The Value Signal — October 03, 2026

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Executive Summary

Regulators are tightening scrutiny of how public healthcare dollars are coded, claimed and priced, just as Medicare Advantage carriers quietly redraw their 2027 strategies.

Risk Adjustment & Program Integrity enforcement is intensifying. Healthcare Dive reports that Independence Blue Cross will pay $22.5M to resolve allegations it inflated diagnosis codes for MA beneficiaries, with the payer framing such settlements as evidence of "industry-wide challenges" in applying risk adjustment standards. On the Medicaid side, HHS OIG finds Wisconsin may have improperly claimed $455 million in reimbursement for its school-based program. In Medicare Advantage, Healthcare Finance News reports that plans are not as robust as insurers and CMS project, even as Humana adds benefits amid a broader MA pullback. Fierce Healthcare notes that SCAN's 2027 slate includes co-branded Costco plans and that MultiCare Health System is launching its own health plan, while the American Hospital Association has weighed in with MedPAC on post-acute care utilization among MA beneficiaries.

Payment Models & Quality are moving from pilot to mandate. AJMC reports that CMS has finalized the mandatory GLOBE Model to test lower Part B drug costs, and separately argues that employers should judge cancer care value beyond cost alone. AASM flags that CMS has released 2025 MIPS performance feedback and final scores, which put payment adjustments in front of clinicians. On Affordability & Coverage, Wakely finds commercial premiums are outpacing general inflation, driven by ACA individual market claims trends, medical and pharmacy costs, insurer retention and projected morbidity. Becker's Payer reports that five governors are pressing HHS to delay Medicaid work requirements, a sign of coverage volatility ahead for at-risk populations.