Maximize Shared Savings. Master Total Cost of Care.
Ensure Data Solutions delivers the complete VBC OS™ for ACOs and accountable care networks — predictive referral optimization, quality management, risk adjustment, population health analytics, and financial intelligence to consistently generate shared savings and thrive under full-risk contracts.
The ACO Challenges the VBC OS™ Eliminates
Shared Savings Erosion
Unmanaged specialty referrals, avoidable admissions, and high-cost utilization patterns erode shared savings pools. Without real-time visibility, problems surface in retrospective reports — too late for effective intervention.
Uncontrolled Referral Leakage
Patients referred to high-cost, out-of-network specialists represent one of the largest controllable cost drivers in ACO programs — yet most ACOs have no systematic tool to measure, manage, or reduce leakage.
Quality Measure Underperformance
MSSP quality benchmarks and measures require continuous monitoring, PCP engagement, and proactive gap closure — capabilities most ACOs cannot execute without a purpose-built population health platform.
Incomplete Risk Adjustment
Undercoded HCCs suppress risk scores, reducing risk payments and misrepresenting population complexity — directly impacting ACO benchmark calculations and long-term shared savings performance.
Avoidable Admissions & Readmissions
Without real-time ADT notifications, care managers learn about admissions days after the fact — missing the narrow window for effective transitions of care interventions that prevent costly 30-day readmissions.
Network Expansion Without Performance Data
Growing the ACO's PCP or specialist network based on geography alone misses the opportunity to recruit high-value providers who strengthen quality metrics and cost performance over time.
VBC OS™ Modules That Drive ACO Shared Savings
Every VBC OS™ module is CTF™ — Customizable to Fit your programs, contracts, and workflows. Deploy the full VBC OS™ or embed individual modules via API.
Specialist Network Intelligence & Referral Optimization
The ACO's most powerful cost containment tool. EnsureXCEL™ identifies high-performing specialists, surfaces them at the point of referral via predictive decision support, flags leakage in real time, and enables your ACO to build a performance-based specialty network that drives savings.
- Specialist ranking by risk-adjusted outcomes, episode efficiency, and readmission rates
- point-of-referral preferred-specialist surfacing within EMR workflow
- High-cost referral leakage detection with quantified revenue-impact alerts
- Centers of Excellence pathway configuration for high-volume specialty services
HCC Risk Adjustment for MSSP & ACO Programs
Capture the full complexity of your attributed population. Prospective and retrospective HCC suspect identification, AI Documentation Auditor for chart review at scale, CMS submission tracking, and RAF score projection — ensuring your ACO benchmark accurately reflects population risk.
- Prospective HCC suspect identification from EMR and claims data across your panel
- AI Documentation Auditor: automated NLP chart review surfaces coding gaps in minutes
- CMS submission tracking and HCC acceptance reconciliation dashboard
- RAF score projection for current and upcoming ACO performance periods
Quality & MSSP Measure Management
Certified quality measures calculations with real-time care gap dashboards across your entire ACO attribution panel. Automated outreach closes gaps before reporting periods end — with full PCP and care manager workflow integration to drive compliance at the practice level.
- Real-time quality measure performance across all attributed providers and practices
- Omnichannel care gap notifications to PCPs, care managers, and members
- MSSP quality measure monitoring and performance trajectory tracking
- Health Risk Assessment and HRSN integration for complete population visibility
Population Health, IDCT & Care Coordination
Hospitalization-risk stratification, validated across a multi-model LLM ensemble, identifies highest-risk patients weekly. Real-time ADT alerts, interdisciplinary care team coordination, specialist engagement, omnichannel outreach, and care plan compliance — keeping your highest-risk members engaged and preventing avoidable utilization.
- Weekly high-risk patient lists — each score cross-validated across multiple LLMs — with recommended care interventions
- Real-time ADT alerts: admissions, discharges, and ER visits for attributed patients
- IDCT workflows: PCP, care manager, specialist, behavioral health, pharmacist, CHW
- Care plan delivery and compliance monitoring across your attributed panel
ACO Financial & Utilization Analytics
Track the metrics that define shared savings performance: admits/1,000, ER visits/1,000, readmission rates, PMPM costs by population segment, and utilization trends by provider — with peer benchmarking to identify outliers before they become losses.
- Real-time PMPM cost and utilization trend monitoring by provider and population
- Admits/1,000, ER visits/1,000, and readmission rate dashboards
- Provider-level performance benchmarking and high-cost-utilizer identification
- Total cost of care projections by cohort and ACO performance period
FHIR Interoperability Across Your ACO Network
FHIR R4 integration with major EHR systems and HIEs — delivering care gap alerts and clinical recommendations within the PCP's existing workflow. No separate portal. No additional login. No workflow disruption.
- FHIR R4 integration with all major EMR platforms
- HIE connectivity via ADT for real-time admission and discharge notifications
- Care gap and risk alerts — surface insights without disrupting PCP workflow
- Structured and unstructured clinical data exchange and normalization
How ACOs Use the VBC OS™ to Drive Shared Savings
Specialty Cost Containment
ACO identifies top-decile cardiologists and orthopedic surgeons via EnsureXCEL™ — builds a preferred specialist network and steers referrals toward it, reducing specialty cost variation by 28% within 12 months.
Transitions of Care Management
Care teams receive real-time ADT alerts via EnsureCM™ within hours of any attributed patient admission — triggering follow-up calls and discharge planning automatically and reducing 30-day readmission rates.
MSSP Quality Score Improvement
Quality director uses EnsureQUAL™ to identify practices with the highest care gap burdens and coordinates targeted outreach campaigns — lifting MSSP quality scores ahead of reporting deadlines.
PCP Network Expansion Planning
ACO growth team uses EnsureXCEL™'s PCP performance intelligence to identify high-value physicians in adjacent geographies — recruiting providers who strengthen quality and cost, not just volume.
HCC Capture for Benchmark Optimization
EnsureRAF™ and AI Documentation Auditor identify HCC coding gaps across the attributed panel — accurately reflecting population complexity to improve the ACO's benchmark and shared savings potential.
High-Risk Population Intervention
Weekly risk scores from EnsureCM™, validated across multiple LLMs, allow care managers to focus on the 5% of patients driving 50% of cost — proactively managing chronic conditions before they escalate to acute hospitalizations.
Ready to Maximize Your ACO's Shared Savings?
The VBC OS™ gives ACOs the network intelligence, population health management, and quality analytics to consistently outperform benchmarks. See how in a personalized ACO demonstration.