ACO & Value-Based Performance Enablement
Connect clinical and operational improvement to the financial measures in your contracts
Quality, risk and utilization work only pays off when it reaches the measures your contracts are scored on. We track the KPIs that drive Star Ratings, quality withholds, risk adjustment, care management billing and shared savings, and tie each improvement to the contract term it affects.
- Star Ratings and withholds
- MSSP, ACO REACH and LEAD
- ROI modeled on your own data
Who it's for
Built for the organizations that carry this work
ACOs and risk-bearing entities
MSSP and ACO REACH participants preparing for 2027, and organizations evaluating the LEAD Model.
Medicare Advantage networks
Groups with Star-linked incentives, quality withholds or percent-of-premium contracts.
Value-based contract holders
Practices and clinically integrated networks with shared-savings or pay-for-performance terms across several payers.
What we do
What you receive
- 01
Contract-to-measure map
Each contract mapped to the measures, thresholds and withholds it pays on, so the team knows what moves money.
- 02
Quality and operational KPIs
HEDIS composite performance, AWV completion rate, CCM enrollment and care gap closure rate, tracked monthly.
- 03
Risk and utilization KPIs
RAF score accuracy, readmission rate, ED visits per 1,000 and HCC audit completion.
- 04
Provider-level reporting
Scorecards by practice and provider, so improvement is visible where the work happens.
- 05
Program ROI modeling
Projections built from your practice-specific data, never from generic benchmarks.
- 06
Participation readiness
Quality reporting readiness and a review of the MSSP and LEAD terms on offer, with the change timeline for 2027.
How it works
Access. Design. Execute. Monitor.
The operating rhythm behind every engagement.
- 1
Access
Connect and diagnose through data: shared insight from your quality, risk and utilization data, targeting the highest-impact gaps first.
- 2
Design
Align people, then redesign workflows, through structured, trust-building conversations that reveal operational breakdowns.
- 3
Execute
Pilot, shadow and hardwire reliability: workflow redesign with your team, validated in real conditions.
- 4
Monitor
Measure, report and loop back: KPI tracking and provider-level reporting feed results back into the data.
Program facts
Codes, requirements and rules
Where the financial impact comes from
Every source depends on your contracts and population, which is why projections are modeled on your own data.
Star Rating improvement
- What drives it
- Bonus tied to HEDIS and operational execution, passed through by the plan under your contract.
Quality withhold recovery
- What drives it
- Earning back dollars your contracts already put at risk.
Accurate risk adjustment
- What drives it
- RAF that reflects true patient complexity: accuracy, not inflation.
Billable care management
- What drives it
- CCM, AWV and TCM services that are delivered and documented.
Avoidable utilization savings
- What drives it
- Fewer readmissions and ED visits per 1,000, which protects shared savings.
What changes in 2027
As of September 2026; proposed items may change in the final rule.
- ACO REACH ends December 31, 2026; the LEAD Model runs from performance year 2027 through 2036 (final).
- LEAD: fixed 2024–2026 baseline, 3% quality withhold, and a symmetric 3% cap on risk-score growth (4% for High Needs).
- MSSP (proposed in the CY 2027 PFS proposed rule): APP Plus trimmed to eight quality measures, and changes to BASIC track duration and prior-savings scaling.
- Star Ratings: eleven mostly administrative measures leave between the 2028 and 2029 ratings, so clinical measures carry more weight (final).
See the CY 2027 Medicare Advantage & Value-Based Care FAQ for details and sources.
FAQs
Common questions
Can you tell us what we will earn?
Not before seeing your data. Program ROI modeling uses your practice-specific data for final projections, and the result depends on your contracts, population and execution. We do not promise revenue or savings.
Which KPIs do you track?
Quality and operational: HEDIS composite performance, AWV completion rate, CCM enrollment and care gap closure rate. Risk and utilization: RAF score accuracy, readmission rate, ED visits per 1,000 and HCC audit completion.
We are staying in MSSP. What changes for 2027?
The CY 2027 Physician Fee Schedule proposed rule would trim APP Plus to eight quality measures and change several track and benchmark terms. The final rule was expected around November 1, 2026, so confirm the final provisions before planning.
Do you negotiate payer contracts?
We do not act as your contracting agent. We map what each contract pays on and model the effect of performance changes, so your team negotiates with the numbers in hand.
Read the CY 2027 Medicare Advantage & Value-Based Care FAQ →
Ready to simplify the complex?
Let’s look at your program together.
A consultation is a working conversation about your panel, payers and EHR, and whether this service fits. Please do not send patient information.
Related services
Practice Transformation & Quality Improvement
HEDIS and Star measures, care gap closure, AWV campaigns and care team redesign.
Learn moreRisk Adjustment & Coding Optimization
CMS-HCC V28 risk capture: prospective review, retrospective audits and provider education.
Learn moreComplex Care & High-Utilizer Management
Post-discharge outreach, TCM, readmission and avoidable ED reduction.
Learn more