Please find excellent examples or case studies of...

of one

Please find excellent examples or case studies of...

While there is no preexisting information to fully answer your question, we've used the available data to pull together key findings. One benefit of alternative payment models that was frequently cited in the literature is reduced hospital readmission, either from inpatient or home-care settings, as well as an increase in the use of home health agencies. Other key findings include that, due to a rapidly changing health care system, home health entities are in line to serve a much larger role in alternative payment models.


To explore this topic, I first looked for information on the types of alternative payments methods used in home health settings. I then searched scientific databases, such as PubMed, Ebsco via the MIT Library, and Dimensions, as well as Google Scholar.

Much of the information I encountered referred to bundled payments, though I also looked for data on outcomes related to accountable care organizations (ACO), Medicare shared savings program (MSSP), comprehensive primary care model, value-based purchasing, outcome-based payments, and the home health value-based purchasing model. I specifically searched for information regarding the use of these models for rehabilitation in home health settings. Despite an extensive search, little data was found on this niche sector. Most data that has been compiled focuses on alternative payment models in hospital or inpatient settings.

I then expanded my search to identify outcomes related to alternative payment models, in general, looking for mentions of home health or rehabilitation among those findings. Again, few references were unearthed.

Finally, I searched for data at the Centers for Medicare and Medicaid Services, the National Association for Home Care and Hospice, and the American Physical Therapy Association in search of research or studies conducted by these organizations. However, these sources provided no useful data.


Ultimately, we were able to compile a list of five research articles assessing outcomes related to alternative payment models.

Changes in Discharge Location and Readmission Rates Under Medicare Bundled Payment
JAMA Intern Med. 2016

This study examined the hospital readmission rates of post-acute patients under the Bundled Payment for Care Improvement (BPCI) model. To control costs from admission to 90 days post-discharge, NYU Langone Medical Center (NYULMC) shifted their referrals from inpatient to home-based care and saw readmission rates unchanged during the study period.

Effect of Bundled Payments and Health Care Reform as Alternative Payment Models in Total Joint Arthroplasty: A Clinical Review
The Journal of Arthroplasty
Volume 32, Issue 8, August 2017, Pages 2590-2597

This report, though not specific to home health, found that bundled payment models result in reduced costs and increased quality of care for total joint arthroplasty, largely due to the reduction in hospital length of stay, lower hospital readmission rates, and fewer referrals to in-patient rehab.

CMS Bundled Payments for Care Improvement Initiative Models 2-4: Year 2 Evaluation & Monitoring Annual Report

While this 2016 report from the Lewin Group was not published in a peer-reviewed journal, it has been included because it is cited in numerous research articles and offers some statistics on the use of bundled payments in various care settings, including home health. During the first year of the Bundled Payments for Care Improvement (BPCI), home health visits increased in relation to BPCI episodes related to cardiovascular surgery with a significant shift from post-acute care (PAC) providers to home health agencies (HHA). Exhibit 144 on page 235 shows quality outcomes for HHAs in terms of improved ambulation, bathing, bed transfer, and lower and upper body dressing.

Untapped Potential of Home Health Care Innovations to Improve Outcomes With Bundled Payment Initiatives
Home Health Care Management & Practice, Vol. 29, Issue 1, 2017

While access to this article is paywalled, it has been included as a possible reference because is specifically addresses the potential for improved outcomes for cardiac rehabilitation in home health care settings due to bundled payments.

Changes in Postacute Care in the Medicare Shared Savings Program.
JAMA Intern Med. 2017 Apr 1

This study found that ACO participation in a Medicare shared savings program (MSSP) resulted in "significant reductions in postacute spending without ostensible deterioration in quality of care."


In conclusion, we found five articles that reference alternative payment models and their related outcomes. A primary benefit of alternative payment models appears to be reduced hospital readmission, in both inpatient and home-care settings, as well as an increase in the use of home health agencies.