What KPIs predict success in value-based care arrangements?

Five KPIs determine settlement outcomes: PMPM cost vs. benchmark, Quality Performance Standard score (must be ≥40th percentile to avoid quality penalty), HCC RAF capture rate (≥95% of expected), attribution retention (≥85% year-over-year), and care gap closure rate (≥80% by year-end). Underneath those, AWV completion, hospitalisation rate per 1,000, post-acute leakage, and specialist leakage are the highest-leverage drivers. Top-quartile ACOs hit all five; bottom-quartile ACOs miss on two or more.

Each VBC settlement metric is determined by a specific operational KPI underneath it. PMPM cost is driven by hospitalisation rate, post-acute leakage, specialist leakage, and AWV-driven primary care engagement. Quality score is driven by care gap closure across the APP measure set (diabetes A1C, CBP, BCS, COL, fall risk, statin therapy, tobacco, depression, AWV). HCC capture is driven by AWV completion rate and the rigour of HCC documentation in primary care visits. Attribution retention is driven by visit frequency — beneficiaries who don't see their attributed PCP within the lookback period get re-attributed elsewhere. The "leading indicators" are these operational KPIs; the "lagging indicators" are the contract settlement metrics themselves.

The KPI most commonly under-managed is attribution retention. Most ACOs focus on the patients they have and forget that 10–20% will be re-attributed elsewhere next quarter. The mechanism is straightforward: Medicare attributes a beneficiary based on a plurality of primary care visits. A patient who saw your PCP once last year and a competing PCP twice this year will move. The leading indicator is "Medicare beneficiaries in your panel who have not had a PCP visit in 6+ months" — these are at risk of attribution loss. Most ACOs don't track this until the next attribution list arrives and the population has already shifted. Top-quartile ACOs surface this list monthly and run outreach campaigns specifically to drive PCP visits among attribution-at-risk patients.

A practical KPI dashboard for VBC success organises the five settlement metrics with their operational drivers nested underneath each. PMPM gets hospitalisation rate, post-acute leakage rate, and AWV completion. Quality gets per-measure gap roster sized in dollar terms. HCC capture gets the suspected-HCC patient list with AWV scheduling status. Attribution retention gets the no-PCP-visit-in-6-months list. Care gap closure gets the per-patient gap roster ranked by revenue value. Updated continuously, not quarterly. Available to PCPs as patient lists, not just to executives as charts.