Most accountable care organizations already receive a steady supply of reports: payer files, quality measures drawn from the electronic health record, and spreadsheets that finance staff update each month. These static reports record what has already occurred and often require significant effort to turn into actionable insights. An ACO that carries financial risk under the Medicare Shared Savings Program (MSSP), a CMS episode-based model, or a commercial or Medicare Advantage contract needs timely insight into why results are moving and what can still be favorably impacted before the performance year closes.
What is the difference between VBC software and traditional reporting tools?
Traditional reporting tools summarize past activity, usually from one data source at a time. VBC software can combine claims, clinical, provider roster, and related data in a single normalized environment; measure results against benchmarks and contract terms; and project performance while there is still time to act. Given enough time and analyst resources, much of this can be approximated with traditional reporting tools. The primary difference is automated integration of the various reporting dimensions: VBC software performs this work efficiently and repeatably, freeing constrained teams to act on results and scale their impact faster.
| Dimension | Traditional reporting tools | VBC software |
|---|---|---|
| Primary purpose | Document past activity and meet reporting requirements | Manage cost, quality, and financial risk under value-based contracts while also meeting reporting requirements |
| Effort and scalability | Highly manual integration; labor-intensive and scales only as staff are added | Automates data preparation and analysis, freeing team capacity and scaling impact across populations and contracts |
| Data sources | Multiple disparate sources, often with several files per source (e.g., separate payer rosters and claims extracts); typically integrated manually | Multiple disparate sources including payer, purchaser, EHR, lab, ADT, HIE, and PBM data that is ingested and normalized together in an automated manner |
| Timing | Typically retrospective and subject to claims lag | Enables trending and settlement projections reflective of near-real-time1 activity with greater efficiency and frequency during the performance year |
| Context | Limited points of benchmark comparison that may be less adjustable; typically oriented to cost and utilization | Flexible adjustment of comparative benchmarks (e.g., internal, regional, national), risk adjusters, and contract targets to suit the needs of the organization with the option of integrating greater clinical context |
| Level of detail | Summary views that are difficult to drill into without significant effort | Drill-down to provider, encounter, and patient-level grain to inform targeted outreach and management |
| Multiple contracts | Separate reports for each payer agreement/plan | Ability to view performance across arrangements in aggregate and by line of business or contract |
| Primary users | Analysts and report writers assembling and reconciling reports | Cross-functional roles at all levels of the enterprise (e.g., finance, care management, provider network, and analytics teams), from the C-suite to the front line |
What reporting tools do ACOs typically use today?
Most ACOs work from payer-provided reports and claims summaries, dashboards and quality reports within the electronic health record, finance spreadsheets, and business intelligence platforms such as Power BI or Tableau, which may not have been designed to operate together.
These tools remain valuable for historical, operational, and regulatory reporting. Their limits begin to surface when an organization, often with a small analytics staff and no dedicated actuarial support, needs to explain performance across its whole population, every contract at once, or at different levels of aggregation.
Traditional reporting often places the work of identifying patterns and trends on a small group of analysts or actuaries. As stakeholders across the organization bring their own custom questions, that group can become an information choke point, and the organization may accumulate a broad library of bespoke reports that are costly to produce and used by only a handful of people. A well-integrated analytics platform can consolidate that work into a more manageable set of standardized, high-impact reports available to a broad range of stakeholders. It can also shift routine requests away from over-subscribed analysts, so end users can generate custom insights themselves.
What is VBC software?
VBC software is the combination of analytical logic and methodologies, such as analytic groupers, risk adjusters, and benchmarks, to support performance management under risk-based arrangements and alternative payment models. It ingests, normalizes, and consolidates claims, utilization, financial, clinical, and quality data. This enables reporting that shows actual or projected results against contract targets and models, and flags cost and quality concerns while there is still time to address them.
Why are traditional reporting tools not enough for value-based care?
When data resides in separate systems, arrives months after services are delivered, and cannot be easily traced to an actionable level of detail, teams expend effort assembling a view of performance that is limited by out-of-date information and a rigid framework. This leaves little capacity for insights that drive improvement. These challenges are amplified as organizations add covered lives and pursue better results. Over time, a traditional approach can limit continued growth, population reach, and sustainable population-based care.
- Fragmented data and manual reconciliation: Payer reports arrive in inconsistent formats and at varying levels of detail. When finance, quality, care management, and other stakeholders each rely on a separate source, meetings can turn into debates over which figure is correct, with analysts spending hours reconciling spreadsheets instead of focusing on performance improvement efforts.
- Claims lag and static views: Claims data trails the date of service, and many reports are delivered monthly or quarterly. A report that confirms rising post-acute spending late in the year arrives after most of the opportunity to impact outcomes in the performance period has passed.
- Limited drill-down: An ACO-level figure can show that total cost of care exceeds the benchmark, but not why. Most traditional tools offer no direct path to the service categories, providers, and patients behind it.
What data do ACOs need to manage value-based care performance?
ACOs need claims data for cost and utilization; clinical data for quality measure performance, more precise cohorting, and risk adjustment; provider data for attribution and accountability; and contract data for performance targets and settlement terms. Claims aggregated across payers must be normalized so that each service is counted consistently, and the organization should be able to review how its data was prepared. Once normalized, paired with benchmarks and risk adjustment, and checked for quality, these sources together show how utilization, cost drivers, and quality results relate to one another.
