CMS offers new care model for Medicare

'CMS aims to make sure that care in the home is supported by a value-based care delivery model that is consistent with the rest of the system'
By Bernie Monegain
08:19 AM
nurse with elderly patient at home

The Centers for Medicare & Medicaid Services is poised to launch a new model of care designed to support greater quality of care among Medicare beneficiaries.

The model, announced by CMS on July 6, is included in the 2016 Home Health Prospective Payment System proposed rule, which updates payments and requirements for home health agencies under the Medicare program.

The Home Health Value-Based Purchasing model would test whether incentives for better care can improve outcomes in the delivery of home health services.

[See also: Foundational elements for switching to value-based care.]

The model is part of the U.S. Department of Health and Human Services' commitment to build a healthcare delivery system that’s better, smarter, and healthier – one that delivers better care, spends health care dollars more wisely, and results in healthier people and communities, CMS officials state in a news release.

"People want to be taken care of in their homes and communities whenever possible, and CMS aims to make sure that care in the home is supported by a value-based care delivery model that is consistent with the rest of the system," said Acting CMS Administrator Andy Slavitt in announcing the initiative. "The goal is that no matter where the care is delivered, it is supported by a payment system that rewards providers who deliver the highest quality outcomes."

[See also: Clinical informatics to help shift to value-based care.]

Authorized under the Affordable Care Act, the model leverages the successes of and lessons learned from other value-based purchasing programs and demonstrations – including the Hospital Value-Based Purchasing Program and the Home Health Pay-for-Performance and Nursing Home Value-Based Purchasing Demonstrations.

The model would apply a payment reduction or increase to current Medicare-certified home health agency payments, depending on quality performance, for all agencies delivering services within nine randomly-selected states. Payment adjustments would be applied on an annual basis, beginning at 5 percent and increasing to 8 percent in later years of the initiative.

The proposed model is designed so there is no selection bias, participants are representative of home health agencies nationally, and there is sufficient participation to generate meaningful results among all Medicare-certified home health agencies nationally.

CMS is soliciting comments on its plans until September 4, 2015.

Instructions on ways to submit comments are found in the proposed rule.

Read the CMS fact sheet here.