HHVBP Achievement, Improvement, and Care Points – Oh My!

by Elaine Gardner, MS, RN, COS-C, CPHQ, CHPN

Key Terms Used in the Interim Performance Report (IPR)

In the beloved movie, “The Wizard of Oz,” Dorothy exclaims, “Lions and Tigers and Bears, Oh My!” as she courageously embarks on her journey of unknowns to reveal the mysterious and elusive Wizard of Oz.

Such a journey is not unlike ours in home health as we seek to understand Home Health Value-Based Purchasing (HHVBP) Model performance reports – and then work towards improvement! One challenge we can quickly surmount is understanding a few key terms and how they are used in the calculations. Let’s take a look.

ACHIEVEMENT POINTS represent the home health agency’s (HHA’s) performance relative to other HHAs within the respective volume-based cohort in the Model baseline year, and are calculated for each measure as follows:

  • The difference between an HHA’s performance score and the ACHIEVEMENT THRESHOLD (the median, or 50th percentile, of Medicare-certified HHAs’ performance scores on each measure during the Model baseline year)
  • Divided by
  • The difference between the BENCHMARK (the mean, or average, of the top decile, or 90th percentile, of all Medicare-certified HHA’s performance scores on the measure during the Model baseline year) and the ACHIEVEMENT THRESHOLD.

IMPROVEMENT POINTS represent the HHA’s performance relative to its own performance in the HHA baseline year, and are calculated for each measure as follows:

  • The difference between an HHA’s performance score and the IMPROVEMENT THRESHOLD (the individual HHA’s performance on a measure during the HHA baseline year)
  • Divided by
  • The difference between the BENCHMARK (same as above for Achievement Points) and the IMPROVEMENT THRESHOLD.

CARE POINTS are the higher of achievement points or improvement points for each measure with sufficient data reported in the HHVBP Model performance feedback reports: the IPRs and the Annual Performance Reports (APRs).

So how are these terms applied in the IPR, and how does the HHVBP Model use quality measures to impact your agency’s payment?

First, in the HHA’s report, an HHA is awarded ACHIEVEMENT POINTS AND IMPROVEMENT POINTS for performance in EACH quality measure.

Next, each measure’s achievement points and improvement points are compared, and the higher value is then reported as the measure’s CARE POINTS.

Finally, the care points are weighted and summed to become the TOTAL PERFORMANCE SCORE (TPS), a numeric score ranging from zero to 100 and used to calculate the HHA’s adjusted payment percentage provided annually in the APR (the first APR is expected to be provided in August 2024!)

While you are beginning to become more familiar with these terms, we hope that you are faring well in this new HHVBP world. We are definitely not in Kansas anymore!

To learn more through an insightful visual walk-through (and in less than 15 minutes!), access the How Measure Performance Becomes Care Points Instructional Video, an on-demand recorded resource available on Expanded HHVBP Model webpage in which Linda Krulish, from OASIS Answers, is the featured presenter.

Consider sharing this with other key stakeholders in your HHA as you prepare to discuss these reports. Good luck as you interpret your HHA’s reports and plan for success in the Model!


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