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:
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.
CMS introduced VBP in 2016 through a nine-state pilot with goals to:
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:
To ensure equity, CMS compares small and large agencies separately.
The CY 2026 final rule doesn’t change VBP mechanics directly—but it raises the stakes by tightening PDGM payments.
CMS finalized:
Importantly, CMS scaled back the proposed permanent cut after commenters highlighted that some assumed “behavior change” was attributable to:
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.
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:
This allows high-performing agencies with limited room for improvement to still earn points.
Two familiar measures:
Success requires accurate OASIS scoring and clinician understanding of assessment requirements.
A composite of 13 GG self-care and mobility items that determine whether patients meet or exceed expected function at discharge.
Education on GG items is now critical.
Agencies must examine clinical decision-making, triage models, escalation workflows, and early risk detection.
Post-discharge visibility and early symptom monitoring are essential.
Agencies can access Interim and Annual Performance Reports in iQIES, which include:
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.
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:
Maxwell TEC partners with home health organizations to build sustainable quality programs through:
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:
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:
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.
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:
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.