Considerations in value-based purchasing.

In health care (and in life) reimbursement drives behavioral change. If providers are reimbursed based on the quantity of services provided, it is likely that the quantity of services will increase. Likewise, as payment shifts towards reimbursement based on quality or value--then those metrics will be more closely evaluated and managed. The current Home Health P4P Demonstration gives the home care industry a good idea of the baseline metrics that will likely be included in any P4P program to be broadly implemented across home care in the future. What remains to be seen, however, is whether the methodology and structure of the demonstration will be associated with real cost savings, and if so, what the magnitude of savings is. These findings will surely impact the degree to which the current methodology and structure will be adjusted or revised prior to seeking full implementation. Until such findings are revealed, one can be sure savvy home care providers will be focusing on how to get a handle on what patient populations drive their performance on the risk-adjusted outcome measures included in the current P4P demonstration and exploring approaches to care to achieve continued improvement.