CommercialReimbursementHigh impact
Evolving Primary Care Reimbursement in 2027: Introducing ValueBlue and ValueBlue Connect
Highmark·PA, NY, WV, DE · Family Medicine, General Practice, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Aug 28, 2026
Summary
Highmark is replacing its current PCP fee-for-service and True Performance programs with two new value-based models effective January 1, 2027: ValueBlue (partial capitation with monthly payments for attributed members plus fee-for-service for preventive/wellness services) and ValueBlue Connect (incentive program rewarding quality outcomes and care coordination). This fundamentally changes how primary care providers are reimbursed, shifting from visit-based billing to population health management with stable monthly payments.
Action Required
By December 31, 2026: Billing team must transition all primary care provider reimbursement workflows from fee-for-service and True Performance models to ValueBlue and ValueBlue Connect. Actions required: (1) Update billing system configuration to process monthly capitation payments for attributed members in ValueBlue; (2) Reprogram fee-for-service reimbursement rules to apply only to preventive and wellness services under ValueBlue; (3) Configure ValueBlue Connect performance measure tracking and incentive calculations based on selected organizational metrics; (4) Train billing staff on new payment reconciliation and monthly capitation billing processes; (5) Update provider contracts and encounter documentation to align with capitation model; (6) Contact Highmark at providers.highmark.com/valueblue to confirm eligibility, obtain program details, and receive implementation support. Providers must select performance measures for ValueBlue Connect prior to January 1, 2027. Failure to transition may result in billing delays and payment processing errors when old programs terminate.