The Value Signal — October 13, 2026

468 articles scanned · 10 high-signal

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Executive Summary

Value-based care's battleground has shifted from strategy to administrative plumbing: denials, prior authorization mechanics and billing modifiers now decide margins, even as enrollment drifts toward Medicare Advantage and employer coverage.

On Prior Authorization, Medical Economics reports that claim denials are rising while most practices are fixing the wrong problem, that the coming shift to electronic prior auths requires physicians to press their EHR and billing vendors on readiness, and that MedPAC is now examining MA physician networks. The message for VBC operators is blunt: automation will not rescue practices that misdiagnose the root causes of their denials, and network adequacy in MA is drawing regulatory attention.

On Medicare and coverage mix, HFMA reports that employer plans and Medicare Advantage gained enrollees year over year while individual, Medicaid and fully insured plans lost members, citing a Mark Farrah Associates analysis of second-quarter trends. On the fee schedule, ACP has joined national and state medical organizations in objecting to proposed changes to Modifier -25 in the Medicare Physician Fee Schedule, a fight with direct consequences for same-day visit revenue in primary care. On Healthcare Affordability, Health Tech Nerds examined one San Antonio employer's experience while also flagging Atrium's dispute with North Carolina's State Health Plan and the 2027 Stars ratings. Together these items point to growing purchaser and plan friction over cost.