What You Will Learn
- Why 2026 raises the stakes for VBC organizations - what has materially changed since 2025 and what demands immediate attention
- How the highest-performing VBC organizations are structuring team-based care to stay ahead of rising regulatory expectations
- What separates organizations that retain physicians from those that lose them — and why it directly affects clinical performance
- How AI is solving the unstructured patient data problem at the point of care, not just in the back office
- Why the real measure of AI's value in VBC is whether patients feel the difference — and what that looks like in practice
Value-based care is not getting easier. In 2026, healthcare organizations that made the commitment to risk-based contracts are navigating higher Stars thresholds, fully implemented HCC V28 coding standards, and MSSP benchmark resets that will lock in performance expectations for the next multi-year period. The window to build competitive advantage through better risk adjustment, quality performance, and clinical workflow efficiency is narrowing.
The strategies that separate high-performing VBC organizations from the rest have become clearer over the past year. Drawing on expert perspectives from Dana McCalley, VP of Value-Based Care at Navina, Dr. Vivek Garg, MD, MBA, Chief Medical Officer for Primary Care at Humana, and Dr. Yair Lewis, MD, PhD, Chief Medical Officer at Navina, here are five strategies that define value-based success in 2026.
1. In 2026, the bar for value-based success is higher - and the clock is moving faster
The HCC V28 risk coding model is now fully implemented. For organizations that adapted their coding workflows early, V28 has strengthened their RAF accuracy and competitive positioning. For those still catching up, the gap is widening with every quarter. V28 was one change. It will not be the last.
In parallel, Stars quality thresholds continue to rise, Medicare Advantage reimbursement conditions have tightened, and MSSP ACOs that launched in 2022 are approaching benchmark reset years - meaning 2026 risk scores will set the ceiling for their next multi-year agreement period. The pace of change has not slowed.
Dr. Garg captured this pressure precisely: "2025 is about perseverance. If you've made the commitment to truly change the value equation for the patients you serve, this is a challenging time. You've made investments. You've changed how your care teams work. You've built data and analytics. You've changed your contracting arrangements."
That framing is even more true in 2026. As Dr. Garg explained: "We've got to keep making it work and progressing towards that value equation so that we can get there faster. Because the environment has changed in so many ways."
Pro Tip: V28 will not be the last change. New CMS payment models, rising Stars thresholds, and tighter RADV scrutiny are already forming. Optimize your workflows to proactively address these changes.
2. The organizations winning in VBC have solved team-based care
Team-based care is not a novel concept in value-based care. What separates high-performing organizations in 2026 is not whether they have adopted it, but how well they have operationalized it. The coordination complexity that Dr. Garg described - managing more people, more interactions, more information across a larger care team - has not decreased. It has increased as panels grow and contracting arrangements add layers of accountability.
“Inevitably, in this value-based care journey, there are more people on our team or other teams that we’re coordinating with who need to do things with our patients or each other. That introduces a lot of complexity and day-to-day work: indication complexity, information coordination complexity,” noted Dr. Garg. “So orchestrating team-based care – a team sport, which is one of the core ways to move the needle on value-based care – is a fundamental challenge we have.”
Pro Tip: Measure clinician satisfaction the same way you measure clinical performance - formally, with feedback loops and leadership accountability. Organizations that do are better positioned to address burnout before it affects coding accuracy and staff retention.
3. Clinician satisfaction is a VBC performance lever, not a benefit package line item
The connection between clinician satisfaction and VBC performance is measurable, not theoretical. Burned-out physicians document less accurately, engage less with care gap closure protocols, and leave practices at higher rates, disrupting the continuity and team-based workflows that value-based care depends on.
One step Dr. Garg described is having leadership that brings together physicians and operational professionals. “Every geography of our care teams has a physician leader and an operational leader that are essentially joined at the hip,” he explained. “[That’s] a leadership team that has reconciled the tensions that are inherent in doing patient care and trying to integrate all the different purposes that we do [it] for. Because they can all meld: you can reduce the total cost of care while improving patient care quality and outcomes, and meeting the standards of value-based care programs.”
