Value Based Purchasing: What is it and are You Ready?

 Bundles / Financing 
 CMS Demonstration 

Partners HealthCare at Home, eastern Massachusetts.

Agency Description:
Partners HealthCare at Home is part of Partners HealthCare System, co-founded by Massachusetts General Hospital and Brigham and Women's Hospital, serving eastern Massachusetts.

Together, Partners HealthCare at Home and the Spaulding Rehabilitation Network constitute the non-acute care services division of Partners HealthCare. The system is committed to delivering compassionate care across the health care continuum to improve quality of life for persons recovering from, or learning to live fully with, illness, injury, and disability.

Population Impacted:
The populations impacted by this project are Medicare beneficiaries served by Partners HealthCare at Home.

Strategic Partners:
A strategic partner in this program is Strategic Healthcare Programs (SHP).

Project Description:
Home Health Value Based Purchasing (HHVBP) is a new CMS Pay for Performance program linking payments to improved outcomes. This project was designed to ensure adequate understanding of the Home Health Final Rule for CY2016, and provide insights as to how best to prepare. The agency studied the key measures, assessed current performance, opportunities for selective and targeted improvement based on ability to operationalize, and expected quantitative/financial impact.

Project Goals:
  1. Identify the components to HHVBP defined in the Final Rule as well as lessons learned from the Hospital VBP program.
  2. Illustrate the methodology for the calculating the Total Performance Score (TPS) and how to understand the current ratings and planning for improvement.
  3. Identify the actions one agency addressed in operational and workflow considerations to be successful under HHVBP.

To date, the agency has assimilated information to clinical teams, ensured that clinical managers understood the relative performance of their teams, as well as individual clinicians, and begun the process of rolling out specific interventions designed to result in team-level improvements. Financial modeling has aided in decision/analytical support.

Outcome Measures:
  • Performance scores by team and clinician relative to benchmarks.
  • Interventions and process improvement initiatives with specific measurable goals to influence financial reimbursement in HHVBP.

Barriers to Implementation:
  • Multiple competing priorities.
  • Methodology complexity.
  • Inclusion of new previously unrecorded measures.
  • Any further modifications to HHVBP by the Centers for Medicare and Medicaid Services.