Why CMS’s 2026 Home Health Value-Based Purchasing measures deserve the attention of healthcare leaders.
For home health organizations, medication management has traditionally been viewed primarily as a clinical responsibility.
CMS’s Expanded Home Health Value-Based Purchasing (HHVBP) Model gives executives another reason to pay attention: clinical performance ultimately affects Medicare reimbursement.
For the CY 2026 performance year, Home Health Agency performance under the applicable HHVBP measure set will determine payment adjustments applied to CY 2028 Medicare Fee-for-Service home health claims.
Are we simply managing medications—or proactively identifying the risks that may affect patient outcomes, utilization and performance under value-based care?
One Measure Is Directly About Medication. The Potential Impact Is Broader.
CMS assigns 11% of the Total Performance Score for larger-volume agencies and 13.75% for smaller-volume agencies to Improvement in Management of Oral Medications.
Other heavily weighted measures include:
Potentially Preventable Hospitalization
15%/18.75%
Discharge to Community–PAC
15%/18.75%
Medicare Spending per Beneficiary–PAC
10%/12.5%
Weights shown as larger-volume cohort / smaller-volume cohort.
51%
of the Total Performance Score
for larger-volume agencies
63.75%
of the Total Performance Score
for smaller-volume agencies
Together with Improvement in Management of Oral Medications, these measures represent 51% of the Total Performance Score for larger-volume agencies and 63.75% for smaller-volume agencies.
CMS does not define all of these as medication measures. However, medication-related problems can contribute to the outcomes they measure.
That distinction matters.
The Hidden Risk Inside the Medication List
Home health agencies frequently care for medically complex patients taking multiple prescriptions.
The medication list itself may not reveal the entire risk picture.
Previous medication failure, adverse drug reactions, polypharmacy, drug-drug interactions and differences in how individual patients metabolize certain medications can all complicate treatment.
Pharmacogenomics adds another potential layer of clinical intelligence by providing information about how genetic variation may affect an individual’s response to certain medications.
When clinically appropriate, that information can support medication selection, dosing decisions and identification of medications that may warrant closer evaluation.
Moving From Reactive to Proactive
The opportunity for home health organizations is to identify medication risk before it becomes an adverse outcome.
A practical strategy can begin with four steps:
- Review HHVBP performance data and identify gaps.
- Stratify appropriate patients for medication-related risk.
- Route high-risk cases for appropriate pharmacist and clinical review.
- Document interventions and monitor subsequent performance.
This transforms medication management from a largely reactive process into a measurable clinical strategy.
CMS provides preliminary Interim Performance Reports quarterly, giving eligible agencies repeated visibility into their performance.
For organizations caring for increasingly complex patient populations, the answer may have implications well beyond the pharmacy cabinet.
Source: Centers for Medicare & Medicaid Services, Expanded Home Health Value-Based Purchasing Model, CY 2026 Measures and Reports At-A-Glance.
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