Dr. Garg also discussed other steps that his team has taken to help ensure high clinician satisfaction, such as implementing a clinician experience survey and using its insights to make improvements. In addition to factors like competitive salaries and benefits, he emphasized the value of having mechanisms for “celebrating patient care stories” and helping clinicians feel recognized and appreciated for their work. “We’ve got to reactivate some delight and joy in practice – and make that not just talk, by being willing to invest in it in different ways,” he said.
Learn how Navina improved value-based care performance for CVFP.
4. Is your patient data working for you, or burying your clinicians?
In 2026, the volume of patient data a primary care physician is expected to process has not decreased. EHR notes, HIE records, specialist correspondence, lab results, scanned documents, claims files - the list of data sources has grown as interoperability has improved. More data reaching the physician is only an advantage if it arrives in a usable form at the right moment.
Dr. Lewis discussed this challenge, providing some valuable context. Reflecting on how much more advanced the state of medicine is today than it was in the past, he remarked, “There are more tests, there are more medications than have ever been available. [And] that’s great. We’re able to treat those diseases – [such as] diabetes, cardiovascular disease – better than we have ever been able to treat them. But on the other hand, the flipside of that is there’s just so much data. And although the state of interoperability is definitely improving … there’s still a lot of data that is either not being shared in the right format or is just unstructured.”
Dr. Garg also discussed the challenge of dealing with so much patient data and how Humana is taking steps to address it. “[Dealing with large volumes of patient data is] not reducing the total workload; it’s adding to it. People know it’s important, and yet we need to maintain our workforce, help them be sustainable, help them retain that time with patients. And so I think operational excellence [and] technology enablement are huge things,” he said. “We are investing in new technology platforms, and we are questioning how we use data and get it into the point of care, so that it’s most useful for our teams [and] so that we can expand the pie of what we do for patients, without essentially making people feel like it’s unmanageable.”
Organizations that have solved this problem share a common approach: they have moved data processing upstream, using AI to aggregate and interpret information before the visit rather than expecting clinicians to perform that synthesis themselves. The result is not less data; it is the right data, surfaced at the point of care, linked to its source, and prioritized by clinical relevance.
Pro Tip: The critical question when evaluating AI platform is not whether they process data; it is whether they surface the right data, linked to its source, at the point of care. Suggestions a physician cannot verify get ignored. Navina's 77% acceptance rate is driven by one thing: every suggestion shows its evidence.
5. The real measure of AI in VBC: do your patients feel the difference?
Healthcare AI is often evaluated on what it saves administrative teams: hours of back-office coding review, reduced manual chart searches, faster documentation. Those are real gains. But the organizations that extract the most value from AI investments in 2026 are those that trace the benefit all the way to the patient interaction.
Dr. Garg discussed the importance of time and attention from the perspectives of both clinicians and patients, and how AI can benefit both parties by saving time for clinicians. “When I talk to our clinicians about why they joined our model – where they have smaller panel sizes but more complex patients and more that we ask them to do, and we hold them accountable [for] outcomes – they say they want the time with their patients,” he explained. “When we ask our patients what they value about our model, they say [they] value the time with our clinicians and care team members. And so, the ability of this technology to shift how we use our time and how our teams can use their time is the single most transformative thing we can do.”
An independent AAFP study across 1,600 providers found that Navina's AI copilot saved 9 minutes of chart review per complex patient visit. For a physician seeing 20 complex patients a day, that is 3 hours returned to direct patient care. That time does not disappear into administrative efficiency. It goes back into the room.
For a deeper understanding of all of these key takeaways and more, please check out the webinar video on-demand.
Key Takeaways
- HCC V28 is fully implemented in 2026. Organizations that built prospective coding workflows during the transition are pulling ahead; those still relying on retrospective methods are widening the performance gap.
- Team-based care is the operational backbone of VBC success - not a philosophy, but a structural model that pairs physician leaders with operational leaders and coordinates care across an expanded team.
- Clinician satisfaction is a VBC performance variable, not a soft HR concern. Organizations that measure and act on physician experience data outperform those that do not.
- Patient data is only an asset when it is structured, synthesized, and surfaced at the point of care. The organizations solving this problem with AI are seeing measurable improvements in HCC accuracy, care gap closure, and physician time.
- The ultimate ROI of AI in value-based care is time - physicians get it back, and patients feel it in the quality of the interaction.
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