Suite 1300
Salt Lake City, UT 84111
Block-1 3rd Floor, Perungudi Bypass Rd, Perungudi,
Chennai - 600096
MGR Main Rd,
Perungudi, Chennai - 600096
Villupuram,
Tamil Nadu – 605602
Population Health & Value-Based Care Billing
Manage Population Risk. Improve Outcomes. Maximize Value-Based Revenue.
AI-enabled population health and value-based care execution that improves outcomes, reduces cost of care, and maximizes shared savings and incentive payments.
$800B+
Healthcare delivered under
value-based arrangements
in the US
2%
Medicare VBP adjustment
range — from bonus to penalty
based on quality
MSSP
Medicare Shared Savings
Program — primary ACO
model for hospital systems
HCC
Hierarchical Condition Categories — RAF scores
drive capitation payments
CMS risk adjustment
Why value-based care is financially difficult — key challenge areas?
Incomplete HCC Risk Adjustment Coding
Chronic conditions documented in the chart but not coded in claims do not contribute to the patient's RAF score. Under-coded populations generate systematically lower capitation payments and ACO risk adjustment. Each missed HCC represents a compounding loss across every plan year it goes uncaptured.
Quality Measure Data Not Reported Accurately
CMS and commercial payers require HEDIS, eCQM, and payer-specific quality measure data to calculate performance bonuses and penalties. Inaccurate data collection, abstraction errors, or missed submission windows result in quality scores that do not reflect actual performance — costing hospitals incentive payments they have earned clinically but failed to document financially.
VBP Domain Performance Not Monitored in Real Time
Medicare's Hospital Value-Based Purchasing program adjusts all DRG payments by up to 2% based on quality domain performance. Without real-time monitoring of VBP scores, revenue cycle leadership has no visibility into payment adjustments until after the fact — when there is no opportunity to improve performance.
MSSP ACO Cost Trends Not Tracked Proactively
MSSP shared savings calculations are based on benchmark spending compared to actual attributed beneficiary costs. Hospitals that discover poor ACO financial performance at year-end reconciliation have already lost the opportunity to manage utilization, reduce avoidable admissions, and protect shared savings potential.
HRRP and HAC Penalties Not Anticipated
Hospital Readmissions Reduction Program penalties of up to 3% and Hospital-Acquired Condition penalties of 1% reduce all Medicare DRG payments retroactively. Hospitals without continuous readmission and HAC monitoring cannot identify the patterns driving penalties in time to intervene before the measurement period closes.
Medicare Advantage Contract Performance Not Managed
MA contract financial performance requires tracking member attribution accuracy, RAF score optimization, utilization patterns, and quality star rating contributions across multiple plan relationships simultaneously. Without a dedicated management infrastructure, MA revenue is consistently lower than contract terms support.
Annual HCC Risk Adjustment Coding
Comprehensive annual HCC coding review across Medicare Advantage and ACO attributed patient populations: chronic condition identification, ICD-10-CM code accuracy validation, RAF score optimization, and prospective HCC gap closure. Ensures every documented condition is captured in claims data before the risk adjustment window closes.
Quality Measure Reporting
CMS and commercial payer quality measure data collection, abstraction, and submission management: HEDIS measures, CMS eCQMs, PRO-PMs, and VBC-specific quality metrics. Includes measure-level performance tracking, gap identification, and submission compliance monitoring across all reporting periods.
Medicare VBP Performance Monitoring
Medicare Value-Based Purchasing domain performance tracking across all four quality domains: clinical outcomes, safety, efficiency, and patient experience (HCAHPS). Monthly performance reports against national benchmarks with projected payment adjustment forecasting so revenue cycle leadership can anticipate — not react to — VBP payment adjustments.
MSSP ACO Management Support
ACO attributed beneficiary cost and quality performance tracking, benchmark monitoring, and shared savings or repayment forecasting for MSSP ACO participants. Real-time utilization analytics enabling ACO leadership to manage financial performance proactively rather than discovering results at year-end reconciliation.
HRRP & HAC Monitoring
Hospital Readmissions Reduction Program and Hospital-Acquired Condition program performance monitoring with identification of readmission patterns and HAC events affecting Medicare DRG payments. Includes root cause analysis and corrective action support targeting the highest-penalty exposure areas.
