Value-Based Care & Risk Economics
Under two-sided risk, a guess gets expensive. Size a bundle or an ACO off a vendor's benchmark, using a risk score you cannot inspect, and you can take on episodes that lose money. We model the economics directly from your claims, with a risk adjustment you can audit, so you can see where the opportunity is, and where the risk is, before you commit.
Book an opportunity reviewA risk model you can open, not a score you have to trust
Under two-sided risk, the economics and the risk adjustment have to be defensible to a CFO, a board, and a payer. That is hard to do with a benchmark you license and a risk score you cannot inspect.
Modeled from claims, not estimated
We build the episode economics directly from claims (ResDAC payment standardization, RVU-based Part B estimation, and the actual 30- and 90-day windows), so the opportunity is grounded in real spend rather than a vendor's national benchmark.
A deterministic risk model
The risk and acuity adjustment runs on a versioned engine (HCC, MS-DRG, and service-line classification across a unified ICD-10, CPT, HCPCS, and PCS taxonomy), not an opaque score. Every risk tier traces back to the codes that set it, so the adjustment is fair and defensible.
Sized before you sign
We rank-order the opportunity by episode, service line, and partner, and surface the attribution and overlap that decide who actually owns the patient, so leadership takes two-sided risk where the economics work, not where the brochure says.
From raw claims to an opportunity you can underwrite
- An episode-economics model built directly from claims (TEAMs 30-day and CJR-X 90-day windows, ResDAC payment standardization, RVU-based Part B estimation) that prices every episode against its target.
- A deterministic risk and acuity engine (HCC, MS-DRG, and service-line classification on a unified ICD-10, CPT, HCPCS, and ICD-10-PCS taxonomy) that risk-stratifies the population directly from claims, so comparisons are fair and the adjustment is auditable.
- A rank-ordered opportunity engine that sequences savings by episode, service line, and partner, so two-sided risk is taken where it actually pays.
- MSSP and ACO attribution and overlap logic that resolves who owns the patient and the episode before the savings are counted.
- A production analytics platform delivered in your own cloud account, with the models documented and owned by your team, not a dashboard you rent.
Delivered into your environment and documented so your team owns the model, not a black box you license.
Metrics it moves
- Episode cost vs target price
- Savings opportunity per episode
- Attribution and overlap
- Two-sided risk exposure
- Post-acute spend
Typical path: an Advisory opportunity-sizing sprint, then Delivery to stand up the production platform and ongoing analytics.
Proof, measured and caveated
From an engagement with a value-based-care analytics venture, building the economic and risk models that size hospital opportunity under CMS bundled-payment and ACO programs. Figures describe the scope of the build, not a guaranteed return for any single organization.
The episode economics were modeled from standardized Medicare claims; the figures above describe the scope of the models, not a realized return. The risk and acuity engine is the firm's deterministic classification underpinning (a unified ICD-10, CPT, HCPCS, and MS-DRG taxonomy with a five-tier acuity score and nineteen service lines), used here as the risk model under value-based care rather than as a standalone product. The platform was delivered into the client's own cloud account so the team owns the models and the data never left their environment.
Size the opportunity before you take the risk
Tell us which bundles or contracts you are weighing. We will scope an opportunity review and show you what the economics look like, modeled from claims, with a risk adjustment you can defend.