Key Takeaways:
- V28’s code eliminations and coefficient reductions have significantly lowered RAF (Risk Adjustment Factor) scores, making insufficient documentation a costly oversight and compelling practices to meticulously “code to the truth” every year to stave off artificially suppressed benchmarks.
- ADT (Admission-Discharge-Transfer) feeds are transformative, enabling near-instant transition workflows. This supports timely post-discharge outreach within two business days, facilitates medication reconciliation, and expedites follow-up, all of which directly mitigate readmissions and unnecessary expenditures.
- Optimal use of clinical staff—“top-of-license” deployment— via standing orders and collaborative, team-based workflows, increases physician availability, reduces burnout, and ensures gaps in preventive care, quality, and documentation are addressed during routine appointments.
- Contractual details—benchmarking, attribution, quality requirements, and data access—play a pivotal role in whether operational excellence can yield financial rewards, positioning pre-signature contract diligence as the most critical financial safeguard.
- Effective panel stratification, proactive patient engagement, data-driven management, and physician-led governance with aligned compensation are essential to focus resources on high-cost drivers and prevent value-based initiatives from devolving into mere administrative exercises.
Navigating a Shifting Landscape in Primary Care
Primary care organizations have endured a turbulent period recently. The introduction of V28, the new Medicare Advantage risk adjustment model by the Centers for Medicare & Medicaid Services (CMS), marked a significant turning point. Phased in beginning in 2024 and fully implemented this year, V28’s methodology recalibrated how patient risk is assessed and compensated. By removing certain codes and reducing coefficients, this change has caused most practices to see a drop in their overall risk scores. For many, this means delivering the same standard of care for the same patient population—but with reduced reimbursement and more stringent benchmarks.
This financial tightening was compounded as patient utilization patterns shifted. Care postponed during the pandemic returned in full force, with patients often presenting sicker and incurring higher costs. CMS further acknowledged this uptick in utilization in their payment calculations for the current year, emphasizing that every healthcare dollar now weighs more heavily against increasingly challenging benchmarks.
Then came a brief reprieve: the 2026 Medicare Advantage rate announcement introduced a 5.06% average payment increase, infusing over $25 billion of new funding into the system. For many, it appeared as if the tide had at last turned.
However, this relief was temporary. The 2027 rate announcement has already confirmed a much slimmer increase of just 2.48%—less than half of the previous year’s bump. The ample funding seen in 2026 is a one-off, not the start of a new trend. Meanwhile, underlying structural pressures remain, including the full effects of V28, persistently high utilization rates, and a slate of 2027 policies designed to accelerate the shift of financial risk onto providers. When payments are generous, operational inefficiencies may be masked; in leaner years, only those who master the fundamentals will remain viable.
Ten Value based care Fundamentals Practices Can’t Afford to Overlook
In this landscape, success hinges on execution. Here are ten essential Value based care fundamentals—none novel, but all critical—whose consistent application often makes the difference between earning shared savings and facing financial shortfalls.
1. Maximize Every Team Member’s Scope
A common pitfall for practices new to value-based care is maintaining a fee-for-service mindset, where physicians handle tasks that could be delegated to other licensed professionals like medical assistants, LPNs, or RNs. By leveraging standing orders—which authorize staff to manage vaccines, screenings, documentation gaps, social needs assessments, and point-of-care testing—practices empower their teams to act proactively without waiting for physician intervention.
If a physician spends even 45 minutes per day on tasks that could be delegated, the practice forfeits substantial clinical capacity and risks exacerbating provider burnout. In aggregate, this translates to lost revenue and diminished morale—both of which undermine the mission of value-based care.
2. Treat ADT Feeds as Non-Negotiable
Admission-Discharge-Transfer (ADT) feeds are crucial for high-performing value-based care. Without real-time notifications, practices may learn of a patient’s hospital admission or discharge only when a delayed fax of the discharge summary arrives—often a week or more later, rendering any intervention moot.
ADT feeds transform transitions of care from passive hopes into actionable workflows. They are one of the most underutilized yet powerful data streams in healthcare, enabling near-real-time interventions that prevent readmissions and reduce costs.
