ACO & Value-Based Care Analytics

ACO & Value-Based Care Analytics: Attribution, PMPM, Shared Savings

More than 60% of Medicare payments now flow through value-based arrangements — MSSP, REACH, Medicare Advantage, BPCI Advanced, and commercial risk contracts. Vizier ingests attribution lists from each contract, tracks PMPM cost trends against benchmark, computes contract-specific quality measures, and projects shared-savings or downside-risk outcomes.

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$1.8BShared savings distributed across MSSP ACOs in PY 2023 — concentrated in ACOs with mid-year benchmark visibility
The Data Challenge in Value-Based Care

Attribution Changes Quarterly. Benchmark Adjusts Annually. Most ACOs Don't See Either Until It's Too Late to Act.

An ACO running an MSSP contract carries attribution for thousands to hundreds of thousands of Medicare beneficiaries each year. CMS publishes the attributed list quarterly, the benchmark annually, the Quality Performance Standard updates each rule cycle, and the final settlement arrives 18 months after the performance year closes. By the time most ACOs see a settlement, the analytics window to influence it has been closed for a year.

The financial mechanics compound the complexity. MSSP Pathways to Success requires risk-bearing assumption on a defined schedule. REACH carries professional and global risk options. Medicare Advantage uses RAF scoring with HCC capture as the primary lever for revenue. Commercial VBC contracts vary by payer with bespoke quality measure sets and shared-savings formulas. Each contract needs its own dashboard.

Generic BI tools don't know what an APP measure is, can't compute the Web Interface quality score, and can't reconcile a Medicare Advantage RAF gap against the next AWV visit. Vizier ingests attribution by contract, joins claims and clinical data, computes the measures that determine payment, and surfaces the patients and providers driving the variance.

Attribution and Re-attribution Tracking
Quarterly attribution updates ingested per contract. New attributions surfaced for outreach (annual wellness visits, care management initiation). Lost attributions tagged with the encounter pattern that drove the change so the ACO can intervene where attribution is recoverable.
PMPM Cost Trend vs. Benchmark
Per-member-per-month spend by service category (inpatient, outpatient, professional, post-acute, pharmacy, DME) compared against the contract benchmark. Variance is decomposed by service line, provider TIN, and patient cohort so the leakage and overspend sources are explicit.
HCC Risk Adjustment & RAF Gap Analysis
Suspected HCC categories surfaced from clinical documentation, claims patterns, and chronic condition flags. The patient-level gap list shows which conditions need documentation in the current performance year to maintain or improve the RAF — typically the highest-leverage revenue lever in MA contracts.
Quality Measure Performance — APP, Web Interface, MA Stars
All contract-specific quality measures computed continuously, with patient-level gap rosters. Pre-submission, the projected quality score is visible, with the patients pulling each measure down and the action items required to improve.
What Vizier Tracks

ACO & VBC-Specific Analytics Capabilities

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Multi-Contract Attribution View
Each contract's attributed beneficiaries managed separately while the platform reconciles patients across contracts. A patient attributed to your MSSP ACO and also enrolled in a commercial VBC contract is surfaced once, with both contract contexts visible.
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PMPM Decomposition by Service Category
PMPM cost broken into inpatient, outpatient, professional, post-acute, pharmacy, and DME categories — month over month — with variance vs. benchmark and trend signals. Catches a hospital-utilization spike or a SNF-leakage trend before it becomes a settlement loss.
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HCC Capture & RAF Trend
Suspected HCCs (acute and chronic) flagged from problem lists, encounter diagnoses, and laboratory or medication signals. Each patient's prior-year RAF, current-year-to-date documented RAF, and gap-to-recapture are surfaced so the panel manager can prioritise the highest-revenue conversations.
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APP & Web Interface Quality Measures
All measures used in MSSP quality reporting (Alternative Payment Model Performance Pathway plus legacy Web Interface for ACOs still using it) computed continuously — diabetes A1C poor control, CBP, BCS, COL, fall risk screening, statin therapy, tobacco screening, depression screening, AWV.
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Leakage & Network Performance
Out-of-network utilisation by service category, provider, and PCP attribution. The patients driving the largest dollar value of leakage are surfaced for care manager outreach, network steerage, and post-acute partner selection.
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Shared Savings Projection
Year-to-date PMPM, trend factor, projected end-of-year spend vs. benchmark, and projected shared savings or downside-risk exposure. Updated with every data refresh — so leadership sees the trajectory in real time, not in next year's settlement letter.
Contracts & Programs

VBC Contract Types Vizier Supports

Medicare Shared Savings Program (MSSP) is the largest of the federal VBC programs. ACOs progress through Pathways to Success risk levels — BASIC Levels A–E (escalating shared-savings/loss rates), then ENHANCED (the most risk-bearing track with up to 75% savings rate). The Quality Performance Standard now uses the APP measure set; ACOs scoring below the 40th percentile face a quality-tied penalty that can erase shared savings.

ACO REACH (formerly Direct Contracting) offers Professional and Global risk-track options, with both prospective and aligned beneficiary attribution and capitation-style payment mechanics for Global track ACOs. Medicare Advantage contracts pay on RAF, so HCC capture and AWV completion drive both quality and revenue. Commercial VBC contracts vary by payer — Vizier supports the major payer-specific quality measure sets and bespoke shared-savings formulas.

Federal VBC Programs
MSSP (BASIC A–E, ENHANCED), ACO REACH (Professional, Global), BPCI Advanced bundled payments, KCC/KCF for ESRD, Primary Care First
Quality Reporting
APP (Alternative Payment Model Performance Pathway), legacy Web Interface, Medicare Advantage Star Ratings, NCQA HEDIS for commercial VBC
Risk Adjustment
HCC v24 / v28 transitional weighting, MA RAF score trend, MSSP risk-adjusted benchmark, ESRD ICD-based risk adjustment under KCC
Commercial VBC
BCBS / Anthem total cost of care, UnitedHealthcare value-based contracts, Aetna commercial ACO, Humana Medicare Advantage, employer direct contracts
ACO & VBC Analytics

Real-Time Visibility Into the Number That Determines Your Settlement

Upload an attribution list and a claims export. Vizier presents PMPM trend vs. benchmark, HCC gap rosters, APP quality projection, leakage by service category, and projected shared savings within 48 hours.

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