The Value Signal — September 02, 2026

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Executive Summary

VBC’s center of gravity is shifting from upside rhetoric to downside enforcement: risk scores, Medicaid eligibility, MA retention, and pharmacy payments are all being stress-tested at once.

Risk and oversight discipline is tightening around the coding-to-payment machinery, with The Villages Health System agreeing to a $541.5 million settlement tied to HCC risk scoring, AAPC reports. CMS oversight also failed to prevent Medicare Part D sponsors from making $587.7 million in ineligible pharmacy payments for OTC-available drugs labeled prescription-only, HHS OIG reports, underscoring that documentation, formulary controls, and payment integrity are now board-level VBC risks.

Medicaid and Medicare economics are becoming less stable at the member level: 10 million Medicaid expansion adults could lose coverage because of inconsistent work hours, Fierce Healthcare reports, while Medicaid coverage losses are leaving more patients paying cash after an Epic analysis of more than 550 million encounters, Healthcare Dive reports. In Medicare, disenrollment from Medicare Advantage rises with each diagnosis, Becker's Hospital Review reports, while Medicare DMEPOS supplier enrollment has reopened as a moratorium expires, Hallrender reports—together pointing to churn, selection pressure, and network exposure as material contract-performance variables.

Operating model modernization is moving from optional to urgent: NCQA is working with Komodo to accelerate quality measure development, Hcinnovationgroup reports, while clinical results increasingly require financial innovation rather than care-model pilots alone, OPEN MINDS reports. Risk-based contracting is likewise being reframed around collaboration and clinical outcomes, Amga reports, as Medicaid drug price deals with pharma firms add fresh pricing uncertainty to state programs, Modern Healthcare reports.