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CMS is asking a question they don't ask often: is primary care fundamentally undervalued? That question is driving a lot of what's in this edition.

CMS Wants to Redesign Primary Care. Here's What They're Asking.
Medicaid Fraud War Room flags $203M, physicians unionize, and more
Upcoming webinars you should have on your calendar

CMS Wants to Redesign Primary Care. Here's What They're Asking.

If you've been waiting for a signal that CMS is serious about revaluing primary care, this is it.

The CY 2027 Medicare Physician Fee Schedule includes a request for information titled "Redesigning Primary Care To Make America Healthy Again." It covers everything from how E/M visits are valued to what it would look like to embed technology into primary care workflows.

Jake Quinton, CMS's chief medical officer for Medicare Parts A and B, called it "one of the more substantive requests for information in this really broad fee schedule."

CMS is seeking comment on three fronts: whether primary care services are undervalued, the payment implications of technology enablement (including AI), and how prospective payment within the MSSP could evolve.

The draft already has over 1,600 comments as of early August. The deadline is September 14. If your organization touches value-based primary care, this is the moment to weigh in.

Read the full piece

Medicaid Fraud War Room flags $203M, physicians unionize, and more

Medicaid Fraud War Room Flags $203M in First 88 Days

CMS's Medicaid Fraud War Room released its first official report. The data-driven unit flagged 50 high-risk Medicaid providers linked to $203.3 million in 2025 payments, using machine learning to catch suspicious billing before payments go out.

The OIG issued 42 federal notices of intent to exclude providers, and states took 15 enforcement actions based on War Room referrals
No funds have been recovered yet, and notices of intent are not criminal charges
The unit is part of a broader shift toward prepayment fraud prevention rather than after-the-fact recovery

Key Takeaways from the CY 2027 Proposed Rule Webinar

VBC Exhibit Hall and Patient 360 hosted a deep dive on the proposed rule. Amanda Lord walked through the major MSSP changes, MIPS updates, and ASM refinements.

Beneficiary assignment changes could bring higher-cost patients into ACO panels, with CMS simulations showing an average 3.9% dip in gross savings for affected ACOs
CMS proposes sunsetting full MIPS Promoting Interoperability reporting at the ACO level, replacing it with a single attestation option
The A+ measure set moves to eight measures, but the scoring safety net narrows significantly, and CMS is seeking comment on that tradeoff
Traditional MIPS is proposed for sunset in 2029, with MVPs becoming the only reporting option

After Chiles, States Lack a Clear Map for Regulating Speech-Based Health Care

The Supreme Court's 8-1 ruling in Chiles v. Salazar classified talk therapy as protected speech, requiring strict scrutiny for viewpoint-based regulation. The implications extend to psychiatrists, nutritionists, addiction counselors, and palliative care consultants. Licensing boards face new uncertainty around enforcing standards of care for speech-based treatment.

Also this week: nearly 10,000 UC attending physicians are moving to unionize with SEIU Doctors United, citing unsustainable patient loads and shrinking clinical autonomy.

Upcoming webinars you should have on your calendar

Think Like a Value-Based Care Consultant for Your Organization's Success
August 12, 2026 | Free Webinar
WellSky and VBC Exhibit Hall partner with national VBC consultant Karen Burke to walk through how to frame VBC challenges through the Quadruple Aim, assess where your organization stands today, and build a care coordination roadmap from strategy to implementation.

A Friday Follow Up to Avoid the Weekend Admission
August 26, 2026 | Free Webinar
Altitude Cares leadership presents an AI clinical case review on complex-chronic transitions of care, exploring the value impact of AI-native workflow on medical group economics. Presented by Dr. Brett Ives, Chief Clinical Officer, and Sean O'Donnell, Head of Partnerships.

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