M1051 Pneumococcal Polysaccharide Vaccine Ever Received M1056 Reason Pneumococcal Vaccine Not Received Why is this a focus? Complications in the elderly and disabled are costly and can be prevented with immunizations.

23. NEW Measures (Process) Portal Influenza Vaccination Coverage for Home Health Care Personnel Portal Herpes Zoster (Shingles) Vaccination: Has the patient ever received the shingles vaccination? Portal Advance Care Plan Note: Not the same as Advanced Directives Why are employees a concern? How about advanced care planning?

24. Patient Safety (Outcomes) M1242 Improvement in Pain Interfering with Activity M2020 Improvement in Management of Oral Medications M1900 Prior Functioning ADL/IADL Again, why do you think these items are being monitored?

25. Community and Care Coordination Discharged to Community Outcome Measure M2102 Care Management: Types and Sources of Assistance Process Measure

26. Efficiency and Cost Reduction Acute Care Hospitalization: Unplanned Hospitalization during first 60 days of Home Health Claims/ Outcomes Emergency Department Use without Hospitalization

27. Scoring PT/CG Experience NQS DOMAINMEASURE TITLEMEASURE TYPEDATA SOURCENUMERATORDENOMINATOR PATIENT AND CAREGIVER CENTERED EXPERIENCE CARE OF PATIENTSOUTCOMEHHCAHPSN/A PATIENT AND CAREGIVER CENTERED EXPERIENCE COMMUNICATIONS BETWEEN PROVIDERS AND PATIENTS OUTCOME HHCAHPS N/A PATIENT AND CAREGIVER CENTERED EXPERIENCE SPECIFIC CARE ISSUESOUTCOME HHCAHPS N/A PATIENT AND CAREGIVER CENTERED EXPERIENCE OVERALL RATING OF HOME HEALTH AGENCY OUTCOME HHCAHPS N/A PATIENT AND CAREGIVER CENTERED EXPERIENCE WILLINGNESS TO RECOMMEND THE AGNECY OUTCOME HHCAHPS N/A

28. Scoring CAHPS Satisfaction Survey

32. Scoring for CAHPS measures will be based on the agency’s improvement or achievement versus the achievement threshold determined by CMS STAR Ratings comparison: Agency ratings vs. average State Level (broken into small or large size agency groups) Scoring CAHPS Satisfaction Survey

33. Proposed COPs and QAPI CMS proposed an update to the Home Health Conditions of Participation in October 2014 –Assures the protection and promotion of patient rights –Enhances the process for care planning, delivery, and coordination of services –Streamlines regulatory requirements –Builds a foundation for ongoing, data-driven, agency-wide quality improvement The first update since 1989

34. Proposed COPs and QAPI New requirement for each HHA to develop, implement, and maintain an agency-wide, data-driven quality assessment and performance improvement (QAPI) program Part of a move toward a prospective quality of care approach based on quality improvement Based on data already collected in the OASIS process, CMS-provided patient outcome and process reports, and numerous other industry efforts currently underway

35. Proposed COPs and QAPI QAPI is the merger of two approaches to quality management: –Quality Assurance (QA) Retroactively reviewing care provided and assessing if it meets established quality standards –Performance Improvement (PI) Proactively and continuously identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems

36. QAPI Framework from CMS The framework is comprised of 5 standards 1. Executive Responsibility 2. Program Scope 3. Program Data 4. Program Activities 5. Performance Improvement Projects (PIP)

37. Executive Responsibility Require the HHA’s governing body to assume responsibility Ensure program represents the complexity of the HHA and services provided – Includes contracts and other arrangements Focus on indicators related to improved outcomes Ensure actions address the HHA’s performance across the spectrum of care Require the HHA to maintain documentary evidence of its QAPI program

38. QAPI Program Scope Utilize process measures to assess its processes, services, and operations Track outcomes measures-to-measure, and analyze/track quality indicators (including adverse patient events) – Show any improvements to measurable improvements in health outcomes, safety and quality of care for patients

39. How Agencies Succeed QAPI Processes QAPI Projects-Quarterly CASPER Reports HHCAHPS Participation PEPPER Reports Home Health Compare STAR Ratings Internal Reports Employee Orientation and Ongoing Training Employee Skills Assessments

40. What QUESTIONS do you have??

41. Thank you for your attention!