Top ten essential value-based care fundamentals your practice cannot miss

The 2026 Medicare Advantage raise is a pause, not a trend. When rates tighten in 2027, these basics will separate a shared savings check from a shortfall.

Primary care has faced a challenging few years. V28, the new Medicare Advantage risk adjustment model from the Centers for Medicare & Medicaid Services (CMS), was phased in starting in 2024 and reached full implementation this year. It reduced risk scores by dropping codes and trimming coefficients, so the same patient panel now produces a lower risk adjustment factor than two years prior, in most cases. Many practices saw their top-line revenue decline: caring for the same patients with less money and a more difficult benchmark to meet. Then, utilization rebounded. Care deferred during the pandemic returned with patients being sicker and more expensive, and CMS also highlighted increased service use in this year’s payment calculations. Every dollar spent now counts against a benchmark that must be exceeded.

Click to read the article on the Medical Economics website.