Value-Based Care Attribution Agent
Maintains patient attribution, quality scores, and total cost of care insights for value-based contracts.
Value-based contracts fail operationally when attribution is disputed, quality gaps are discovered too late, and total cost of care (TCOC) insights are fragmented across payers
Finance, quality, and care management work from different rosters, causing missed shared-savings opportunities and surprise downside risk
The Value-Based Care Attribution Agent maintains living attribution, tracks quality performance, and surfaces TCOC trends with actionable leaks so VBC teams can manage contracts proactively
The agent reconciles payer attribution files with internal panels, monitors quality measure denominators and numerators, calculates TCOC and leakage metrics, and alerts owners when attribution, quality, or cost trajectories threaten contract performance.
Reconcile Attribution and Panels
- Ingest payer attribution, prospective/retrospective methodologies, and internal PCP panel assignments
- Detect joiners, leavers, dual assignments, and disputed members
- Generate appeal packets for incorrect attribution with visit and claim evidence
Track Quality Measure Performance
- Map members to contract quality measures and STAR/HEDIS-aligned metrics
- Compute open gaps, predicted year-end rates, and measure-level opportunity ranking
- Route gap worklists to clinics and care management with measure-specific actions
Analyze Total Cost of Care and Leakage
- Aggregate medical and pharmacy spend PMPM by service category and high-cost claimants
- Identify out-of-network leakage, site-of-service shifts, and avoidable acute utilization
- Link cost drivers to care programs and specialty referral patterns
Publish Contract Intelligence and Alerts
- Produce contract dashboards for quality, cost, and attribution movement
- Alert finance and clinical owners when performance crosses risk corridors
- Support quarterly joint operating committee packs with narrative variance analysis