ACO Mid-Year Performance: The Quality Measures You Need to Fix Before MSSP Reconciliation

By mid-year your ACO's quality measure direction is largely set. The patients in the denominator are mostly the patients who will be there at reconciliation. The interventions you start in Q3 will only move a subset of measures. Six measures most often drift between Q1 and Q4 — surfacing them in February gives you eight months to act; surfacing them in October leaves you two.

The six measures that drift

1. Diabetes A1C poor control (CMS122v12). Patients who entered the year with A1C <9 can drift above 9 by Q3 if medication adherence slips. The intervention window is a Q2 outreach.
2. Controlling high blood pressure (CMS165v11). The measure uses the most recent BP in the year. A patient with a stable controlled BP in March can show an uncontrolled reading in October, which is what counts. Q3 in-office BP recheck visits move this one.
3. Colorectal cancer screening (CMS130v11). Patients aging into eligibility through the year need outreach. Practices that don't auto-flag 45-year-olds for FIT testing accumulate misses by Q4.
4. Depression screening and follow-up (CMS2v12). The follow-up component is the drift driver. Screens happen; documented follow-up plans don't always.
5. Statin therapy for cardiovascular disease (CMS347). Patients started on statins in Q1 who discontinue by Q2 (side effects, cost, adherence) drop out of the numerator.
6. Falls risk assessment in older adults (CMS139). Process measure that requires documentation, not just clinical action. Easy to miss documentation; hard to remediate at year-end.

What to do in February

Pull each measure's denominator and numerator for January. Look at:

• Which patients are missing from the numerator.
• Whether the gap is documentation (workflow) or clinical action (intervention).
• Whether the gap concentrates with specific providers, payers, or panels.

Documentation gaps are recoverable in Q1 with a workflow change. Clinical gaps need outreach campaigns that take 60-90 days to show in the measure.

The MSSP reconciliation tie-in

For MSSP ACOs, quality measure performance affects shared savings. The reconciliation calculation looks at quality as a multiplier on savings — bad quality numbers can zero out a positive savings result. Mid-year quality intervention is therefore not just a clinical concern; it's a financial one.

Combine quality tracking with MSSP attribution monitoring to see the full reconciliation picture.

What the analytics layer must do

Quality measure tracking for an ACO requires:

• Continuously updated denominator membership as patients age in / change coverage.
• Real-time numerator counting, not month-end batch.
• Patient-level drill-down so care coordinators can act on individual gaps.
• Provider-level rollups so leadership can target intervention.

Vizier connects to your EHR via direct connector and ships ACO quality measure analytics out of the box.