We’ve used data from our 2025 Disease Burden Management Program (DBM) along with feedback collected from our ACN partners to build our 2026 DBM Program. Here’s a look at what’s coming.
We’ve updated how we calculate payout for the Chronic Condition (HCC) Recapture Rate Incentive for high-performing ACNs
Because it’s increasingly difficult for high-performing ACNs to improve their HCC recapture percentages, we’ve adjusted how the incentive is calculated for high-performers. If an ACN achieves a recapture rate of 85% or higher, we’ll review both:
- Their total recapture rate increase which includes recapture from any risk-adjusted eligible encounter, including but not limited to PCPs, specialists, hospitals and more, and
- Their PCP recapture rate increase (a new metric in 2026 and specific to PCPs only)
We’ll use whichever percentage is higher to calculate earnings for the HCC Recapture Rate Incentive, based on the current scale of 2%, 4% or 6% improvement. See below for examples.
- Example 1:An ACN’s baseline is at 83% for total recapture, and they achieve 85% total recapture for the program year. The ACN’s PCP recapture rate baseline is at 56%, and they achieve 60% recapture. The ACN’s incentive earnings will be calculated based on their PCP recapture of 4%, which is $4 PMPM.
- Example 2:An ACN’s baseline is 81% for total recapture, and they achieve 83% for total recapture. The ACN will not qualify as a high performer but will receive an incentive based on the 2% total recapture, which is $2 PMPM.
- Example 3:An ACN’s baseline is at 83% for total recapture, and they achieve 85% total recapture for the program year. The ACN’s PCP recapture rate baseline is 56%, and they achieve 62% recapture. The ACN’s incentive earnings will be calculated based on their PCP recapture of 6%, which is $6 PMPM.
- Example 4:An ACN’s baseline is at 83% for total recapture, and they achieve 85% total recapture for the program year. The ACN’s PCP recapture rate baseline is at 56%, and they achieve 57% recapture. The ACN's incentive earnings will be calculated based on their total recapture of 2%, which is $2 PMPM.
ACNs can request to have specific HCCs removed from their patient’s chronic condition recapture list if they can provide supporting documentation to justify the removal
To maintain accuracy in documentation and HCC recapture rates, ACNs who believe a patient’s condition is incorrectly documented may request a review from their DBM Provider Programs Specialist. The specialist will conduct a chart audit at the HCC level to assess whether the condition is appropriately supported for the date of service . If the condition is found to be unsupported—and has not been billed elsewhere during the program year—it will be excluded from the ACN’s denominator.
We’ve updated our membership lock-in date to align with the PCP Incentive Program (PIP)
To promote consistency across our incentive programs, beginning in 2026, DBM membership will fluctuate monthly until the final lock-in date of October 31, following the same lock-in timeline as PIP.
The Clinical HCC Suspecting Incentive will remain in 2026 DBM for select ACNs
ACNs who didn’t participate in the Clinical HCC Suspecting Incentive in 2025 DBM will have the opportunity to earn this incentive in 2026. Those awarded the incentive in 2025 won’t be eligible for participation in 2026.
Want an in-depth review of 2026 DBM?
Register for our 2026 DBM Program webinar and keep an eye out for the 2026 DBM Program Manual for more details.