Medicare Advantage Contract Performance Management
MA plan contract financial performance management: member attribution verification, RAF score optimization, utilization analytics, quality star rating contribution tracking, and payer-specific quality measure reporting across all active MA contract relationships.
Commercial VBC Reporting
Commercial payer value-based contract performance reporting: quality measure submission, shared savings calculation, pay-for-performance tracking, and contract compliance monitoring across all commercial VBC arrangements.
Population Health Analytics
Patient population analytics supporting VBC financial performance: chronic disease prevalence mapping, care gap identification, high-risk patient segmentation, and utilization pattern analysis. Data delivered via ImpactBI.AI dashboards with executive-level financial performance visibility.
How it works — the AnnexMed VBC execution model?
-
18+
Years of experience -
40+
Specialties served -
99.1%
Client retention
Phase 1: Assess & Baseline
Population Risk Assessment
HCC coding gap analysis, quality measure baseline, VBP domain performance review, and attributed beneficiary cost benchmark analysis across all active VBC contracts.
VBC Financial Baseline
Quantify shared savings potential, identify HCC under-coding exposure, and establish performance benchmarks against national and regional comparators.
Phase 2: Optimize & Execute
HCC Coding & Risk Adjustment
Annual HCC coding review and gap closure. Chronic condition capture validated against clinical documentation. RAF score optimization deployed across Medicare Advantage and ACO populations.
Quality Measure & Contract Execution
Quality measure data collection, abstraction, and submission. VBP monitoring. MSSP cost tracking. Commercial VBC contract reporting across all payer relationships.
Phase 3: Monitor & Improve
Real-Time Analytics
Continuous VBC financial performance monitoring via ImpactBI.AI: shared savings trending, VBP payment adjustment forecasts, quality measure gap alerts, and RAF score performance dashboards.
Continuous Optimization
Monthly performance review against benchmarks. Proactive identification of deteriorating quality metrics before measurement windows close. Annual contract renegotiation support.
Technology platform — value-based care intelligence modules
HCC Gap Detection Engine
Analyzes clinical documentation signals against coded diagnoses to identify chronic conditions present in the record that are not reflected in claim data. Generates prioritized HCC gap closure queues by attributed population, risk score impact, and plan year deadline.
Quality Measure Analytics
Tracks HEDIS, eCQM, and payer-specific quality measure performance in real time. Identifies care gaps at the patient and population level, generates measure-specific improvement alerts, and projects year-end quality scores against bonus thresholds before submission deadlines.
VBP Domain Performance Monitor
Continuously tracks Medicare VBP domain scores across clinical outcomes, safety, efficiency, and patient experience. Projects payment adjustment impact based on current performance trajectory, enabling revenue cycle leadership to forecast Medicare DRG payment adjustments 90 days in advance.
Population Health & ACO Analytics
Real-time attributed beneficiary cost and utilization dashboards for MSSP ACO management. Tracks spending against benchmark, identifies high-cost utilization patterns, and models shared savings or repayment scenarios based on current cost trajectory and quality performance.
VBC Financial Performance Dashboard
Executive-level VBC revenue analytics: shared savings earned, quality incentive payments received, VBP adjustments applied, HRRP and HAC penalty exposure, and MA contract performance metrics — consolidated into a single CFO-facing financial performance view.
MA Contract & RAF Score Tracker
Medicare Advantage contract performance monitoring: member attribution verification, RAF score by member and population, quality star rating contribution analysis, and payer-specific reporting compliance — ensuring MA contract revenue reflects actual documented patient complexity.
