Transform Your Health System Into a VBC Leader.
Ensure Data Solutions delivers the VBC OS™ for risk-bearing health systems and CINs — providing population health analytics, quality management, network intelligence, FHIR interoperability, and operational infrastructure to succeed under MSSP, MA, Medicaid, and direct-to-employer risk arrangements.
The Health System VBC Challenges the VBC OS™ Eliminates
FFS Culture Inertia
Transitioning a health system from FFS revenue optimization to VBC population health management requires a platform that bridges both worlds — providing operational analytics while building the VBC infrastructure required to succeed under risk.
Fragmented CIN Performance Visibility
Health systems with dozens of employed and affiliated physicians in a CIN struggle to monitor quality performance, care gap status, and financial metrics across the entire network from a single vantage point.
Specialist Referral Leakage
Patients referred outside the health system's owned or preferred network represent both a revenue and quality risk — yet most health systems lack the tools to systematically measure and reduce out-of-network leakage.
Quality Performance Gaps
Meeting MSSP, MA Star, and commercial quality benchmarks requires proactive, data-driven population management that EMR workflows alone cannot support without a dedicated analytics and care management layer.
Total Cost of Care Accountability
Health systems assuming global risk need real-time visibility into PMPM costs, utilization trends, and service fund performance — not retrospective claims data arriving 60–90 days after the care event.
Multi-Vendor Data Silos
Most health systems have EMR, claims, lab, pharmacy, and patient engagement data spread across 8–15 systems. Integrating these into actionable population health insights without a dedicated platform is effectively impossible at scale.
VBC OS™ Modules for Health System & CIN Programs
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.
CIN Network Performance & Referral Intelligence
Systematic CIN network performance management. EnsureXCEL™ identifies high-performing physicians, detects out-of-network referral leakage, and enables performance-based network tiers that reward quality and retain patients and revenue within your system.
- CIN physician performance ranking by outcomes, cost efficiency, and care adherence
- Out-of-network referral leakage detection and revenue-impact quantification
- Performance-based network tiering for MA and commercial VBC products
- Geographic expansion analysis for strategic network and service area growth
Population Health, IDCT & Care Management Across the CIN
Hospitalization-risk stratification validated across a seven-model LLM ensemble, real-time ADT alerts, interdisciplinary care team coordination, specialist engagement, and MOC care plan compliance — scaled across your entire CIN to reduce avoidable utilization and drive the quality outcomes your VBC contracts require.
- Hospitalization-risk stratification — validated across 7 independent LLMs — across your entire attributed CIN population
- Real-time admission and discharge alerts to care management teams across the system
- Cross-continuum IDCT coordination: hospital, post-acute, and ambulatory care
- Specialist engagement: bidirectional PCP-specialist care plan sharing and co-management
Quality Management Across Employed & Affiliated Physicians
Quality measures calculations and real-time care gap management across your entire physician network — with automated outreach, MSSP quality measure tracking, and comprehensive reporting to protect quality bonuses and Stars performance.
- Network-wide quality care gap dashboard: practice, physician, and measure level
- Automated patient and provider outreach for care gap closure across the network
- MSSP and MA quality measure performance monitoring and trajectory tracking
- CAHPS/HOS simulation to forecast patient satisfaction score impact
System-Wide Risk Adjustment Management
Capture your full population's clinical complexity with structured HCC identification, AI Documentation Auditor for chart review at scale, RADV-ready documentation, and CMS submission tracking — deployed across your entire physician network.
- Prospective HCC suspects from EMR and claims data across your physician network
- AI Documentation Auditor: NLP chart review for coding gap identification at scale
- CMS submission tracking and RADV audit preparation documentation
- RAF score projection by population segment and VBC contract
FHIR Interoperability Across Your Clinical Ecosystem
Connect your EMR infrastructure to the VBC OS™ via FHIR — delivering population health insights within existing clinical workflows. ADT-based HIE connectivity ensures real-time event notification across all care settings and disciplines.
- Epic integration with bi-directional FHIR R4 data exchange
- HIE connectivity via ADT for cross-continuum admission and discharge notifications
- In-EMR care gap and risk alerts — no separate portal required for clinical staff
- Structured and unstructured clinical data ingestion and normalization
VBC Financial Analytics & Total Cost of Care Management
Real-time visibility into PMPM costs by population and service category, utilization benchmarks, service fund performance, and total cost of care projections by risk contract — enabling proactive financial management under global risk arrangements.
- Real-time PMPM cost and utilization analytics by population and service segment
- Service fund performance and provider stop-loss analysis
- VBC contract performance dashboard across all concurrent risk arrangements
- Cost and utilization projections for financial planning and risk contract negotiations
How Health Systems Use the VBC OS™ in Risk Programs
CIN Quality Performance Management
Health system deploys EnsureQUAL™ across 85 employed and affiliated PCPs — providing the medical director a single dashboard with quality performance by physician, enabling targeted coaching and care gap closure campaigns network-wide.
MSSP Shared Savings Optimization
System uses EnsureXCEL™ to identify top-performing CIN specialists, builds a preferred referral network, reduces out-of-network leakage by 26%, and improves MSSP benchmark performance in Year 2 of the program.
VBC Program Entry Strategy
Leadership team evaluates MSSP vs. direct contracting vs. capitation using EnsureXPERTS™ advisory — then deploys the VBC OS™ platform infrastructure to operationalize the chosen path within 90 days of program selection.
Cross-Continuum Care Coordination
Care management team receives real-time ADT alerts via EnsureCM™ for all high-risk attributed patients — coordinating transitions from inpatient to SNF to home health with IDCT visibility across every care setting.
Medicare Advantage Quality Program
CIN participating in delegated MA quality uses EnsureSTARS™ and EnsureQUAL™ to manage Stars measures across the attributed population — achieving 4.5-Star performance in Year 3 of the partnership.
Clinical Data Unification
EnsureXCHANGE™ and EnsureVAULT™ integrate claims, EMR, lab, and pharmacy data from 12 disparate systems into one enterprise data warehouse — one source of truth for all population health decisions.
Ready to Lead Your Market in Value-Based Care?
The VBC OS™ gives health systems and CINs the platform, intelligence, and operational support to succeed in risk-based arrangements at scale. See the complete health system capability set in a personalized demo.