Value Based Care isn’t a contract problem, it’s an operating model problem.
From Readiness to Sustainable Performance.
✓ Focused on readiness
✓ progress striving on achievement
operational strides with Partnership
Streamline Growth: Move from fragmented initiatives to enterprise level value based execution
Too many organizations enter risk arrangements without truly understanding their readiness, financial exposure, or the operational discipline required to perform. As an advisor, my role is to bring clarity and structure to Value-Based Care strategy before downside risk shows up on the P&L.
We help leadership teams assess VBC readiness across care management, utilization, quality, risk adjustment, data, and governance, while translating complex contract terms into clear financial and operational implications. From there, I establish performance baselines, benchmark results, and design future-state operating models built for proactive care, early risk identification, and sustainable outcomes.
Value-based success requires more than dashboards, it requires accountability. We work with organizations to define meaningful KPIs, embed performance management into decision making, and build governance models that align incentives and ownership. The goal is simple: move from reactive participation in value based contracts to confident, repeatable performance.
The Anatomy of a
Value Based Transformation
From 92% Fee-for-Service Dependency to 38% Value-Based Revenue in 24 Months · Zero Qualifying VBC Arrangements to Three Active Agreements · $400M+ Incremental Revenue Captured
Priced Below Its Value
VBC Readiness Assessment — 6-Dimension Maturity Diagnostic
CMS1 Partners™ applies a proprietary 6-dimension maturity diagnostic at engagement inception, establishing a baseline score and target architecture for each pillar. The radar maps the full transformation from Month 1 to Month 24.
VBC Maturity Radar — Baseline vs. Post-Engagement
Gold = Post-Engagement · Dashed = Baseline · Scale: 0–100
Transformation Architecture — Four-Phase Engagement Design
A 24-month engagement structured as four sequenced phases. No Contract arrangement was signed until the underlying performance infrastructure was operational and validated.
- 6-dimension VBC readiness assessment
- FFS revenue dependency and risk mapping
- Quality gap analysis vs. all payer thresholds
- Payer VBC landscape & opportunity inventory
- Board-ready transformation roadmap
- HEDIS tracking and gap-closure platform
- HCC / RAF V28 coding program launch
- Care coordination workflow integration
- Quality reporting infrastructure deployment
- VBC contract term evaluation & negotiation
- VBC Contract Arrangement #1 activated
- Prospective care gap closure workflows live
- Cost trend monitoring vs. risk-adjusted benchmark
- Shared savings threshold tracking & management
- Arrangement #2 structured and negotiated
- Full Contract portfolio management (3 active)
- Shared savings acceleration and pool maximization
- 4.1★ Star Rating milestone achieved (Month 18)
- P4Q bonus pool fully unlocked ($840K+)
- MA contract renegotiation using quality leverage
Engagement Roadmap — 24-Month Milestone Timeline
Key milestones across the full engagement. The financial inflection arrived at Month 9 with the first contract arrangement activation.
Transformation Roadmap — Phase Bands & Key Milestones
Color bands = Engagement phases · Month scale on horizontal axis
Cumulative Value Capture — Quarterly Build Across 24 Months
Value capture was structurally back-loaded. The curve accelerated sharply from Quarter 4 as arrangements went live and quality bonuses became accessible.
Cumulative Incremental Revenue Captured ($M) — Q0 through Q8
Q0 = Engagement start · Q8 = Month 24 · Gold curve = Cumulative value captured
Performance Delta — Six Dimensions Before vs. After Engagement
Six core performance metrics at engagement inception vs. Month 24. Each directly contributed to financial outcome: quality scores unlocked P4Q pools, RAF improvement drove capitation uplift.
Key Performance Metrics — Baseline vs. Post-Engagement
Gold bars = Post-Engagement · Muted bars = Baseline · All metrics on 0–100% scale
24-Month Engagement Outcomes — Summary
Why This Worked — The CMS1 Partners™ Execution Approach
The transformation happened because CMS1 Partners™ built the strategic and operational layer that translated existing clinical performance into documented, contractually recognized value.
- 6-dimension readiness assessment before any recommendations
- Payer-by-payer opportunity mapping against actual contract terms
- Quantified gap-to-threshold: how far, at what cost to close?
- Revenue-at-risk modeling: what happens if VBC is not pursued?
- Board-ready investment case with phased ROI projections
- No contract signed until quality infrastructure was validated
- RAF V28 coding program with physician-level accountability dashboards
- HEDIS gap closure workflows integrated with existing EMR
- Care coordinator embedded with high-risk attribution population
- Monthly performance reporting ahead of payer quarterly reviews
- Arrangement #1 matched to current capability — no overreach
- Shared savings threshold set with safety margin above baseline
- Each arrangement modeled for downside risk before activation
- Payer negotiation anchored on documented quality improvement
- Arrangement #2 structured with lessons from Arrangement #1 data
- Engagement investment tracked against live value capture in real time
- P4Q bonus pool harvest timed to payer measurement cycle deadlines
- RAF coding designed for RADV defensibility — not score lift alone
- Cost reduction scoped to avoid care quality degradation
- MA renegotiation initiated only after 4.0★ milestone was confirmed
Three payers offered VBC terms.
They were declined. That changes today.
CMS1 Partners™ builds the infrastructure, designs the strategy, and manages the execution — so your organization captures the value already embedded in your clinical performance.
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