I model value-based care contracts to isolate the drivers of financial performance -- across MSSP, Medicare Advantage, and other risk-bearing arrangements -- including benchmark construction, risk adjustment dynamics, and utilization relative to peer cohorts.
For MSSP ACOs → the model is already built.
Current focus → MSSP ACOs, where contract mechanics create the largest gaps between clinical performance and financial outcomes.
Most value-based care analytics tell you what happened. This practice tells you why -- and what it was worth.
The work sits at the intersection of contract architecture and financial outcomes: how benchmark construction, risk adjustment ceilings, attribution mechanics, and utilization dynamics combine to produce the number on the CMS settlement check.
Current work is concentrated in MSSP ACOs, where the gap between clinical performance and financial outcome is largest and most precisely modelable from public data. The same modeling approach applies to other value-based arrangements where contract structure shapes financial outcomes.
What is the benchmark actually based on -- and how did baseline-period decisions shape it? Regional blend dynamics, coding trajectory, ratchet effects, and agreement-entry position translated into dollar impact.
Segment-level RAF ceiling analysis per 42 CFR 425.610. How close did each population come to its CMS-defined cap? What documentation effort earned credit -- and what was wasted?
Performance across ESRD, DIS, AGDU, and AGND decomposed to isolate exactly where recoverable value sits and what it is worth in settlement dollars under specific contract parameters.
How far is the ACO from threshold -- and in which direction? Scenario modeling in gross savings, payout, and RAF delta. Category-level utilization sensitivity expressed as settlement dollars per 1% reduction across IP, SNF, OPD, Professional, HHA, Hospice, DME, and Ambulance. Every lever quantified before a dollar is spent on intervention.
Category-level spend across IP, SNF, OPD, Professional, HHA, Hospice, DME, and Ambulance compared against a derived peer cohort. Derived metric -- not CMS-published. Lever sensitivity in settlement dollars.
Aggregated client data, Medicare Advantage, commercial VBC, alternative payment models. If the contract has financial performance levers, the model can be built.
Derived from the most recent CMS MSSP performance data, N=476 ACOs. Coding intensity signals and peer cohorts are constructions of VBC Contract Performance Intelligence -- not CMS-published figures.
ACOs that generated positive gross savings and earned $0 in shared savings payments -- not due to clinical performance, but contract mechanics. MSR threshold not cleared. Combined uncollected potential: $158.3M post-sequestration.
Of all 476 ACOs, 61.3% carry an AGND coding intensity signal below 1.0. Median 0.979. Specialist-managed conditions not being re-documented within the attributed TIN at scale.
AGDU carries the lowest HCC-to-demographic ratio program-wide. $566M in uncaptured benchmark value in this segment alone -- the largest single concentration of recoverable value in the program.
In the most recent performance year, 5 ACOs entering new agreement periods missed their MSR threshold solely because of the new segment-level RAF ceiling methodology -- forfeiting a combined $26M in shared savings their clinical teams had already earned. The contract architecture eliminated the payout.
VBC CPI — RAF Ceiling Analysis — N=135 mainstream MSSP ACOsFor MSSP work, all 476 ACOs are already modeled. No data sharing. No vendor agreements. No implementation timelines. Other arrangements scoped from client-provided aggregated data.
Applied analysis and commentary published from ongoing model work. Derived metrics are constructions of VBC Contract Performance Intelligence, not CMS-published figures.
For ACOs entering new agreement periods in the most recent performance year or later, the flat 3% cap on HCC growth no longer applies. The new formula is segment-specific and population-dynamic. 29% of the cohort are operating under a tighter ceiling than before. 5 ACOs missed MSR clearance solely because of the change, forfeiting a combined $26M.
In the most recent performance year, 73 of 476 MSSP ACOs generated positive gross savings and earned nothing in shared savings payments. The $158.3M they left uncollected is not recoverable -- but the structural conditions that produced it will repeat unless the underlying levers are identified and addressed before the next performance year closes.
For MSSP ACOs -- the model is already built. The conversation can start with your numbers on the table.
Cameron Ginn, MPH is an independent analyst. VBC Contract Performance Intelligence is not a vendor, a dashboard, or an advisory firm -- it is the translation layer between CMS contract mechanics and what they cost in dollars. Not affiliated with any vendor or platform. Analysis derived from CMS public use files. Other engagements conducted under mutual NDA.
Include your ACO or organization name and the model will be open before we speak.