Home-Based Care

Home-based care is moving deeper into VBC infrastructure as CMS’ proposed physician payment changes create stronger incentives for ACOs, primary care groups, and home-based providers to partner around longitudinal management, dementia care in residential settings, and avoidable post-acute utilization. At the same time, Medicare Advantage is becoming a sharper strategic fault line: plans are denying prior authorization for SNF, IRF, and LTCH care at much higher rates than overall requests—often overturned on appeal—pushing providers toward payer selectivity, tighter referral governance, and risk-based contracts where they can influence utilization rather than simply absorb friction (KFF analysis). Larger home-based care organizations such as Bayada are positioning beyond fee-for-service and transactional payer contracts toward value-based risk, signaling that scale, data capabilities, and control of post-acute pathways are becoming prerequisites for success in ACO and MA-aligned home care models (Bayada strategy).