This level of data integration is the foundation of reliable ACO analytics.
How does VBC software help ACOs manage performance during the year?
VBC software makes the performance year visible while it is under way. It tracks trends against benchmarks and contract targets, forecasts the year-end settlement ahead of reconciliation, and identifies the providers, services, and patients contributing to surplus or loss.
Savings work usually begins with claims data analysis of total cost of care. A team translates its financial target into utilization and unit cost requirements, then locates the areas where actual experience exceeds the benchmark. Frequent sources of opportunity include avoidable emergency department visits, variation in post-acute care, leakage to high-cost settings, and gaps in annual wellness visits and risk coding.
Risk adjustment and attribution warrant particular care. Incomplete documentation of clinical care and associated diagnoses can understate member complexity and intensity of service, expected cost, and potentially benchmarks. Unclear or inaccurate attribution of members to specific providers makes it harder for the ACO to identify and engage the right providers. Software that efficiently surfaces coding gaps and enables real-time workflow interventions with minimal provider friction gives teams time to address both before the year closes.
Who uses value-based care software within an ACO?
Finance and contracting staff, care management and population health teams, network and quality leaders, data analysts, and executive and operational leaders all benefit from VBC software. Finance teams track each agreement, forecast settlements, and see which programs and initiatives have the greatest impact and warrant ongoing investment; care management teams stratify patients by risk and care gap closure opportunity to prioritize outreach; network leaders assess provider performance and monitor leakage; analysts work with the underlying data in familiar tools; and executives can make better-informed strategic decisions such as which VBC programs and lines of business to pursue. Because every group draws on the same source of truth, less time goes into reconciling numbers and more into deciding where constrained resources will have the greatest impact.
How does VBC software support alternative payment models?
Many ACOs hold several value-based contracts at once, each with its own benchmarks, quality measures, attribution rules, and timelines. VBC software can integrate the distinct terms and elements of each arrangement into a common data foundation so the organization can compare contract performance without having to maintain separate VBC reporting resources for each.
Traditional reporting, by contrast, often treats each contract as a separate effort, obscuring which providers or services drive results in aggregate and by contract.
Can an ACO build this in its existing BI tool?
A business intelligence platform can display VBC data effectively, yet it does not supply the analytic logic and methodologies beneath the results. Attribution logic, risk adjustment, groupers, benchmarks, and settlement rules must be built, validated, and revised each year, which requires actuarial and clinical expertise that many ACOs do not have in-house.
Many organizations use both: a VBC platform supplies normalized data and established methodologies, and analysts apply Power BI, Tableau, or SQL to that foundation.
What should ACOs expect from value-based care software?
ACOs should expect accurately integrated data that delivers visibility into contract and network performance, identifies providers who would benefit from greater support, supports cost and utilization analysis, and produces reporting their teams can trust and act on. The measure of success is clearer decisions and greater confidence in the numbers, which can be challenging with traditional reporting. These questions can help teams evaluate VBC software solutions against these requirements:
- How is claims data from different payers aggregated, normalized, and checked for quality, and can our team review that process?
- Which benchmarks, risk adjusters, and groupers are included, and how often are they updated?
- Can we trace an ACO-level result to the provider, encounter, and patient behind it?
- Does the platform forecast settlements for each contract during the performance year?
- How does it handle several contracts with different benchmarks, measures, and timelines?
- Can our analysts reach the underlying data with the tools they already use?
For a fuller evaluation framework, see What to look for in ACO healthcare software: A buyer’s guide.
How MedInsight supports ACOs in value-based care
The MedInsight VBC Platform combines Milliman’s actuarial expertise with claims, clinical, and supplemental data processed by industry-leading groupers, benchmarks, and risk adjusters, so clinical, financial, and analytics teams work from the same numbers. It supports the MSSP, CMS episode-based models, and commercial and Medicare Advantage arrangements, with progress tracked against Milliman benchmarks throughout the year.
More than 300 payers and ACOs have relied on MedInsight since 1997 to aggregate and analyze claims data with benchmarks, risk adjusters, and groupers that are peer-reviewed through the MedInsight Data Confidence Model. These include the Milliman Advanced Risk Adjusters (MARA), Chronic Condition Hierarchical Groups, and the Health Waste Calculator. Supplemental applications forecast settlement across agreements and project a contract before it is signed.
MedInsight also builds on its foundation of high-confidence claims analytics with clinical data enrichment when needed, and helps organizations resolve patient identities across fragmented claims and clinical data sources, enabling a complete, trusted view of each individual for more accurate analytics and value-based care.
Moving from reporting to performance management
ACOs accountable for cost, quality, patient outcomes, and financial risk need more than static reports and claims summaries. They need software that connects their data accurately, measures it against credible and relevant benchmarks, and shows what can still be changed while there is time.
Learn how MedInsight’s VBC software helps ACOs connect cost, utilization, clinical, provider, and contract data to manage performance across every value-based arrangement. Request a demo or contact a MedInsight analytics expert to discuss your current agreements and reporting workflow.
- Software can achieve near-real-time insights by enriching claims data with clinical data. ↩
