ACO

Support H.R. 8163 and H.R. 8261

There are currently two bipartisan bills that shall modernize the Medicare Physician Fee Schedule to address decades of declining physician reimbursement (the Provider Reimbursement Stability Act of 2026), and eliminate the co-payment that beneficiaries must agree to pay before they can participate in Medicare CCM (the Chronic Care Management Improvement Act of 2026).

Support these two bills

To lean more, listen to the 6 1/2-minute Your Advocation is Needed Now-More-Than-Ever (mp3) and Click Here to download our support flyer (pdf).

Creating Total Cost of Care Savings and Medicare Shared Savings Program (MSSP) distributions for your members and their physicians is your ACO’s primary mission. But increasing administrative burdens have lead to an environment of financial uncertainty.

Our ACO support platform is the timely solution that shall help your ACO meet the expectations of your members.

Top-Performing ACOs Should Only Utilize the Services of Top-Performing Professionals.

Our service provider partner team is the most qualified and the ‘best-in-class’ at helping ACOs address and bridge vulnerabilities.
Their skill-set, strategies, tools, and support provide the structure that increase billing encounters, reimbursement, shared savings, and patient satisfaction.

The team is deeply experienced in healthcare and large scale program implementation and operations. And their comprehensive understanding of regulatory requirements and advanced proprietary software technologies makes them the ideal service partner. And their continuous updates in response to industry changes make their technology platforms crucial for meeting quality metrics and achieving better patient outcomes.

How much money has your ACO invested in the systems and processes (and people) that help to optimize results? What is the annual ROI to your members? And what are you doing to create an increase in ROI?

Many ACO executives boast about their cost of care savings, Quality Scores, care coordination, and care management, and more. But the truth is they need new and significant value to show their Board and members.

Our ACO Support platform provides the expertise your ACO needs, and all services are tailored to your ACO and members specific needs, which can change from one year to the next.

The offerings a comprehensive suite of services:

MACRA for ACO (QPP & MIPS)
Medicare CCM - MCCM Enhanced Relationship Care for ACO

See below and our services webpages for the important details on each.

The Bottom Line

Our ACO Support platform is the empowering solution that ensures your ACO meets its mission goals with unparalleled technology, guidance, and support.

We help you meet requirements and improve Quality Scores, patient outcomes, attribution, maximize financial performance, and increase shared savings distributions.

MACRA requirements make up thousands of pages of regulations in the Federal Registry and are a very complicated beast and no small task to manage or optimize.

Though most ACOs did a good job meeting Quality Measures in the past, many are missing the opportunity to help members qualify for the maximum payment adjustment of up to 9%.

MACRA is Worth Money$$

The high cost of doing business has been met with inadequate increases in reimbursement by CMS. But MACRA can actually help.

Make sure your members and their physicians don’t leave any money on the table. Help them qualify for up to the maximum payment adjustment in the next PAY.

Understanding the financial implications of the QPP & MACRA helps in making the decision on whether to invest in MACRA Optimization / Registry Services or stay the course with your ACOs current effort - very easy.

The only thing worse than failing to maximize your members payment adjustment is not taking the simple steps to help them qualify for it. And that’s exactly what many ACO decision makers are doing.

The MACRA Optimization Cycle

Optimization consists of a 9-step process that can only be achieved with an Active or On-Going Program that follows a regiment of extract, report, analyze, plan, and act for each quarter or month. And only by taking each step can your ACO earn an exceptional Category Weights and a Final MIPS Score that shall qualify yours and their for the maximum payment adjustment in the next PAY.

Technology That Provides More Than EHR

Who Needs It? (Epic, Cerner, Allscripts, eClinical Works) - Almost All EHR Users

EHR’s can't submit MACRA data directly to CMS. In fact, it can be hard to even analyze MACRA data in meaningful ways. That's why the platform subscribers get better reimbursements, with less manpower.

