From fb58e3ca53f07140f919ba77489504d6581bbb91 Mon Sep 17 00:00:00 2001 From: Teleo Pipeline Date: Fri, 27 Mar 2026 15:10:57 +0000 Subject: [PATCH] extract: 2026-03-20-kff-cbo-obbba-coverage-losses-medicaid Pentagon-Agent: Epimetheus <0144398e-4ed3-4fe2-95a3-3d72e1abf887> --- ...ouch value metrics but only 14 percent bear full risk.md | 6 ++++++ 1 file changed, 6 insertions(+) diff --git a/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md b/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md index 8f737a515..ffd1c0639 100644 --- a/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md +++ b/domains/health/value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk.md @@ -73,6 +73,12 @@ VBC transitions face a second stall mechanism beyond the payment boundary: popul --- +### Additional Evidence (extend) +*Source: [[2026-03-20-kff-cbo-obbba-coverage-losses-medicaid]] | Added: 2026-03-27* + +OBBBA adds a new VBC stall mechanism beyond payment structure: population instability. Even when payment is fully risk-based, semi-annual Medicaid redeterminations (starting October 2026) create enrollment churn that breaks the multi-year patient relationships VBC prevention economics require. CBO projects 700K additional uninsured from redetermination frequency alone, concentrated in the expansion population where VBC pilots were most active. + + Relevant Notes: - [[healthcare is a complex adaptive system requiring simple enabling rules not complicated management because standardized processes erode the clinical autonomy needed for value creation]] -- the systems framework for why payment reform alone fails - [[four competing payer-provider models are converging toward value-based care with vertical integration dominant today but aligned partnership potentially more durable]] -- the structural models competing to deliver on VBC