Value-Based Contracting

CMS’ CY 2027 OPPS and Medicare PFS proposals are intensifying provider-payer tensions around site-neutral payment, 340B policy, and specialty reimbursement, with hospital groups warning the changes could undercut safety-net and outpatient economics while VBC advocates press for stronger incentives to shift care to lower-cost settings and accountable models. At the same time, HHS OIG found Medicare Part D sponsors made $587.7 million in ineligible payments for OTC-available drugs labeled prescription-only, sharpening scrutiny on plan oversight, pharmacy claims integrity, and risk-bearing entities’ medication cost management in MA, ACO, and payer contracts (OIG report). Rural hospital stabilization remains a near-term flashpoint as Georgia receives $93 million in federal aid, but local leaders say the funding is insufficient—raising questions for ACOs and Medicaid managed care plans about network adequacy, rural access, and whether VBC participation is feasible without more durable operating support ([Georgia rural hospital aid](https://www.atlantanewsfirst.com/2026/09/02/georgia-hospitals-get-93m-federal-aid-rural-leaders-say-it-wont