Inside Value-Based Purchasing in Home Health Care

The VBP Clock Is Ticking: How to Improve Quality Scores [Free On-Demand Webinar]

Value-Based Purchasing (VBP) continues to reshape home health care—and the latest CY 2026 Home Health Final Rule makes it clear that agencies must strengthen quality performance to protect revenue.

On November 28, 2025, CMS finalized a 1.3% aggregate decrease in home health payments for 2026, driven by:

• 2.4% payment update
• -0.9% permanent adjustment
• -2.7% temporary adjustment
• -0.1% outlier Fixed Dollar Loss (FDL) adjustment

While PDGM recalibration, new functional impairment and comorbidity subgroups, and modernized face-to-face encounter requirements aim to improve accuracy, they also add operational complexity. And with PDGM payment reductions stacking year over year, VBP performance becomes even more critical for sustaining margin.

This blog breaks down where VBP stands today, what’s changed for the 2025 Performance Year, and how the 2026 Final Rule impacts financial pressure.

Plus, you'll learn how Maxwell TEC helps agencies strengthen outcomes with real-time visibility, streamlined processes, and patient engagement tools that influence OASIS, claims-based measures, and HHCAHPS.

How We Got Here: A Proven Model, Expanded Nationwide

CMS introduced VBP in 2016 through a nine-state pilot with goals to:

• Tie financial incentives directly to quality
• Validate selected measures
• Increase public transparency

The pilot delivered measurable results: 4.6% average improvement in quality and $141M in annual Medicare savings, driven largely by reductions in unplanned hospitalizations.

After its success:

• 2022 became the pre-implementation baseline year
• 2023 became the first performance year
• 2025 is both a payment year and a new performance year under the updated measurement model

To ensure equity, CMS compares small and large agencies separately.

2026 Final Rule: Why VBP Matters More Than Ever

The CY 2026 final rule doesn’t change VBP mechanics directly—but it raises the stakes by tightening PDGM payments.

CMS finalized:

• -1.023% permanent adjustment to reflect behavior changes from PDGM implementation
• -3.0% temporary adjustment to mitigate the impact of a single large payment shift
• Ongoing annual analysis of PDGM-related behavior through 2026

Importantly, CMS scaled back the proposed permanent cut after commenters highlighted that some assumed “behavior change” was attributable to:

• The introduction of OASIS-E
• The expansion of HHVBP nationwide
• Growth in Medicare Advantage penetration

The result: PDGM continues to tighten margins, but CMS acknowledged the need for measured cuts. For agencies, however, the message is clear: VBP is now one of the only remaining pathways to meaningfully offset rate reductions.

2025 Performance Year: What’s Changed—and Why It Matters

CMS finalized updates in CY2024 that reshape how agencies are evaluated beginning in 2025. The most significant update:

2023 is now the baseline year.

Improvement is measured between 2023 - 2025, offering agencies a more current—and potentially more favorable—starting point.

Agencies earn two types of points:

• Improvement Points: Reflect progress from baseline to performance year.
• Achievement Points: Compare performance to national thresholds and percentiles, calculated separately for small and large agencies.

This allows high-performing agencies with limited room for improvement to still earn points.

Breaking Down the Measures: What Agencies Need to Know

OASIS Measures: Longstanding but Still Challenging

Two familiar measures:

• Improvement in Dyspnea
• Improvement in Management of Oral Medications

Success requires accurate OASIS scoring and clinician understanding of assessment requirements.

NEW: Discharge Function Score

A composite of 13 GG self-care and mobility items that determine whether patients meet or exceed expected function at discharge.

• Key challenge: Missing, dashed, or skipped items trigger statistical imputation, which may not reflect the patient’s true status.

Education on GG items is now critical.

Claims-Based Measures: Higher Stakes, New Timeframes

Home Health Within-Stay Potentially Preventable Hospitalization (PPH)

• 26% of total VBP score
• Includes Observation stays
• Evaluates the entire home health stay
• Excludes planned admissions

Agencies must examine clinical decision-making, triage models, escalation workflows, and early risk detection.

Discharge to Community – Post-Acute Care

• Weighted at 9%
• Measures discharge without unplanned hospitalization within 31 days

Post-discharge visibility and early symptom monitoring are essential.

