Clinical Scorecard: Value-Based Purchasing in Home Health Care and Its Impact on Postacute Visits for Older Adults with Dementia

At a Glance

Key Highlights

• Over 3 million Medicare beneficiaries use home health care, with one-third for postacute care.
• HHAs are the second most common discharge destination after hospitalization.
• HHVBP linked to improved patient outcomes and reduced Medicare costs.
• Persistent racial and ethnic differences in home health service frequency for ADRD patients.
• PDGM changed reimbursement models, impacting care delivery patterns.

Guideline-Based Recommendations

Diagnosis

• Identify ADRD using the Medicare Beneficiary Summary File (MBSF) Chronic Conditions Segment.

Management

• Utilize HHVBP and PDGM frameworks to enhance care quality and efficiency.

Monitoring & Follow-up

• Evaluate changes in service volume and type in the first 30 days of home health episodes.

Risks

• Address disparities in access to high-quality home health agencies (HHAs) based on race, ethnicity, and socioeconomic status.

Patient & Prescribing Data

Medicare fee-for-service beneficiaries aged 65 years or older with ADRD.

Focus on early postacute home health episodes initiated within 14 days of hospital discharge.

Clinical Best Practices

• Ensure equitable access to home health services across diverse patient populations.
• Monitor the impact of HHVBP on care delivery patterns for ADRD patients.
• Implement training and resources for HHAs to adapt to new reimbursement models.

Related Resources & Content

• Centers for Medicare & Medicaid Services (CMS)
• Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)