Physicians Buy EHR for Patient Care - Not for Fast-Moving Regulatory Compliance

Managing MACRA from a physician point of view should be a by-product. We find that even the best EHRs only keep up with MACRA at the superficial level of creating numerator / denominator values, and honestly - those rules don't change much.

CMS Publishes Hundreds of Pages of New MACRA Rules Each Year

Our platform relies on EHR to do the numerator and denominator work but does all the rest relating to those hundreds of pages.

EHR Plugin

Our platform is a cloud-based tool that connects to EHR with no local software needed. And our enhanced reporting and sophisticated concierge team shall take it to the next level - beyond simple numerator / denominator content.

Whether EHR is sophisticated enough to create QRDA3 output, a simple spreadsheet, or just a PDF - connecting to the platform simplifies connecting to CMS.

Automated Data submission

With our platform there is no need to manually submit or upload data via EIDM. It provides an automated streaming API directly to CMS, with automated response and tracking at the level of TIN, Provider, MIPS Category and Measure.

MACRA Financial Projections

Our platform automatically queries CMS for Medicare billing and payment history for each physician. Then it applies statutory minimum / maximum expectations based on each year's MACRA rules, adjusted for estimated CMS Scaling Factors. It then sets budgets that tie operational performance with financial performance. Finally, as it accumulates PI, CQM, Cost, and CPIA data throughout the year, it displays actual financial results against these budgets.

Provider Dashboards and Scorecards

Our platform's excellent dashboard integrates financial performance with MACRA operational performance in uniquely powerful models. It flags individuals, TINs, and customizable groupings against operational targets throughout the year. And it provides potent provider communication tools that clearly share the impact of performance.

Analysis of Alternatives

As our platform tracks actual performance data throughout the year, you shall have instant visibility into which submission models (Group / Individual, EHR / Registry, ACO / Advanced APM / Standalone), which earns the greatest MACRA reimbursement.

Physician Compare / Review and Correction Cycle Management

Submission is not the end of your MACA Season. CMS ultimately echo’s back their understanding of submissions, and gives the chance to agree, or to submit data for further review. Our platform gives provider groups the tools to manage the overall process.

Complex TIN and Provider Organization Management

No one tracks complex organizations like our platform. Its tools incorporate not only TIN dashboarding but also identify the key workflow steps that keep track of progress across complex TIN structures.

Software + Concierge

Because our platform is independent of EHR and Registry offerings, it is in a unique position to identify, configure, and submit your very best MACRA options. It often blends from multiple offerings, which really fine-tunes your result.

Tools and Consulting Combined

Not even the best tools stand alone. And not even the best consultants can organize and optimize complex data. We believe your needs include both consulting and software thoroughly integrated.

Your Concierge is always available for help with any MACRA tasks. Our platform’s software integrates with any EHR and any Registry to give you the best of both worlds.

MACRA is much more than a year-end submission exercise or a periodic measure calculation.

You can’t improve performance by looking at your metrics after the year is over. And simply making numbers available a couple times a year only improves things a little.

At times, your ACOs Category Weights and Final MIPS Score may not be complete and/or accurate. And while some solutions can be applied retroactively, many require that coders or physicians change the way they describe things or even change physician behavior.

Many so-called MIPS or MACRA experts’ (vendors) give lip service to CMS quarterly or monthly requirement of integration and feedback. They get by with a dashboard that clients can look at any time. Such a passive approach is NOT dependable. The fact is – a dashboard is the least dependable of all.

What Else is Required

For your members with fewer than 100 physicians & clinicians, it should be enough to run reports from your EHR quarterly, post them to a standalone MACRA database for performance analysis, and discuss shortfalls against targets. For complex multi-TIN organizations, MACRA Optimization steps need to be done monthly.

Sophisticated program analytics is required because raw MACRA data doesn’t mean a lot to ACO and TIN management, physicians, or clinicians. By adding the financial impact, this creates a clear frame of reference. And once CMS publishes their Physician Compare content, the MACRA team should study the impact of public scores on the flow of new patients.

