Modeled final settlement reconciles to the actual CMS settlement within 0.5%.
Anonymized ACO cleared its minimum savings rate in PY2024 and captured $1,699,913 in shared savings, on gross savings of $4,336,512 at a 4.1% savings rate.
The AGND segment is the primary savings driver, contributing $3,398,274 of gross savings across 7,518 lives. Segment economics are modeled separately and the minimum savings rate is applied once at the contract level, consistent with how CMS actually settles.
Beyond what was captured, an estimated $1,548,511 in additional settlement is recoverable by bringing HCC documentation up to each segment's remaining risk-adjustment headroom, before reaching the positive adjustment cap, with no change to utilization or clinical operations. The largest single opportunity is the AGND segment, with 5.2% of headroom remaining across 7,518 lives.
On the utilization side, spending sits above the median peer cohort in Outpatient, 29.8% above peer, which is where a cost lever would return the most before touching any category already at or below peer. Bringing Outpatient to the peer median would remove roughly $9.7M in spend.
| Segment | Lives | Benchmark PMPM | Adjusted PMPM | Savings % | Gross Savings | Coding Signal* | RAF Headroom |
|---|---|---|---|---|---|---|---|
| ESRD | 36 | $7,299 | $5,891 | 19.3% | $608,038 | 0.926 | 16.1% |
| AGDU | 196 | $1,945 | $1,903 | 2.1% | $97,177 | 0.956 | 15.3% |
| AGND | 7,518 | $1,031 | $993 | 3.7% | $3,398,274 | 0.954 | 5.2% |
| DIS | 383 | $1,000 | $952 | 4.8% | $219,581 | 1.005 | 7.2% |
*Coding intensity signal and median peer cohort are derived constructions built by VBC Contract Performance Intelligence. They are not CMS-published fields. A signal below 1.00 indicates HCC coding running under the segment demographic baseline.
| Scenario | Savings PMPM | Gross Savings | Cleared MSR | Final Payout | vs. Baseline |
|---|---|---|---|---|---|
| Baseline | $44.43 | $4,336,512 | Yes | $1,699,913 | — |
| Utilization | $144.36 | $14,089,281 | Yes | $5,522,998 | +$3,823,085 |
| RAF | $73.40 | $7,163,546 | Yes | $2,808,110 | +$1,108,197 |
| Max RAF | $84.91 | $8,286,794 | Yes | $3,248,423 | +$1,548,511 |
Risk adjustment is the highest-return lever that requires no clinical or operational change, at approximately $11,082 of settlement per 1% of RAF movement, within the remaining 5.6% weighted headroom. The utilization scenario returns more in absolute dollars but requires reducing Outpatient spend to the peer median. Scenarios apply the 40% sharing rate and the 2% sequestration reduction.
| Category | This ACO PMPM | Median Peer PMPM | Difference vs Peer |
|---|---|---|---|
| Inpatient (IP) | $286.30 | $289.50 | -1.1% |
| Skilled Nursing Facility (SNF) | $52.65 | $57.42 | -9.1% |
| Outpatient (OP) | $335.76 | $235.83 | +29.8% |
| Professional | $277.80 | $360.25 | -29.7% |
| Hospice | $20.68 | $20.75 | -0.3% |
| Home Health | $25.67 | $41.00 | -59.7% |
| Durable Medical Equipment | $29.02 | $33.08 | -14.0% |
| Ambulance | $6.79 | $12.08 | -78.0% |
This analysis is built entirely from CMS public use files. The settlement engine reproduces contract sequencing as CMS applies it: segment-level benchmark and risk adjustment, a single contract-level minimum savings rate gate, sharing rate, the positive risk-adjustment cap, and sequestration. Peer cohorts use the median rather than the mean. VBC Contract Performance Intelligence holds no financial relationship with any vendor, payer, or coding company. It is not a coding vendor and not a care-gap product. The figures here are independent estimates for the organization's own decision making.
Every figure on this page came from public CMS data, with nothing required from the ACO. The same analysis, on your contract, starts with a call.
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