ValueBlue Base Rates Set for 2027

As previously announced, starting Jan. 1, 2027, we will launch the ValueBlue partial capitation program.   

What You Need to Do

• Review the 2027 base capitation rate and performance adjustment factor (PAF) information below.
• View your 2027 PAF Report in the Static Reports Application in Provider Facing Analytics (PFA).
• Review ValueBlue Connect incentive program.

2027 Base Rate, Member Adjustment Factor (MAF), and Performance Adjustment Factor (PAF)

• Base Rate: The 2027 base capitation rates by line of business (LOB) are shown below:

• MAF: This is designed to reflect the anticipated healthcare needs of your attributed member population.
  • Commercial and Medicare members will receive a MAF that can be found on the monthly attributed member roster. This roster will be available in Value Insight Center (VIC) starting in 2027.
  • Risk score is a key driver of the Commercial and Medicare Advantage MAFs. Risk scores can be viewed in Highmark’s VIC.
• PAF Components: In 2027, ValueBlue will have two components that Highmark uses to measure the PAF.
  • Quality: Measurement for this component will use the metrics shown in the ValueBlue User Guide.
  • Efficiency: Based on the Emergency Department (ED) Utilization metric.

Highmark uses the PAF to adjust payments to primary care providers (PCPs) based on their performance. High-performing PCPs can receive up to a 40% increase in PAF, while lower-performing PCPs may see a decrease of up to 20% in PAF. You can now view your 2027 PAF Report in the Static Reports application on the PFA platform.

Please note that ValueBlue capitation payments are retrospective. For complete details on base rate, MAF, PAF, and other program components, refer to the ValueBlue User Guide. To access the user guide, go to the ValueBlue and ValueBlue Connect page of the Provider Resource Center (PRC) and click on the "ValueBlue FAQs" button. (Note: You must be logged into the Availity Essentials portal to view the user guide on the ValueBlue Frequently Asked Questions page.)

Explore ValueBlue Connect

Highmark is also introducing a new complementary program, ValueBlue Connect, offering additional opportunities to earn incentive payments while supporting your efforts to deliver high-quality, preventive care.

Review benefits of ValueBlue Connect and additional program information on the PRC's ValueBlue and ValueBlue Connect page.