The Critical Elements of Home Health Value-Based Purchasing

In 2025, home health agencies face one of the most transformative shifts in healthcare payment: the Home Health Value-Based Purchasing (HHVBP) model. Unlike fee-for-service systems, which reward providers for the number of visits or services delivered, HHVBP ties reimbursement directly to patient outcomes and the quality of care. 

This program fundamentally changes how agencies approach compliance, clinical documentation, and patient engagement, as performance will determine whether financial rewards or penalties are received.

As this is the first payment year of this expanded model, the stakes are high. Agencies that adapt quickly to HHVBP will not only improve care delivery but also position themselves for stronger financial sustainability. 

At K&K Healthcare Solutions, we want to make sure your agency is set up for success. We’ll briefly go over what value-based purchasing in home health is, as well as how your agency can succeed under this new system.

What is Value-Based Purchasing in Home Health?

Value-Based Purchasing (VBP) is a payment model designed to shift healthcare away from volume-driven incentives and toward quality-based outcomes. In traditional fee-for-service models, agencies were paid based on how many services they provided. 

Under VBP, payments are adjusted based on performance in specific quality measures, including patient satisfaction, hospitalization rates, and timely documentation.

The Centers for Medicare & Medicaid Services (CMS) introduced the expanded HHVBP model to home health agencies as part of its larger push to reduce costs while improving patient care. Starting with pilot programs in select states, CMS has expanded HHVBP nationwide, requiring all agencies to participate by 2025.

By linking payment directly to value, HHVBP encourages agencies to prioritize long-term patient health and operational excellence over short-term service counts.

Why HHVBP Matters for Home Health Agencies

At its core, the program ties reimbursement not to the number of visits completed but to the measurable quality of care delivered. This means that two agencies providing the same number of services could see dramatically different payment outcomes depending on patient satisfaction scores, documentation accuracy, and clinical results.

The financial stakes are also significant. CMS allows for payment adjustments based on performance, with top-performing agencies eligible for bonus payments and lower-performing agencies facing reimbursement reductions. This system not only incentivizes efficiency but also rewards agencies that invest in robust documentation and coding compliance.

For example, accurate OASIS assessments and ICD-10 Coding directly impact how quality measures are calculated and reported. Agencies with strong compliance processes are better positioned to capture the full value of the care they provide.

Equally important, Home Health Value-Based Purchasing pushes agencies to improve patient engagement. Satisfied patients are more likely to provide positive survey feedback, comply with care plans, and achieve better health outcomes, all of which directly contribute to higher performance scores.

For agencies willing to adapt, HHVBP represents an opportunity to elevate both clinical and operational performance while building a sustainable future in a competitive market.

The Core Measures of Home Health Value-Based Purchasing

To understand HHVBP, agencies must become familiar with the performance measures CMS uses to evaluate success. These metrics span several domains and directly determine whether an agency earns incentive payments or faces reimbursement reductions.

Patient Experience Scores

Patient satisfaction surveys play a central role in HHVBP. These surveys measure communication quality, responsiveness of care, and overall patient confidence in the agency. High survey results not only reflect strong engagement but also significantly impact final performance scores.

Clinical Outcome Measures

Clinical outcomes evaluate improvements in patient health and functionality. Examples include hospitalization rates, improvements in mobility, and effective symptom management. Agencies that reduce avoidable hospital admissions and demonstrate progress in functional independence perform strongly in this domain.

Cost/Utilization Measures

HHVBP measures resource utilization, including how effectively agencies manage care to avoid unnecessary expenses while maintaining quality. Efficient use of resources strengthens both patient outcomes and reimbursement potential.

HHVBP: What’s Changing

While HHVBP has been piloted and refined in select states since 2016, 2025 marks a new phase with expanded requirements and greater financial implications.

After years of demonstration models, HHVBP is now applied to home health agencies nationwide. Every agency must participate, eliminating the option to sit on the sidelines. CMS has also updated how measures are weighted in 2025, giving more emphasis to outcomes and patient-reported experiences. 

Payment adjustments tied to HHVBP are now also more significant. Agencies performing well may see bonus payments of up to 5%, while underperforming agencies could face equivalent penalties.

In short, HHVBP represents a turning point: agencies must operate with precision, compliance, and a strong commitment to patient-centered care. Those who invest in quality improvement and proactive planning will gain a clear competitive edge.

