Step 1 Aggregate and Normalize Across Contracts

The Data Platform harmonizes MSSP and MA contract data — claims, EHR, payer feeds, and HCC scoring details — into a single model. Metric governance ensures apples-to-apples comparisons regardless of source.

Step 2 Analyze Performance with Full Context

Impact Analytics provides side-by-side and year-over-year performance views, adjusting for claims completion, practice portfolio shifts, and HCC model version changes. AI-driven forecasting identifies practice and provider billing pattern deviations before they compound.

Step 3 Generate Prioritized Worklists

Care Operations produces prioritized opportunity lists, spotlighting practices and providers with the greatest recapture potential. Structured review workflows handle suspect capture, recapture, and resubmissions through a multi-level QA pipeline.

Step 4 Measure and Optimize

Impact Analytics tracks field team efforts and recapture rates, ensuring resources go to the practices where coding accuracy improvements will have the greatest financial impact.

Example: MSSP ACO Improving HCC Recapture

• ACO leadership sees in real time which practices are performing better or worse year-over-year on recapture.
• The system detects that a subset of practices have never billed more than 4 diagnosis codes — a practice management system bug, not a clinical issue.
• Targeted recommendations guide those practices to resolve the PMS configuration, improving risk adjustment accuracy.