Many of your mid-to-large sized members may need at least one person with the expertise, time, and resources (including access to external expertise) to maintain or achieve the highest performance status.

If your ACO is already working with a MACRA or MIPS vendor or Registry, you still need an independent 3rd party review of their work to ensure they’re following up on all requirements. Because you can’t afford to find out if they’re not after the fact.

We shall also help your ACO identify areas that need improvement for getting a patient scheduled for Medicare Chronic Care Management (M-CCM) conditions.

Payment Adjustment Remittance Verification

In PAY 2026, CMS reports that more than 21% of all MIPS eligible TINs, physicians, and clinicians shall be penalized with a negative payment adjustment.

It is estimated that more than $4 billion shall be redistributed to 2024 top MIPS performers in 2026.

Your members can find their payment adjustment in their QPP Detailed Final Report. But they need to verify the payment adjustment on each claim they submit because it may not be easy to identify and requires a bit of calculation to show if it is correct. It shall show as a dollar amount on their remittance advices, but to determine if it is accurate they need to convert it to a percentage and compare it to the expected percent for the submitting physician, which does not appear on their remittance advices. Our Payment Adjustment Remittance Verification pulls the expected percent from the CMS / QPP database and compares that value to the value calculated on your members Remittance Advices.

Your management team needs to contemplate the value of the payment adjustment in the Medicare Fee Schedule under the QPP & MACRA to those same TINs knowing that a single point (increase or decrease) in MIPS score probably be worth up to $250k or more.

Some of our MACRA solutions shall be oriented towards your ACO (i.e., calculation of eCQMs under optional / mandatory regulations, and real-time calculations of ACO-level MACRA (MIPS) scores throughout the Corresponding Performance year (CPY), and others towards your members (i.e., enabling a hierarchy of CQM, PI, IA, & Cost evaluation and submission and Patient Engagement options that can enhance the TINs Payment Adjustment Year (PAY) revenue and reimbursement beyond ACO-level results).

We help your members earn that return and probably for considerably less than half the cost of a single new hire.

eCQM

As CMS incentivizes ACOs to integrate eCQM into their reporting repertoire, your members look to your ACO for guidance. We provide the needed knowledge, tools, and people to support all required data collection, communication, and analytics to help. And quite probably do it for less than the cost of one employee.

Our formal process for optimizing MIPS (Category Weights Scores) proves that early corrections have big impact, and that year-end (submission-time) analysis has little or no impact on improvement.

Advanced APMs

Advanced APMs are exempt from MIPS. However, most if not all physicians shall likely fall into “Partial QP” status due to the QP threshold increase from 50% to 70%.

The impact is that Partial QPs are optional MIPS submitters. But with your normal high performance, submissions should earn your member physicians more than their historical QP reimbursement of 5%. (Note: by electing to not submit they receive zero).

Here is the best option going forward - First, as Partial QP’s, submission should be made by all TINs individually, and the ACO-level CQM submission does not apply. In this approach, we fulfill the role of ACO support by interacting with each TIN throughout the year to optimize their own Category Weights Scores. For all but one TIN, this involves generating CQM data from their Certified EHR. This approach avoids any chance of penalties and maximize earning & efficiency for your members.

ACO MACRA Snapshot

We how you what your ACO and members MACRA opportunity looks like. We shall email you a pdf of a CMS data snapshot on your ACO and a few of your member clinics, which shows you how much more revenue can be captured with MACRA optimization.

The summary breaks down the data for you in very simple language.

ACO MIPS Data Analysis

This analysis is an invaluable tool to present to your board and members. It shall include an MACRA Strategy Report and data spreadsheet that calculates your MIPS opportunity based on the current PY.

Member medical groups, hospitals, clinics, and physicians are overburdened by paperwork,

administrative burdens, rising costs, and declining reimbursement.

