In value-based care (VBC), the strength and effectiveness of the provider network play a major role in determining success under a risk-bearing contract. The right mix of providers can improve outcomes, reduce costs, and help achieve savings targets. The wrong mix can lead to missed quality measures, financial losses, and patient dissatisfaction. Historically, however, network composition was often determined by incomplete data, personal relationships, and basic geographic access and adequacy requirements, approaches that did not take measurable performance into account.
A strong provider network is essential for accountable care organizations (ACOs) to succeed in VBC. Building strategic partnerships with high-performing providers and specialists enables ACOs to effectively manage population health, control costs, and meet the quality standards set by payers and regulators. A well-structured network also fosters collaboration, supports the exchange of accurate and timely information, and promotes the use of evidence-based practices. These elements are critical for improving efficiency and achieving shared savings as healthcare continues to move away from traditional fee-for-service models.
With experience serving Medicare ACO clients across the nation, Milliman MedInsight offers a comprehensive range of analytic tools and services to help ACOs manage risk, improve performance, and achieve lasting success in the VBC landscape.
In this article, Christopher Kodama, MD, Chief Medical Officer of Milliman MedInsight, shares how Milliman ACO Builder®, integrated with our VBC Platform, helps organizations make data-driven network decisions, model contract outcomes, and improve performance over time.
Q. What specific features of ACO Builder enable organizations to identify and select high-performing providers before finalizing contracts?
A: ACO Builder helps answer one of the most important questions in provider network development: “What is the right contract for each provider?” Unlike tools that focus only on network access and adequacy, ACO Builder uses complete Medicare claims data to evaluate providers across cost, utilization, and quality, and how this translates into performance under each contract structure. If multiple practices serve the same area, ACO Builder pinpoints which one delivers the most efficient and effective care. These insights let ACOs recruit strategically, select risk contracts and build networks based on measurable performance.
Q. How do ACO Builder’s modeling tools help compare performance across Medicare risk programs and forecast financial outcomes?
A: With ACO Builder, ACO leaders can quickly compare financial outcomes across MSSP, ACO REACH, and Medicare Advantage. Scenario modeling shows results under each program option (e.g., answering, “Which is the best baseline period for my network?”) and quantifies the risk and reward under best-case, worst-case, and expected scenarios, linking these results directly to provider performance. This gives executives clarity on potential upside and downside risk before committing to contract terms.
Q. How do ACO Builder and VBC Insights work together to monitor, benchmark, and optimize provider performance?
A: ACO Builder helps you design the network and choose the best contracting vehicle(s), while the VBC Platform lets you track and optimize performance in real time. Together, they create a continuous improvement cycle: select → model → monitor → refine. This closed loop reduces uncertainty and ensures that networks evolve as performance data emerges.
Q. How does integrating ACO Builder with the VBC Platform support ongoing performance improvement and risk management?
A: Together, ACO Builder and the VBC Platform create a full lifecycle approach to network development and management.
- Upstream: ACO Builder guides building your provider network, program selection, and contract modeling.
- Downstream: The VBC Platform monitors multiple contracts in near real-time, identifies high-impact intervention opportunities, and supports mid-course adjustments.
This integration gives organizations a comprehensive view of performance across contracts and populations, helping them adjust quickly to improve outcomes and financial results.
Q. What were the limitations of traditional network development approaches compared to data-driven solutions like ACO Builder?
A: Before tools like ACO Builder, network development often relied on:
- Including all employed providers by default.
- Addressing network gaps to ensure adequate geographic coverage.
- Selecting providers based on personal familiarity or reputation.
- Standard contract provisions versus fine-tuning contract options to maximize the opportunities for success.
While this approach ensured access, it rarely optimized for cost and quality. Without performance data, organizations risked including providers who might underperform in a risk-based arrangement or picking the wrong contract structure altogether.
ACO Builder enables objective evaluation of each provider, employed or independent, identifying who can contribute positively now and who may need performance support before inclusion.
Q. How does a data-driven approach create strategic advantages in value-based care?
A: The shift from volume to value requires organizations to:
- Select providers likely to succeed under risk-based terms.
- Model financial and clinical outcomes before signing contracts.
- Monitor and improve performance continuously.
ACO Builder, VBC Insights, and the VBC Platform enable this by replacing guesswork with evidence-based strategy. Organizations gain:
- Greater confidence in entering risk-based agreements.
- Networks aligned with both clinical and financial objectives.
- The ability to adjust quickly to improve results.
This integrated, data-driven approach reduces uncertainty and increases the likelihood of long-term success in competitive healthcare markets.
In VBC, success depends on three interconnected capabilities:
- Selecting the right providers.
- Designing contracts that align with organizational strengths and goals.
- Managing performance over time.
The next contract cycle is your opportunity to succeed in VBC
Every month you delay starting your network design and optimization is a missed chance to improve quality, reduce costs, and capture shared savings.
ACO Builder and the VBC Platform give you the power to design, model, and optimize a high-performing network, before you sign your next agreement.
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