Succeed Under Risk. Scale Your Organization.
Ensure Data Solutions delivers the VBC OS™ for primary care groups and MSOs — giving you the population health, quality management, referral analytics, financial intelligence, and professional services infrastructure to enter risk contracts with confidence, perform consistently, and scale your organization efficiently.
The PCP & MSO Pain Points the VBC OS™ Eliminates
No Unified Patient & Financial View
Patient clinical data lives in the EMR, financial data in the billing system, and quality data in the payer portal. PCPs and MSO managers lack a single view connecting clinical performance to financial outcomes.
Referral Spend Is a Black Box
Most PCP groups have no visibility into which specialists their patients are seeing, at what cost, treatment efficacy, quality, or whether it would be more efficient to develop in-house specialty capacity versus continuing to refer out.
Hospitalization Surprises
Learning about a patient's admission through a 60-day claims lag eliminates any opportunity for effective care transitions management and 30-day readmission prevention where it matters most.
Quality Program Complexity
Managing quality measures, risk coding, care gaps, and payer quality incentive programs simultaneously overwhelms clinical and administrative staff without a purpose-built VBC platform to orchestrate all activities.
Scaling Without Infrastructure
MSOs expanding to new service areas or adding payer risk contracts face replicating quality operations, analytics, and reporting without building duplicate infrastructure at each new site and market.
VBC Contract Complexity
Understanding the financial terms, quality gates, and performance requirements of multiple concurrent risk contracts — across MA, Medicaid, ACO, and ACA — requires specialized expertise few PCP organizations have internally.
The Complete VBC OS™ Toolkit for Primary Care & MSOs
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.
Population Health, IDCT & Care Management
Hospitalization-risk stratification, validated across a seven-model LLM ensemble, interdisciplinary care team coordination, specialist engagement workflows, real-time ADT alerts, Remote Patient Monitoring, and MOC care plan compliance facilitation — giving every PCP a unified command center for their patient panel.
- Weekly LLM-validated hospitalization risk stratification: high-risk patient lists with recommended care interventions
- Real-time ADT alerts for any attributed patient admission or ER visit
- IDCT coordination: PCP, care manager, specialist, behavioral health, pharmacist, CHW
- MOC care plan delivery, compliance monitoring, and HEDIS quality measure impact tracking
Quality & Care Gap Management
Track every open and closed care gap across your entire patient panel in real time. quality measures calculations, automated care gap outreach, and health risk assessment tools that keep you ahead of quality incentive targets and payer performance requirements.
- Open and closed care gap dashboard by patient, provider, and quality measure
- One-click care gap export lists for care coordinator workflow assignment
- Omnichannel patient outreach: phone, text, and patient portal notification
- Health Risk Assessment and HRSN/SDOH screening integration
Financial Performance & Referral Analytics
Referral volume and cost by specialist taxonomy, PMPM utilization trends, payer contract performance, and financial KPIs — with the granularity to manage cost before month-end surprises hit. Know where every risk dollar is going and why.
- Referral dashboard: top specialists by taxonomy, volume, and cost per referral
- PMPM cost tracking by patient cohort, payer, and reporting period
- Admits/1,000, ER visits/1,000, and other critical KPI monitoring
- Pharmacy cost management: brand vs. generic analysis and adherence monitoring
Risk Adjustment & Condition Documentation
Capture your true clinical burden with structured HCC suspect identification, AI Documentation Auditor for chart review at scale, and documentation workflows integrating directly with your EMR — ensuring your risk scores reflect the full complexity of your patient population.
- Prospective and retrospective HCC suspects from EMR and claims data
- AI Documentation Auditor: automated NLP chart review for coding gap identification
- Easy-read dashboard: conditions coded, submitted, and accepted by CMS/HHS
- RAF score projection and performance-period tracking for risk contracts
Referral Optimization & Specialist Intelligence
Make every referral decision data-driven. EnsureXCEL™ surfaces which specialists deliver the best outcomes at the lowest cost — enabling preferred specialist relationships, reducing referral leakage, and directly improving PMPM cost performance under risk contracts.
- Specialist ranking by outcomes, cost efficiency, and episode performance metrics
- Referral cost comparison: in-house specialist vs. refer-out financial analysis
- preferred-specialist surfacing at point-of-referral in your EMR workflow
- High-cost referral pattern detection and out-of-network leakage quantification
VBC Professional Services & MSO Operations
Not just software — a strategic partner with 30+ years of payer and MSO leadership experience. Risk contract structuring, back-office operations support, market entry planning, and service area expansion strategy from operators who have done it at scale.
- MSO back-office services: operations, compliance, and regulatory reporting
- Risk contract structuring: terms negotiation, quality gates, and financial modeling
- Service area expansion strategy and new market opportunity analysis
- VBC program selection guidance based on your risk tolerance and organizational goals
How Primary Care Groups & MSOs Use the VBC OS™
New Risk Contract Onboarding
A primary care group entering its first MA risk contract uses EnsureXPERTS™ to structure contract terms and EnsureCM™ + EnsureQUAL™ to build the care management and quality infrastructure required to perform from Day 1.
Referral Cost Optimization
Practice manager uses EnsureFIN™ to discover 40% of cardiology referrals go to a single high-cost group — then uses EnsureXCEL™ to identify a higher-performing local alternative and redirect, reducing cardiology PMPM spend by 22%.
Care Gap Closure Campaign
Quality director exports open care gap lists from EnsureQUAL™ weekly, assigns them to care coordinators by provider panel, and tracks closure rates — turning HEDIS compliance from a reactive scramble into a managed weekly process.
MSO Service Area Expansion
MSO uses EnsureXPERTS™ to analyze a new market, evaluate risk contract opportunities, and deploys the same VBC OS™ infrastructure across the new service area — scaling without rebuilding analytics from scratch.
High-Risk Patient Monitoring
Care managers receive risk scores weekly from EnsureCM™, each validated across multiple LLMs. The top 50 highest-risk patients are added to outreach queues automatically — ensuring the most complex members receive proactive care coordination.
Pharmacy Cost Management
Medical director uses EnsureFIN™'s pharmacy dashboard to identify patients on high-cost brand medications with generic equivalents — enabling targeted prescribing conversations that reduce pharmacy PMPM costs under risk contracts.
Ready to Thrive Under Risk Contracts?
The VBC OS™ gives primary care groups and MSOs the platform and expertise to succeed under risk from Day 1 to full-risk capitation. See the complete PCP and MSO capability set in a personalized demo.