Key billing & regulatory reference
Billing Dimension
Technical Detail
AnnexMed Approach
VBP Adjustment Range
±2% of total Medicare DRG payments — hospitals at top of performance receive bonus; bottom receive penalty across four quality domains
VBP domain performance monitored monthly; projected payment adjustments reported 90 days in advance
HRRP Penalty
Up to 3% reduction in all Medicare DRG payments for excess readmissions — heart failure, pneumonia, COPD, TKA, CABG
HRRP readmission patterns identified and root-caused; corrective action tracking by condition category
HAC Reduction Program
Bottom quartile hospitals on HAC measures receive 1% reduction in all Medicare DRG payments regardless of other performance
HAC event monitoring integrated into revenue integrity reporting with penalty exposure quantification
HCC Coding Mechanism
ICD-10-CM codes for chronic conditions in claims map to HCC categories; each HCC contributes to RAF score driving capitation and risk adjustment payments
Annual HCC gap closure program with documentation-to-code validation across full attributed population
MSSP ACO Structure
Two-sided risk model: ACO shares savings if costs fall below benchmark; repays if costs exceed benchmark; quality performance gates savings eligibility
Real-time attributed beneficiary cost tracking against benchmark with shared savings forecasting
MA Stars Rating
CMS 5-star quality rating system affects MA plan bonus payments and contract renewal; tied to quality measure performance reported by providers
Star rating contribution tracking by measure category with improvement opportunity prioritization
Quality Measure Types
Process measures, outcome measures, patient experience (HCAHPS), efficiency measures — each domain affects VBP payment and value-based contract performance
Measure-specific performance tracking with gap closure workflows and submission compliance monitoring
5–10%
Quality Scores (HEDIS, VBP, Star)
3–10%
Shared Savings Performance
5–10%
HCC RAF
Accuracy
15–25%
HRRP & HAC Penalties
90-day
VBP Payment
Visibility
5–12%
MA Contract Revenue
Why AnnexMed for population health & value-based care?
Not Traditional Billing — Outcome-Driven Revenue Management
AnnexMed positions VBC services as a financial performance and risk management function, not a transactional billing service. We manage the full continuum from HCC coding through quality measure submission to shared savings forecasting — the infrastructure hospitals need to succeed financially in outcome-based payment models.
HCC Risk Adjustment Coding at Population Scale
Annual HCC gap closure across attributed Medicare Advantage and ACO populations ensures all documented chronic conditions are captured in claims data. Our coding teams specialize in the population-level review required to close RAF gaps systematically, not on a claim-by-claim basis.
Quality Reporting Managed End to End
Our team manages the full quality data cycle from EHR extraction through CMS and payer submission — including HEDIS abstraction, eCQM data validation, and payer-specific measure reporting. Quality performance is accurately reported and bonuses are received rather than forfeited to administrative execution failures.
VBC and FFS Billing as a Unified Service
AnnexMed manages VBC reporting alongside standard fee-for-service billing as a coordinated service. This eliminates the coordination gaps and data inconsistencies that occur when quality reporting and revenue cycle billing are managed by separate teams with separate data systems.
Real-Time Financial Visibility for CFOs and Finance Leadership
VBP domain monitoring, MSSP cost tracking, HRRP exposure quantification, and MA contract performance analytics are delivered through ImpactBI.AI dashboards giving finance leadership live visibility into value-based revenue performance rather than relying on lagging indicators discovered after plan years close.
No Additional Technology Investment Required
AI Agents & Intelligent Automation and ImpactBI.AI are included as part of the AnnexMed engagement — hospitals receive AI-powered HCC gap detection, quality measure analytics, and VBC performance dashboards without incremental technology procurement or implementation cost.
Identify VBC revenue gaps in 2 weeks
Get a complimentary value-based care performance assessment. We will quantify HCC coding gaps, quality measure submission deficiencies, shared savings opportunity, and penalty exposure — and deliver a prioritized improvement plan at no cost and no obligation.
Case Studies
See the impact we deliver
Discover how AnnexMed reduces denials, accelerates reimbursements, and strengthens financial performance. Backed by measurable outcomes and proven RCM expertise, we deliver operational excellence, revenue stability, and sustainable growth you can trust.
Client Voices
See how our clients succeed
Hospital CFOs, revenue integrity directors, and health system finance leaders rely on AnnexMed to succeed financially in value-based care models.
Proven RCM expertise. Delivered at scale.
For over 20 years, AnnexMed has delivered RCM solutions nationwide, combining expert billing, coding, and AR support to drive measurable results and growth.
- 20+ years of proven healthcare RCM experience
- 1,500+ professionals supporting billing, coding & AR
- 500+ certified coders across multiple specialties
- 99%+ compliance with HIPAA and security standards
- All 50 states served with consistent, scalable operations
