What Home Health Agencies Need to Know About Value-Based Purchasing in 2025.
- Stefano Fronte
- Mar 24
- 3 min read
As the home health industry evolves, agencies are being held to higher standards—not only in patient outcomes but also in how care is delivered, measured, and reimbursed. That’s where Home Health Value-Based Purchasing (HHVBP) comes in.
In 2025, the expanded HHVBP Model is reshaping how Medicare-certified home health agencies (HHAs) are evaluated and reimbursed. The model incentivizes agencies to deliver better care by tying Medicare payments to quality performance—and it’s no longer optional.
Whether you're managing a growing agency or trying to improve your performance scores, here’s what you need to know about HHVBP and how consulting support can help you navigate it.
What Is Home Health Value-Based Purchasing?
Originally launched in 2016 in nine pilot states, the HHVBP Model has since expanded nationwide. As of 2022, participation is mandatory for all Medicare-certified HHAs. Under this model, agencies receive payment adjustments—positive or negative—based on how well they perform on a set of quality measures compared to other providers in their cohort.
In short: Better care = better pay.
But delivering better care requires more than good intentions. Agencies must also have:
Accurate and compliant documentation
Strong internal processes
Data-driven quality improvement efforts
A deep understanding of CMS’s scoring and reporting structure
How Performance Is Measured
The HHVBP Model scores agencies across three categories of quality measures:
🔹 OASIS-based measures (like improvement in dyspnea or oral medication management)
🔹 Claims-based measures (like acute care hospitalization rates or ED visits)
🔹 HHCAHPS survey-based measures (patient experience and satisfaction)
Your Total Performance Score (TPS) is based on a combination of achievement and improvement. This score determines your Adjusted Payment Percentage (APP)—which can either increase or decrease your Medicare payments in the following year.
What’s New in 2025
Beginning in 2025, several updates are shaping the future of the program:
✅ New measures like the Discharge Function Score and Total Normalized Composite Change metrics are being integrated
✅ CMS will publicly report agency performance data in the Provider Data Catalog (PDC)
✅ Agencies can submit recalculation and reconsideration requests if they believe there’s an error in their Annual Performance Report (APR)
✅ Data transparency is becoming a greater focus, as consumers and referral sources will increasingly rely on publicly available performance data
Why Home Health Agencies Should Take This Seriously
Even one year of poor performance can impact an agency’s reputation, revenue, and referral flow. With HHVBP public reporting, underperformance isn’t just a billing issue—it’s a brand issue.
Agencies that succeed in HHVBP typically have:
✔ Proactive quality improvement strategies
✔ Accurate data tracking and reporting systems
✔ Staff who are trained in documentation, compliance, and care coordination
✔ Leadership that uses performance data to drive change
How Consulting Can Help You Thrive in a Value-Based World
This new era of performance-based reimbursement is complex—but you don’t have to navigate it alone. Expert home health consultants can help you:
🛠 Audit and improve documentation to ensure compliance and accuracy
📊 Interpret your Annual Performance Report (APR) and Total Performance Score
🔁 Develop quality improvement plans using QAPI best practices
📅 Prepare for upcoming CMS changes in scoring and reporting
🧠 Train staff on the importance of each measure and how to impact them
📝 Submit appeals or recalculation requests when needed
With the right support, agencies can turn the HHVBP Model into an opportunity—not a burden.
Conclusion
The shift to Home Health Value-Based Purchasing is here to stay. It’s no longer enough to simply provide care—you must now prove its quality, document it thoroughly, and continually improve.
Agencies that invest in compliance, education, and strategic consulting will not only protect their revenue—they’ll also raise the bar for patient care and industry standards.
💡 Need help navigating HHVBP and preparing your team for 2025? Learn how our consulting services can support your home health agency with compliance, performance improvement, and value-based success.
