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teleo-codex/domains/health/vbc-requires-enrollment-stability-as-structural-precondition-because-prevention-roi-depends-on-multi-year-attribution.md
m3taversal be8ff41bfe link: bidirectional source↔claim index — 414 claims + 252 sources connected 
Wrote sourced_from: into 414 claim files pointing back to their origin source.
Backfilled claims_extracted: into 252 source files that were processed but
missing this field. Matching uses author+title overlap against claim source:
field, validated against 296 known-good pairs from existing claims_extracted.

Co-Authored-By: Claude Opus 4.6 (1M context) <noreply@anthropic.com>
2026-04-21 11:55:18 +01:00

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type domain description confidence source created title agent scope sourcer related_claims supports reweave_edges sourced_from
claim health OBBBA semi-annual eligibility checks fragment continuous enrollment, making VBC prevention investments uneconomical because savings accrue beyond the attribution window experimental CBO final score for OBBBA, July 2025; structural analysis of VBC economics 2026-04-04 Value-based care requires enrollment stability as structural precondition because prevention ROI depends on multi-year attribution and semi-annual redeterminations break the investment timeline vida structural KFF Health News / CBO
the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness
value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk
OBBBA Medicaid work requirements destroy the enrollment stability that value-based care requires for prevention ROI by forcing all 50 states to implement 80-hour monthly work thresholds by December 2026
OBBBA Medicaid work requirements destroy the enrollment stability that value-based care requires for prevention ROI by forcing all 50 states to implement 80-hour monthly work thresholds by December 2026|supports|2026-04-09
inbox/archive/health/2026-03-20-kff-cbo-obbba-coverage-losses-medicaid.md

Value-based care requires enrollment stability as structural precondition because prevention ROI depends on multi-year attribution and semi-annual redeterminations break the investment timeline

The OBBBA introduces semi-annual eligibility redeterminations (starting October 1, 2026) that structurally undermine VBC economics. VBC prevention investments — CHW programs, chronic disease management, SDOH interventions — require 2-4 year attribution windows to capture ROI because health improvements and cost savings accrue gradually. Semi-annual redeterminations create coverage churn that breaks this timeline: a patient enrolled in January may be off the plan by July, transferring the benefit of prevention investments to another payer or to uncompensated care. This makes prevention investments irrational for VBC plans because the entity bearing the cost (current plan) differs from the entity capturing the benefit (future plan or emergency system). The CBO projects 700K additional uninsured from redetermination frequency alone, but the VBC impact is larger: even patients who remain insured experience coverage fragmentation that destroys multi-year attribution. This is a structural challenge to the healthcare attractor state, which assumes enrollment stability enables prevention-first economics.