May 28, 2026  – A federal value-based payment initiative for home health providers may be helping reduce disparities in care for Medicare beneficiaries living with dementia, according to new research published in JAMA Network Open.

The study examined the impact of the Medicare Home Health Value-Based Purchasing (HHVBP) Model and found that beneficiaries with dementia who received post-hospital home health services in participating states experienced more equitable access to care compared to similar patients in nonparticipating states. Researchers reported that the program was associated with increased therapy utilization and smaller differences in care among racial and ethnic minorities, low-income beneficiaries, and patients served by agencies that primarily care for minority populations.

The findings arrive as policymakers continue to explore ways to improve quality and equity in home-based care for a growing population of older adults living with cognitive impairment. Dementia affects millions of Americans and is often associated with greater health care needs, higher hospitalization rates, and increased dependence on caregivers and long-term services.

The HHVBP Model was first launched by the Centers for Medicare & Medicaid Services (CMS) in selected states to test whether financial incentives tied to quality performance could improve outcomes and reduce Medicare spending. Under the model, home health agencies receive payment adjustments based on their performance across a range of quality measures.

Researchers analyzed Medicare claims data from 2021 and 2022 and linked those records with provider-level information from Home Health Focus and Provider of Services files. The study included over 260,000 Medicare beneficiaries with dementia who received home health services following a hospital discharge.

The analysis compared outcomes between beneficiaries living in states participating in the HHVBP program and those in states where the model had not yet been implemented. Researchers focused on differences in home health utilization and whether the program affected longstanding disparities among vulnerable populations.

Results showed that beneficiaries with dementia in HHVBP states received more therapy visits following hospitalization. More importantly, disparities in utilization between different demographic and socioeconomic groups were reduced. The improvements were particularly noticeable among racial and ethnic minority beneficiaries, individuals with low incomes, and patients receiving care from agencies that serve large numbers of minority populations.

The study suggests that payment models tied to quality performance may help encourage providers to deliver more consistent care across patient populations. Researchers noted that reducing disparities is especially important for people with dementia, who often face challenges accessing appropriate post-acute care and support services.

While the study identified positive associations between the HHVBP Model and home health utilization, the authors cautioned that additional research is needed to understand the long-term effects on health outcomes, quality of life, and overall costs. They also noted that further evaluation could help determine which components of the program are most effective at promoting equitable care.

The findings add to a growing body of evidence supporting value-based care approaches in Medicare. As CMS continues expanding value-based payment initiatives across the health care system, policymakers and providers will likely examine whether similar models can help address disparities in other care settings as well.