Key Challenges Agencies Face With HHVBP

While the HHVBP model offers new opportunities, it also creates new operational and clinical challenges that agencies must overcome to remain competitive.

Data Tracking and Analytics

HHVBP requires agencies to gather, analyze, and report on large amounts of patient and performance data. Many agencies lack advanced analytics platforms or the staff expertise needed to translate raw data into actionable insights. Without reliable reporting, it becomes nearly impossible to optimize quality measures or identify areas for improvement.

Staff Training on Documentation and Compliance

Because performance scoring relies on accurate data, staff must be trained to complete OASIS assessments and documentation correctly. Errors in documentation or ICD-10 Coding can reduce performance scores and jeopardize reimbursement.

Patient Engagement and Satisfaction

Patient surveys weigh heavily in HHVBP scoring. Agencies must improve not just the clinical delivery of care but also the patient’s perception of it. Even minor issues in communication or responsiveness can negatively affect survey outcomes and financial results.

Balancing Quality with Efficiency

Agencies often struggle to balance the dual priorities of maintaining operational efficiency while meeting stricter quality standards. Staffing shortages, tight budgets, and rising patient complexity make it challenging to deliver excellent care without overextending resources.

Best Practices to Succeed Under HHVBP

Agencies that excel under HHVBP are those that combine strong compliance practices with patient-centered strategies. The following best practices can help agencies thrive:

Invest in Accurate Documentation and Coding

Accurate OASIS documentation and ICD-10 Coding are foundational. Errors not only risk compliance issues but also affect reimbursement and performance scoring.

Conduct Regular Quality Audits and Performance Reviews

Routine audits allow agencies to identify gaps in care delivery, documentation, and compliance. By reviewing cases and monitoring trends, agencies can proactively correct issues before they impact HHVBP scoring.

Establish Ongoing Staff Training and Accountability

Training programs should cover both clinical skills and compliance requirements. Building accountability systems ensures clinicians understand how their actions directly influence the agency’s performance. These clinical disciplines need to work collaboratively toward the common goal regarding outcomes for HHVBP.

Educate and Engage Patients

Patients should understand their role in improving outcomes. Educating them about care plans, encouraging active participation, and maintaining open communication can improve survey responses and overall health outcomes.

Leverage Technology and Analytics Platforms

Modern analytics tools allow agencies to track performance measures in real time. These platforms highlight trends, predict risks, and guide targeted interventions that directly improve HHVBP outcomes.

How K&K Supports Agencies in the VBP Era

Successfully navigating value-based purchasing for home health in 2025 requires more than just clinical excellence; it demands precision in documentation, coding, compliance, and long-term strategy. This is where K&K Healthcare Solutions serves as a trusted partner.

Documentation and Medical Coding Services

K&K’s experts provide support for accurate OASIS documentation and ICD-10 Coding. By ensuring data integrity, agencies can confidently report performance measures without fear of costly errors that may lower reimbursement.

Denial Prevention and Claims Management

Our team helps agencies reduce denied claims and safeguard revenue streams. Proactive denial management also minimizes financial disruptions that can hinder HHVBP performance.

Quality Reporting and Improvement Guidance

We provide insights into reporting standards and quality measure improvement strategies. By aligning operations with CMS expectations, agencies are better positioned to earn incentive payments and avoid penalties.

Strategic Consulting for Long-Term Success

Beyond compliance, K&K offers tailored consulting to help agencies create data-driven strategies for performance improvement. From training programs to leadership support, we help agencies stay competitive in the evolving HHVBP landscape.

Why Home Health Agencies Should Act Now

With nationwide implementation in effect, HHVBP is not a future requirement; it’s a present reality. Every agency is already subject to performance measures that will influence reimbursement starting in 2025. Those who wait risk falling behind, while early adopters will thrive in an environment that rewards value, not volume.

K&K Healthcare Solutions is here to help agencies meet these demands with expert documentation, coding, compliance, and consulting services. By partnering with K&K, agencies can safeguard reimbursements, improve performance scores, and build a sustainable future in the HHVBP era.

Don’t wait until penalties affect your bottom line. Connect with K&K Healthcare Solutions today to ensure your agency is successful in the ever-changing world of HHVBP.