Value-Based Contracting
Expert articles and analysis related to value-based contracting.
AI Summary — Last 30 Days
CMS is shifting VBC momentum back toward federal mandatory models, with the Trump administration proposing CJR-X as a nationwide mandatory joint-replacement bundle beginning in 2028—giving hospitals, specialists, SNFs, and home health providers time to redesign episode economics, referral networks, and post-acute performance management around downside-risk bundles (HFMA). At the same time, DOJ enforcement against Medicare Advantage risk-adjustment abuse—including large settlements involving Complete Health and The Villages Health—signals that coding-driven VBC economics are facing sharper scrutiny, raising the strategic premium on defensible documentation, clinical validation, and population-health infrastructure over pure RAF optimization (Healthcare Dive). For ACOs, payers, and provider platforms, the throughline is a pivot from MA-led growth toward CMS-directed accountability models, with opportunity for organizations that can manage episodes and total cost of care—but rising compliance and operational risk for those whose VBC playbooks depend heavily on diagnosis capture.
Related Articles
SUSTAIN 340B Act proposes major changes for hospitals and pharmacies
A bipartisan working group in Congress released a preliminary legislative draft that attempts to resolve some of the most disputed aspects of the 340B Drug Pricing Program. One noteworthy provision in...
Is Stark law keeping pace with value-based care?
Is Stark law keeping pace with value-based care? Becker's Physician Leadership
340B Purchases Surge Past $100 Billion
State Pricing Controls at an Inflection Point: MFP and the Shifting PDAB Landscape
3. Value-based care is entering a new phase. Blue Shield of California shares its playbook here.
3. Value-based care is entering a new phase. Blue Shield of California shares its playbook here. - Becker's Payer Issues beckerspayer.com
STAT+: The latest orphan drug exemptions may not be warranted, analysis finds
A new analysis questions the wisdom of a controversial provision in federal law that exempts so-called orphan drugs from Medicare pricing negotiations.
How to make direct contracting finances work
As direct contracting arrangements grow — including one state requiring health systems to offer them — a leading provider identified keys to boosting their finances. Nick Stefanizzi, CEO of Northwell ...
A digital health company became an insurance carrier under the thin veil of a product launch
By DEEKSHA HEGDE How to spot a fundamental business model shift from a mile away, long before the PR calls it a product launch or market expansion. In April 2026, Progyny, aContinue reading...
Highly Novel Drugs Outperformed Less Novel Drugs In Gross And Net Revenues In The US, Driven Primarily By Utilization, 2013–19
Highly Novel Drugs Outperformed Less Novel Drugs In Gross And Net Revenues In The US, Driven Primarily By Utilization, 2013–19 Health Affairs
Senators introduce bipartisan 340B legislation - aha.org
Senators introduce bipartisan 340B legislation aha.org