HHVBP: A Winning Strategy for Home Health Providers 

The start of 2025 has ushered in a wave of new realities for Home Health providers, from the implementation of the CY 2025 Home Health Final Rule to ongoing quality and regulatory uncertainties. Additionally, agencies are now experiencing payment adjustments based on data from the 2023 Expanded Home Health Value-Based Purchasing (HHVBP) performance year. The good news? Nearly 60% of agencies achieved a positive payment adjustment, with 6% receiving the maximum 5% increase.

However, this is just the beginning. The results of the 2024 baseline year will impact 2026 reimbursements, and with the implementation of new measures impacting total performance score for the 2025 baseline year, 2027 reimbursements will also be affected. While it’s easy to get lost in the complexities of HHVBP, it’s essential to remember that the program is designed to enhance the quality and efficiency of home healthcare while incentivizing agencies to deliver better outcomes.

To help agencies navigate the challenges and opportunities of HHVBP, we have developed a strategic playbook that overlays the entire patient episode—optimizing outcomes and improving efficiency.

1. Start of Care (SOC): Establishing a Strong Foundation

The Start of Care (SOC) is one of the most critical moments in a patient’s home health journey. Agencies must balance the urgency of intake with the need for precision in establishing the focus of care. Ensuring OASIS accuracy is essential to recognize appropriate payment under PDGM and to achieve expected Discharge Function Scores under HHVBP. Inaccurate representation of clinical details on the OASIS can result in lost revenue potential and lower quality outcomes.

Our analysis has revealed that 47% of all patient episodes are mis-coded, and 37% of patients are missing key clinical information—directly impacting OASIS scores and, ultimately, patient outcomes. Ensuring accuracy at SOC is a game-changer for HHVBP success.

Discover how Pulse Referrals & Admissions can enhance SOC accuracy. Discover how Pulse Episodes can sharpen the focus on the Discharge Function Score.

2. Informed Utilization Management: Aligning Care with Patient Needs

With clinician resources becoming increasingly limited amid rising home health demand, agencies must deploy patient-specific clinical intelligence to align care plans with patient acuity. By stratifying patients based on their needs, agencies not only drive efficiencies but also improve patient outcomes—aligning with HHVBP’s mission.

Pulse Episodes drives person-centered care by leveraging risk insights to tailor care to each patient’s needs, demonstrating that strategic, data-driven utilization management can optimize care while maintaining high-quality outcomes. The visit recommendation feature helps create an optimal initial plan of care, while the hospitalization risk feature allows users to ensure that utilization aligns with acuity levels. Lower-risk patients likely require less care, while higher-risk patients need more. The gaps in care feature further identifies any misalignment between utilization and risk while LUPA alerts allow users to ensure that periods with low utilization are expected and clinically appropriate.

Learn more about how Pulse Episodes provides utilization intelligence.

3. Managing Hospitalization Risk: Preventing Avoidable Transfers

The 2025 Home Health Final Rule reinforces CMS’s commitment to reducing hospitalizations. In fact, Potentially Preventable Hospitalizations carry the highest weighting in the total performance score. However, HHVBP doesn’t just assess hospitalization risk during an episode—it also considers hospitalizations occurring within 31 days post-discharge to the community.

Using visit-by-visit risk stratification, Pulse Episodes identifies patient risk from Very Low to Very High risk of Transferring to Impatient Facility (TIF). Patients identified as Very High-Risk patients, over 50% of these individuals will TIF during their episode. This intelligence is critical for informed patient care and recertification or discharge decisions, ensuring that patients successfully transition back to the community while minimizing hospital readmissions. 

See how Pulse Episodes is revolutionizing hospitalization risk scoring.

4. Identifying Patients for Home Health Appropriateness

Since HHVBP prioritizes quality, outcomes, and patient experience, it’s vital to determine whether a patient is appropriate for home health or if their declining condition signals the need for end-of-life care. Patients nearing end-of-life often exhibit higher utilization rates, increased hospitalizations, and continued decline rather than improvement.

Pulse Transition provides real-time, visit-by-visit insights, allowing clinicians to identify patients with a high likelihood of death and adjust care plans accordingly. Agencies leveraging Pulse Transitions have reduced death on home health census by 52%, leading to a better patient and family experience, optimized resource utilization, and improved clinical outcomes.

Learn how Pulse Transitions can improve patient transitions and agency performance.

5. Discharge vs. Recertification: Making Data-Driven Decisions

End-of-episode planning plays a pivotal role in HHVBP performance metrics. While evaluating patient improvement against OASIS-based measures is essential, agencies must also assess hospitalization risks both during and after the episode to make the best recertification or discharge decisions.

Medalogix analysis shows that over 6% of patients with Very High TIF risk are discharged to the community, leading to post-discharge hospitalizations that could have been prevented with better-informed end of episode planning. Agencies utilizing Pulse Episodes can proactively address these risks, improving patient outcomes and HHVBP performance.

Explore how Pulse Episodes supports smarter end-of-episode planning.

Conclusion: Leveraging HHVBP for Success

While HHVBP presents an opportunity for agencies to achieve higher reimbursement rates, sustaining positive outcomes requires informed clinical insights and data-driven decision-making. As outlined in the Medalogix HHVBP playbook, agencies can adopt multiple strategies—from SOC optimization to hospitalization risk management—to enhance patient outcomes and financial performance.

To help agencies fully grasp the impact of Medalogix solutions, we offer a risk-free demonstration with your own patient data—allowing you to experience firsthand how our solutions drive success in HHVBP.

Click here to request more information and transform your agency’s HHVBP strategy.