The ongoing threats of reimbursement cuts and the political instability surrounding federal healthcare funding have reached an inflection point. Without a more meaningful increase in CMS reimbursement, it shall remain difficult to recruit, retain and sustain physicians as Medicare providers.

Medicare CCM (MCCM) Enhanced Relationship Care is now-more-than-ever, a timely solution that creates total cost of care savings and help your ACO increase shared savings distributions. And help your members and their physicians improve patient care and care management, and maximize financial performance. Your members may have heard about it in the past, or may have participated in the past and fell off. But the time has now come for a re-examination.

Why MCCM Enhanced Relationship Care is Important for ACOs

CMS estimates that MCCM reduces Total Cost of Care by $74 pppm.
MCCM and ACO overlap in mission-critical areas.
Chronic condition-based quality.

Where clinical Quality Measures reference chronic conditions, the presence of MCCM Enhanced Relationship Care goes far in sustaining visibility into chronic patients. And visibility is a first step in managing quality.

Physician / Clinic Relationship Management

Imagine a scenario where your activities generate new revenue for your member physician population - daily. In some cases, you enable those revenues in ways the physicians cannot. Might that improve clinic / physician recruitment and retention?

Patient Recruitment (REACH-Model ACO)

REACH-Model ACOs are allowed to provide incentives to patients to be a member of the ACO. What better incentive for a patient than having monthly access to their own nursing staff?

Mission Critical for Your ACO

The presence of MCCM Enhanced Relationship Care goes far in sustaining visibility into chronic patients. And visibility is the first step in managing quality. Cost measures are completely based on Medicare patients. This makes the program particularly powerful in the ability to influence utilization of expensive services, by pre-empting the need with ongoing clinical care.

Helps your ACO meet its mission goals.
Capture Total Cost of Care savings.
Improve quality scores, attribution, and clinic & physician recruitment and retention.
Increase shared savings distributions.

Since 2015 – Poor Utilization

Almost every medium-to-large medical group or practice manager has tried a third-party Chronic Care Management (CCM) or Remote Patient Monitoring (RPM) program vendor in the past.

These fully-outsourced contracts (staffing and all other services) had an initial set of enthusiasm with eligible patients and physicians — but almost always burned them.

The problems:

Almost all vendors utilize a flawed business model and fail to onboard and retain a sufficient number of eligible patients, and use unethical methods to meet onboarding goals.
They promise 'turnkey revenue'—only to leave the clinic exposed to CMS audit risks, EHR documentation messes, or angry patients.
Their care managers often skip minutes, log low-quality notes, or fail to meet strict CMS Incident-to-Billing Rules, putting the physician and clinic legally on the hook for False Claims Act violations.
They call older patients, who are vulnerable to phone scams, sounding like a call-center agent, which confuses patients and makes them call the clinic upset, or leave a bad review.
They promise "turnkey" service, but then bombard the front desk with questions, upset patients with robotic phone calls, or leave the clinic stuck trying to collect $15 co-pays from confused seniors who complain to the doctor.

To make matters worse, most vendors do not do the proper preliminary work required, set any proper level of expectations among physicians and staff, or offer any performance metrics beyond basic billing data:

No Feasibility Analysis to build effective participation and success.
No indication of how many patients are currently enrolled.
No indication of what percentage of eligible patients enrolled.
No software tools that report on staff efficiency; and
No easy access to reporting on CPT billing.

These Are Why Top-Performing Clinics Should Only Utilize the Services of Top-Performing Professionals for MCCM.

Factors of MCCM Enhanced Relationship Care Success

First, a preliminary MCCM Feasibility Analysis on each qualified member is required to address key issues and complete the preliminary work necessary. This includes an in-depth data analysis, developing the clinical policy & culture to follow, provide physician education, conduct patient identification, develop the patient engagement & onboarding strategy, and more.

And second, automation such as SaaS or AI technology, which ensures clean documentation, denial control, and program management.

