Case Study: How One Home Health Agency Improved Outcomes—and Revenue—Through HHVBP Strategy

As a consulting firm dedicated to operational success in home health, we know that great outcomes don’t happen by accident—they’re designed.

In today’s Home Health Value-Based Purchasing (HHVBP) landscape, agencies must not only deliver excellent care but also understand how that care is scored, reimbursed, and reported. The good news? Even struggling agencies can turn things around with the right support.

Here’s how one mid-sized agency used consulting, training, and targeted performance strategies to move from underperforming to top-tier—and how it impacted their Medicare revenue and market positioning.

🏥 Agency Profile

• 📍 Location: Florida

• 🧑‍⚕️ Size: 55 field clinicians, 4 care coordinators

• 💵 Annual Medicare FFS revenue: $3.1M

• ❗ Initial HHVBP Payment Adjustment: –3.2%

• 🔍 Main challenges: Documentation inconsistencies, high hospitalization rates, low HHCAHPS communication scores.

⚠️ The Problem

This agency came to us after receiving a negative 3.2% payment adjustment on their HHVBP Annual Performance Report (APR). That translated to nearly $100,000 in lost revenue—without a single change in census or billing.

Their APR revealed:

• ❌ Hospitalizations 20% higher than state average

• ❌ Patient dissatisfaction with timeliness of care and communication

• ❌ Inaccurate OASIS scoring on ambulation and medication management

Leadership admitted:

“We had no idea how much these issues were costing us. Our clinicians were working hard—but we were losing ground anyway.”

🛠️ Our Strategy: Performance Rebuild Through Data + Execution

Working closely with their leadership and clinical team, we implemented a 90-day strategic intervention plan focused on four key pillars:

✅ 1. APR Analysis + PIP Development

We started by breaking down the agency’s APR to identify high-impact, low-performing measures. From there, we created two Performance Improvement Projects (PIPs):

• Reducing acute care hospitalization rates

• Improving OASIS scoring on oral medication management

✅ 2. OASIS Accuracy Training

Field staff participated in a 2-week training series focused on:

• OASIS-E item intent

• Real-patient scenarios to standardize scoring

• Avoiding over- and under-documentation

This improved both accuracy and staff confidence, especially with new clinicians.

✅ 3. Patient Communication Refresh

Using HHCAHPS data, we saw that patients felt unclear on:

• Visit schedules

• Medication education

• Who to call with questions

We built simple workflows to improve:

• Clinician-patient introductions

• Printed leave-behind guides

• Staff scripting for communication consistency

✅ 4. Rapid Response Hospitalization Protocols

We designed a “red flag” response system based on early warning signs like:

• Weight gain in CHF patients

• Missed therapy visits

• Worsening pain or dyspnea

These flags triggered same-day RN assessments or telehealth follow-ups—catching issues before they led to hospitalization.

📈 The Results (in 6 Months)

By the next CMS reporting cycle, this agency had:

• ⬆️ Improved their Total Performance Score by 34%

• 💰 Received a +2.8% payment adjustment for the following year

• 💵 Regained $86,800 in Medicare revenue

• 💬 Increased HHCAHPS communication scores by 27%

• 🚑 Reduced hospitalizations by 19%

• 📊 Moved into the top 30% of their cohort

Most importantly, they kept the improvements going, turning the new workflows into part of their QAPI program and culture.

💡 Conclusion: Strategy Works—If You Use It

This case study shows that no matter where your agency starts, there’s room to improve—and real money on the line.

With a clear action plan, staff buy-in, and data-driven consulting, your agency can move from reactive to proactive and transform HHVBP into a sustainable revenue strategy.

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💬 Struggling with your HHVBP scores or APR? Our Home Health Consulting team can help you assess, train, and execute a performance plan tailored to your needs—just like we did for this agency.