Where Agencies Struggle Most: Visibility, Understanding & Workflow Execution

Agencies can access Interim and Annual Performance Reports in iQIES, which include:

• Achievement & improvement points
• Care points
• Payment adjustment projections

However, CMS reports remain retrospective—often highlighting issues only after the performance window has closed.

Without real-time insights from CMS, agencies often turn to internal tracking methods. But these aren’t built for speed or real-time analysis. Manual spreadsheets and static EMR reports slow down response time, widening the gap between risk identification and action.

Tech-Enabled Strategies to Strengthen VBP Performance

Improving VBP scores requires coordinated efforts across OASIS, claims-based measures, and HHCAHPS—and technology is the thread that ties these efforts together.

By using digital tools that surface real-time insights and streamline clinical workflows, agencies can reinforce core areas of VBP performance:

• OASIS Accuracy & Education: Technology-supported training modules, audit automation, and scoring validation help teams identify pattern-level errors early and standardize documentation.
• Clinical Workflow Optimization: Digital triage tools, automated alerts, and process mapping platforms strengthen care delivery, reduce preventable utilization, and ensure teams follow evidence-based pathways.
• Real-Time Monitoring: Centralized dashboards and predictive analytics transform raw operational and clinical data into proactive insights so agencies can intervene before issues compound.

How Maxwell TEC Helps Agencies Improve VBP Scores

Maxwell TEC partners with home health organizations to build sustainable quality programs through:

• Operational Assessments & Gap Identification: Evaluating workflows across clinical, intake, quality, documentation, and post-discharge functions.
• Process Redesign & Change Management: Implementing efficient, evidence-based workflows with hands-on support.
• KPI Monitoring & Continuous Support: Using a Plan/Do/Check/Act model to validate results, track performance, and pivot strategies as needed.
• Education & VBP-Focused Training: Supporting OASIS, GG scoring, documentation integrity, and VBP-aligned competencies.

Enhancing VBP Scores with nanaCONNECT: A Low-Effort, High-Impact Solution

To strengthen patient engagement, early symptom detection, and follow-up workflows, Maxwell TEC developed nanaCONNECT, a customizable, bi-directional patient communication platform supporting patients from first check-in to final comfort:

• NOTIFY: Keep patients informed and confident with real-time caregiver arrival alerts and appointment confirmations
• ENGAGE: Stay engaged with your patients’ well-being with simple, daily text check-ins
• REACH: Reach patients post-discharge with relevant, personalized support and resources that guide recovery and strengthen care outcomes
• BEREAVE: Support grieving families with thoughtful, personalized messages that truly resonate

How nanaCONNECT - REACH Supports VBP Performance Improvement

nanaCONNECT - REACH is particularly relevant to improving VBP performance within care at home.

REACH enables agencies to automate post-discharge outreach—such as CHF symptom checks—to identify complications early and intervene before an ED visit or hospitalization. Messages are completely configurable by each agency and can include reminders about symptoms to monitor, educational materials, agency resources, or simple wellness tips and encouragement.

This creates a low-effort, high-return approach to improving:

• PPH
• Discharge-to-Community
• Patient experience

REACH's automation features help to minimize manual follow-ups and repetitive outreach while prioritizing high-risk patients. The solution is not only easy to implement, but also seamlessly integrates into current EHR workflows.

VBP Success Requires Proactive, Tech-Enabled Execution

Between ongoing PDGM adjustments, annual recalibration, payment reductions, and expanded VBP expectations, home health agencies face mounting pressure to deliver higher-quality care with fewer resources.

Sustaining and improving VBP performance requires:

• Accurate, timely assessment
• Efficient clinical workflows
• Continuous monitoring
• Patient engagement beyond the visit
• Technology that surfaces actionable insights

Maxwell TEC delivers the operational support, clinical expertise, and innovative technology agencies need to meet rising VBP demands—without overwhelming already-stretched teams.

Preparing for the next performance year or reassessing your organization's VBP strategy following the 2026 Final Rule? Book time with our team, and we'll assess how we can help you map out a clear, data-driven path forward.