Without an initial deep analysis, MCCM Enhanced Relationship Care success is nearly impossible. And with technology, and a better guidance, and support system; your members and their physicians can achieve double or even triple average eligible patient enrollment and retention results.

ACO Management of MCCM Enhanced Relationship Care

It is the mission of your ACO to create Total Cost of Care savings, and MCCM was developed to help you accomplish this. So, indeed you can, and should manage the program for your members.

But currently, most cannot because of the complexities of MCCM, and the way they are paid by CMS (shared savings). This means they lack the funding, technology, and staff to properly conduct the required preliminary work, and program management.

Your ACO is better suited for conducting patient interaction and CCM work, after a feasibility analysis is completed. Or taking over after members have opted-in 20% or more of their eligible patients. And we help make this happen.

There are some exciting possibilities for your ACO, which shall be discussed later.

Adoption is very easy for ACOs that are owned and operated by a parent health system, medical group, or hospital; However, those that are independent do not move on anything unless it is demanded by their members.

The Offering

Our Service Provider Partner offering is built to help your member clinics and their physicians with evaluating, implementing, and operating MCCM Enhanced Relationship Care successfully. Here are the keys points:

MCCM Feasibility Analysis – Should they participate in MCCM Enhanced Relationship Care? What are the metrics, physician profiles, and cultures that support success? What physicians and patients should be incorporated? Who shall hire / contract for mid-level billers? At what fee (if any) will the physicians be charged for mid-level services?
Implementation – They develop and roll out clinical policies, audit-proof reassurance measures, and a low-friction patient micro-pilot. The initial Feasibility Analysis work includes education of administrative and clinical staff, developing patient education materials, setting up clinic responsibilities for patient onboarding, and micro-pilot patient selection (i.e. avoiding weak patient candidates). They shall run the micro-pilot on a small number of your eligible Medicare patients who have secondary insurance—where there is zero co-pay. They don't commit their whole patient panel. They shall run care management for 60 days, log everything in their EHR, handle all care calls (2 monthly calling cycles), and prove the net revenue and patient satisfaction before they commit. With Congress moving to eliminate the 20% Medicare co-pay for its care codes, the biggest patient enrollment barrier is dropping. They help structure their panel so growth can be captured seamlessly.
Software Operations – Their proprietary SaaS platform ensures clean documentation, denial control, and program management. It manages the scheduling, clinical documentation, telehealth / calling, and executive dashboarding. And it integrates with their clinic’s EHR and billing system. And there is very little to learn.
Clinical Staffing – Flexible staffing models support a range of clinic-level strategies. At the full concierge level, they hire, train, and manage all mid-level staff – which they have final approval on to work with their patients. This model can be either a permanent arrangement, or part of their MCCM Enhanced Relationship Care startup-strategy where they phase out their team as your ACO or members roll in their own employees.

Why Our Service Provider Partner is the Best Choice

They have developed the model that de-risks the operational and clinical worries, and delivers maximum value – MCCM Enhanced Relationship Care.

Our Provider Partner:

Is the ‘best-in-class’ at identifying MCCM Enhanced Relationship Care feasibility and conducting program management.
Skill-set, strategies, tools, and support provide the structure that ensures success.
Deeply experienced in healthcare and large-scale program implementation and operations.
Comprehensive understanding of regulatory requirements and advanced proprietary SaaS technology and continuous updates in response to industry changes, make their platform crucial for meeting quality metrics and achieving better patient outcomes.

Utilizing EHR for MCCM Program Management

For ACO and/or their members currently offering eligible patients MCCM and utilize their EHR for program management, may require technology that integrates and provides all necessary billing data. Our SaaS Technology Platform could be the perfect solution because its advanced software tools scale MCCM efforts upwards.

ACO SUPPORT THAT GETS RESULTS

MACRA FOR ACO

MEDICARE CCM (MCCM) ENHANCED RELATIONSHIP CARE FOR ACO

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