Healthcare Market Trends

Medicare Advantage and Medicaid managed care remain the immediate pressure points for VBC: a CMS recalculation shifted star-rating economics for at least one Florida payer, while investor reaction to favorable risk-adjustment results for Centene and Oscar underscores how sensitive plan valuations remain to coding, quality, and CMS payment methodology. At the same time, providers are pushing deeper into downside-risk care delivery—Bayada’s new CEO is prioritizing value-based risk beyond traditional payer contracts—while network instability, including the Northwell–Fidelis dispute affecting 240,000 patients, raises near-term access and attribution risks for population health strategies. Cost and governance pressures are also intensifying, with projected health plan cost growth and renewed scrutiny of private equity/corporatization likely to shape payer-provider contracting and regulatory oversight in Medicare, Medicaid, and home-based care models (Bayada value-based risk strategy