3. Commit to Coding to the Truth
“Coding to the truth” is not synonymous with upcoding or artificially inflating risk. Instead, it means ensuring that every chronic condition and clinically relevant fact is reliably documented and coded each year. For example, a patient on multiple medications for heart failure and diabetes should have a chart that accurately reflects her complex history.
Failure to thoroughly document conditions leads to artificially low benchmarks and makes achieving savings targets much harder. Under V28, this is especially punitive, as under-documentation now carries even greater financial consequences.
4. Run Efficient Morning Huddles
A morning huddle—a 10-minute meeting before the first patient arrives—can dramatically improve workflow. The care team reviews the day’s schedule, flags open gaps or recent transitions, and assigns responsibilities for gap closure and follow-up. Addressing a care gap during a scheduled visit typically takes just a few minutes. If deferred, it often requires additional calls, documentation, and sometimes more appointments—each adding cost and complexity.
Skipping huddles doesn’t reduce workload; it simply pushes it later and makes it more expensive. Building this discipline into daily routines pays dividends in efficiency and outcomes.
5. Know the Contract Inside Out Before Signing
The biggest financial risk in value-based care is entering into a contract without fully understanding its terms. The benchmarks, attribution methodology, quality thresholds, and access to essential data are all set in the contract language—long before the first patient encounter.
Spending months developing workflows is futile if the contract fundamentally limits your ability to succeed. Pre-signature diligence—thoroughly reviewing and negotiating contract terms—is the most critical financial control point in any value-based arrangement.
6. Stratify Your Panel and Focus on High-Cost Drivers
Managing an entire panel of attributed patients as a monolith is both inefficient and ineffective. In reality, a small subset of patients account for the majority of avoidable costs. These individuals require intensive management, including dedicated care plans, proactive outreach, and close monitoring.
Skipping panel stratification spreads limited resources too thin, negating the benefits of care management programs. Practices must focus care management resources on patients who will move the needle most in cost and outcomes.
7. Close the Loop After Care Transitions
The post-discharge period is one of the highest-risk moments for patients. The most effective intervention is a two-day follow-up call after discharge, which includes medication reconciliation, checking for red flags, and scheduling a timely follow-up appointment—ideally seeing the most vulnerable patients within 48 hours.
This is only possible if you have up-to-date discharge information via an ADT feed. Hospitals win or lose on readmissions; practices win or lose on their ability to prevent them, starting with prompt post-discharge action.
8. Proactively Activate Patients
Most practices rely on reactive outreach—contacting patients when a care gap is identified by measure or report. However, the most effective approach is proactive engagement, establishing patient relationships and activating them before gaps even arise.
This preemptive strategy builds trust and makes future gap-closure conversations smoother and more successful. Proactive patient engagement is often what separates high-performing practices from the rest.
9. Measure Everything and Manage to the Metrics
While billing and collections are meticulously tracked, value-based performance metrics too often go unmeasured. Establishing a clear, executive-level dashboard that presents clinical, financial, patient experience, and operational data in one place is essential.
Such transparency enables leaders to pinpoint where the practice is excelling and where improvements are needed. What gets measured gets managed—especially in lean years, when even small drifts in performance can have outsized impacts.
10. Make Value-Based Care a Physician-Led Program
The single most powerful success factor is physician ownership. Value-based care programs falter when they are seen as administrative mandates that doctors must merely accept. They thrive when physicians govern the initiative, have direct access to performance data, and—most importantly—when the practice’s compensation model directly rewards the outcomes the value-based contract is designed to incentivize.
If physicians are still rewarded based on volume while contracts reward value, the value-based model will fail. Align internal incentives with external contracts, or none of the above fundamentals will matter.
Value based care Fundamentals Are the Only Constant
None of these recommendations are new or exotic. That is, in fact, their strength. In a year with a 5% funding increase, a practice may get by even if it overlooks half of these fundamentals. But when funding growth drops to 2.5% or lower, margins tighten, and only those who execute consistently on the basics will thrive.
The rate environment is cyclical, but mastery of the Value based care fundamentals is timeless. Prepare for lean years now—because they are already scheduled.