ACO Economics
🛡️ Public data only — no PHI permitted on this instance.
ACO Economics Analyzer
MSSP, ACO REACH, MA capitation — shared savings, quality, full-risk transition — 1,330 corpus deals
Beneficiaries
25,000
Benchmark PMPM
$950
Quality Score
0.945
Expected Savings
$3.0M
Total Annual Value
$8.7M
Tracks
4
Infra Items
6
Corpus Deals
1,330
Shared Savings Performance Scenarios
ACO Risk Tracks
| Track | Beneficiaries | Benchmark PMPM | Risk Level | Upside Cap | Downside Cap | Quality Weight | Min Savings Rate |
|---|---|---|---|---|---|---|---|
| MSSP Track A (Upside-Only) | 10,000 | $950 | upside-only | 10% | 0% | 50% | 2.0% |
| MSSP Track E (Two-sided) | 7,500 | $950 | two-sided | 15% | 5% | 60% | 2.0% |
| ACO REACH (Direct Contracting) | 3,750 | $969 | global / full-risk | 100% | 100% | 40% | 0.0% |
| MA Full-Risk Capitation | 3,750 | $1,026 | full-risk | 100% | 100% | 20% | 0.0% |
Benchmark Establishment
| Component | Value PMPM | Basis |
|---|---|---|
| Regional Baseline PMPM | $893 | BY1-3 Medicare FFS weighted average |
| Regional Trend Adjustment | $33 | +3.5% annual growth factor |
| ACO-specific Trend | $10 | +1.0% ACO-specific adjustment |
| Complete-ACO Benchmark | $950 | Final benchmark for shared savings math |
| National MA Benchmark (ref) | $1,064 | For comparison vs MA contracts |
Savings Scenario Detail
| Scenario | Actual PMPM | Savings % | Gross Savings ($M) | Quality Mult | Net Shared Savings | ACO Share | Payout ($M) |
|---|---|---|---|---|---|---|---|
| Strong Performance (-6% vs benchmark) | $893 | +6.00% | $17.10 | 0.90 | $15.39 | 55% | $8.46 |
| Good Performance (-4% vs benchmark) | $912 | +4.00% | $11.40 | 0.85 | $9.69 | 50% | $4.84 |
| Target (-2.5% vs benchmark) | $926 | +2.50% | $7.12 | 0.85 | $6.06 | 50% | $3.03 |
| Marginal (-1% vs benchmark) | $940 | +1.00% | $2.85 | 0.80 | $2.28 | 30% | $0.68 |
| Above Benchmark (+2%) | $969 | -2.00% | $-5.70 | 0.85 | $0.00 | 0% | $0.00 |
Quality Score Components
| Component | Weight | Current Score | Target | Contribution |
|---|---|---|---|---|
| Patient Experience of Care | 25% | 4.2 | 4.5 | 1.05 |
| Preventive Health | 25% | 82.0 | 90.0 | 0.91 |
| At-Risk Population (Diabetes, HTN) | 25% | 72.0 | 80.0 | 0.90 |
| Medication Reconciliation | 10% | 88.0 | 95.0 | 0.93 |
| Falls Screening & Intervention | 5% | 78.0 | 85.0 | 0.92 |
| Tobacco Cessation | 5% | 72.0 | 82.0 | 0.88 |
| Depression Screening | 5% | 85.0 | 90.0 | 0.94 |
Infrastructure Investment Portfolio
| Investment | Y1 Cost ($M) | Ongoing ($M) | Enables Savings ($M) | Payback (mo) |
|---|---|---|---|---|
| Population Health Platform (tech) | $0.85 | $0.45 | $2.18 | 14 |
| Care Coordination Team (RN/SW) | $1.20 | $1.20 | $2.62 | 18 |
| Risk Adjustment / Coding Accuracy | $0.35 | $0.28 | $0.87 | 8 |
| High-Risk Patient Outreach / Home Visits | $0.95 | $0.85 | $1.75 | 22 |
| Remote Patient Monitoring (RPM) | $0.48 | $0.32 | $1.05 | 15 |
| Pharmacy Integration / Med Therapy Mgmt | $0.28 | $0.22 | $0.70 | 12 |
Full-Risk Transition Path
| Stage | Risk Exposure | Required Infra ($M) | Reinsurance ($M) | Shared Savings ($M) | Capitation Margin ($M) |
|---|---|---|---|---|---|
| Current — MSSP Upside/Two-sided | 25% | $2.40 | $0.45 | $7.12 | $0.00 |
| Year 1 — Add ACO REACH Track | 45% | $3.80 | $0.95 | $10.83 | $3.42 |
| Year 2 — MA Partial Risk (30%) | 65% | $5.20 | $1.85 | $12.82 | $9.12 |
| Year 3-4 — MA Full Risk | 100% | $7.50 | $3.50 | $15.68 | $15.68 |
ACO Thesis: 25,000 attributed lives at $950 PMPM benchmark.
Quality score 0.945 unlocks full savings share. Expected $3.0M shared savings
+ $5.7M capitation/MA margin = $8.7M total value.
Transition to full-risk over 4 years unlocks material margin expansion.