Survival is key, as home health providers brace for PDGM, the largest change to home health reimbursement since the implementation of PPS in 2000. The complexity of the new PDGM payment model is overwhelming, with 432 different case-mix groups, 12 different clinical groupings and LUPA thresholds ranging from 2 to 6 visits. When adding the significance surrounding the model’s shift to 30-day payment periods, providers need to be proactive in seeking support to effectively interpret and navigate this new and extensive regulatory payment environment. Agencies will be expected to significantly change day-to-day operational practices to ensure success under PDGM, which must start with further development of all executive and clinical leaders. A strong clinical episode management program is critical to ensure sustained, efficient, cost-effective and uncompromised quality care delivery under the PDGM program.