The Value Signal — September 29, 2026

458 articles scanned · 15 high-signal

Signal Map

Executive Summary

Washington is tightening the screws on the financing plumbing of value-based care, from diagnosis coding to provider taxes to physician fee schedules, even as purchasers and states push capital toward direct contracting and primary care.

On HCC and Risk Scoring, HHS OIG has released a Medicare Advantage compliance audit of specific diagnosis codes submitted to CMS by UnitedHealthcare Benefits of Texas, Inc. (Contract H0609), keeping coding integrity at the centre of federal oversight. The Medicare market is being squeezed from both sides. Fierce Healthcare reports that CMS projects Medicare Advantage premiums to decline by 16% in 2027, while SCAN expands into Oregon through a partnership with the Springs Living. Medical Economics reports that MGMA is shopping a draft bill to curb automatic downcoding in Medicare Advantage and has outlined a 2027 physician pay cut and the end of MIPS, a combination that forces practices to rethink quality-reporting and revenue strategy at once. In Medicaid, HFMA reports that hospital advocates say the July 21 proposed rule implementing provider tax provisions of the One Big Beautiful Bill Act is far more restrictive than the statute required. Separately, the American Hospital Association notes that CMS has launched an outcomes-driven quality measurement initiative for states.

The counterweight is structural reinvestment. On Direct Contracting, MedCity News reports that a new coalition has launched to expand the model. On Primary Care, Healthcare Innovation reports that a task force has recommended Massachusetts set a primary care spending target, a lever other states are likely to watch closely. The intellectual framing of Value-based Care is also being contested. Health Affairs argues that treating value-based care as a payment model is a category error, while the American Enterprise Institute lays out the key choices for getting value-based payment right. AJMC, featuring Christine Pfaff, examines how to close the cell therapy reimbursement gap. On Interoperability, NCQA publishes a warning from InterSystems' Steven Berkow against swapping two healthcare data silos for three, arguing that data integration remains the missing precondition for the operational breakthroughs VBC promises.