Major changes are continuing to reshape the nature of home care. Driven by an aging population, workforce shortages and an increase in demand as a result of the COVID-19 pandemic, government agencies are now demanding more value from home health providers and also requiring new training programs for family caregivers.

These impactful changes in regulations and requirements by the Centers for Medicare & Medicaid Services (CMS), include the expansion of the Home Health Value-Based Purchasing (HHVBP) model that will be taking effect in January, 2023. HHVBP has been piloted in nine states since 2016, providing incentives for better quality care with greater efficiency. It has had promising outcomes, but the impact on the home care field has not been fully examined.

The Research Institute for Home Care has undertaken research to assess the true effect of HHVBP and of the newly required training for family caregivers. What we learn from this research and future studies can help ensure that the industry has the information it needs to prioritize safe, effective, and evidence-based home care for patients.

Value-based purchasing

The purpose of this research was to characterize the quality of home care over time by using longitudinal CMS data, examining the impact of the HHVBP model upon quality indicators. We also used qualitative interviews and a national survey to explore how home health agencies responded to the CMS quality initiatives.

Based on the selected measures, the research found that the overall quality of home care improved substantially from 2012 to 2016; however, those improvements varied by ownership, both in terms of trends (larger improvements for nonprofit agencies) and as a function of nurse staffing.

Once HHVBP was piloted in 2016, participating home health agencies significantly improved their performance on quality of patient care and patient experience measures. Rates of hospital transfers, readmissions and emergency department visits with and without hospitalizations also improved measurably over time.

Data from qualitative interviewees at the HHAs revealed variations in knowledge and opinions about the HHVBP model and its impact upon day-to-day operations. While the research documented improvements under the new model, the extent of progress depended upon home health agency ownership and leadership priorities.

Training for family caregivers

Family caregivers are a vital source of assistance for older adults and Medicare-certified home health agencies are now required to offer family caregiver training. But little has been known about barriers to accomplishing this. So, we funded a qualitative research study through key informant interviews with registered nurses and physical therapists from four diverse home health agencies. Interviews explored major barriers and facilitators to successfully providing family caregiver training.

Clinicians identified a range of factors that helped or hindered effective training, including the tenure of the clinician, the quality of the clinician/caregiver rapport, and the quality of agency-provided resources, including additional visits and formal training materials. Clinicians emphasized the importance of informal communication, both within the care team and between clinician and caregiver. Clinicians said COVID-19 damaged the training effort because it reduced caregivers’ access to hospital staff prior to discharge.

As a result of this research, we recommended that home health agencies consider expanding visit flexibility and encouraging both formal and informal team communication to facilitate successful family caregiver training. Additionally, we suggested that agencies consider expanding current clinician onboarding and continuing education options to include practical training on how best to interact and develop trust with patients’ caregivers.

Building a brighter future for home care

Studies like these can help inform insurers, policymakers and providers so that they can make decisions on the future of home care that are grounded in evidence and best practices. But we need to continue this work.

It is time to increase our investment in peer-reviewed research to bolster the evidence base for home care in order to help legislators, insurers, regulators, and the public realize the tremendous benefits that could be reaped through increased home care.

We stand at a pivotal moment with an opportunity to create lasting change. It will be crucial to have evidence-based policy and best practices to guide the industry; and these guidelines must be based on high-quality research.

J. Mark Baiada is a member of the board of directors for the Research Institute for Home Care and chair of BAYADA Home Health Care.