Evolving Primary Care Reimbursement in 2027: Introducing ValueBlue and ValueBlue Connect

Primary care providers are the quarterbacks of patient health, coordinating care, managing chronic conditions, closing care gaps, and helping patients stay healthy. Yet traditional fee-for-service payment models often don't recognize or reimburse much of the work that happens outside the exam room.

That’s why we at Highmark are excited to announce our new partial capitation and incentive models – ValueBlue and ValueBlue Connect – launching Jan. 1, 2027. These will replace our current PCP fee-for-service and True Performance programs. 

We are shifting the standard primary care payment model from fee-for-service to a partial capitation model called ValueBlue. This approach is designed to provide more stable, predictable revenue for your practice while empowering you to focus on population health management by rewarding patient outcomes, not just office visits.

Complementing ValueBlue, ValueBlue Connect offers incentive opportunities that reward quality outcomes, care coordination, and overall value.

Two Programs. One Connected Approach.

ValueBlue is our partial capitation model (western New York providers know it currently as BestPractice). It combines a monthly payment for attributed members with continued fee-for-service reimbursement for preventive and wellness services.

ValueBlue builds on a model that has already demonstrated success in western New York, where providers saw increases in preventive care and reductions in avoidable utilization.

ValueBlue Connect is the incentive program that complements ValueBlue by rewarding outcomes. Providers will have flexibility to select certain performance measures that align with their organization's strengths and strategic priorities, helping them focus on the areas that matter most to their patients and communities.

Key Benefits of the Shift

• A stable monthly payment supports patient outreach, care coordination, and other activities that improve health outcomes but often occur outside of traditional face-to-face office visits.
• Rather than holding PCPs directly accountable for the entire Total Cost of Care, the model focuses on areas primary care teams can influence most directly, including quality, care delivery, appropriate utilization, and patient experience.
  
• ValueBlue Connect allows organizations to select elective performance measures that align with their strengths and strategic priorities, creating opportunities to focus on what matters most for their patients.
  

Designed Around What Matters Most

Together, ValueBlue and ValueBlue Connect simplify Highmark's primary care reimbursement approach while creating stronger alignment between provider payment and member outcomes.