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Scorecard

Is Your Practice Ready for Value-Based Care?

CMS Innovation Center reports show that practices succeeding in value-based contracts consistently invest in panel analytics, care coordination, and quality-measure tracking before taking on risk. Score your readiness across data and analytics, care coordination, quality-measure tracking, patient-panel management, and payer-contract readiness to surface the gaps that typically separate VBC-ready practices from their fee-for-service peers.

Last updated: May 2026

Value-based care (VBC) operational readiness is a scored assessment of whether a medical practice has the operational infrastructure to participate effectively in value-based contracts. Readiness = (Data and Analytics) + (Care Coordination) + (Quality Measure Tracking) + (Patient Panel Management) + (Payer Contract Readiness). CMS Innovation Center VBC participation typically target In multiple upside-only arrangements moving toward downside.

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What is Value-Based Care Operational Readiness?

Value-based care (VBC) operational readiness is a scored assessment of whether a medical practice has the operational infrastructure to participate effectively in value-based contracts. It covers panel-level analytics and risk segmentation, documented care-coordination workflow with dedicated staff, quality-measure tracking with care-gap workflow, formal patient empanelment with panel-size management, and payer-contract analysis under risk scenarios.

The Formula

Readiness = (Data and Analytics) + (Care Coordination) + (Quality Measure Tracking) + (Patient Panel Management) + (Payer Contract Readiness)

CMS Innovation Center reports consistently identify panel-level risk analytics, care-coordination workflow, and quality-measure tracking as the three operational pillars that separate VBC-ready practices from their fee-for-service peers.

Worked Example

A 6-provider primary-care group has EHR-driven risk segmentation reviewed quarterly, no dedicated care coordinator, tracks HEDIS measures annually for payer reports, soft empanelment in EHR, participates in MIPS only.

Data and Analytics: EHR-driven quarterly (medium)
Care Coordination: no dedicated role, shared responsibility (low)
Quality Measure Tracking: annual for payer reports only (low)
Patient Panel Management: soft empanelment (low to medium)
Payer Contract Readiness: MIPS only (workable for entry)

📌 Composite readiness lands in the workable lower-middle range. Highest-leverage operational fixes: invest in a part-time dedicated care-coordinator role, move quality-measure tracking to monthly with pre-visit care-gap planning, and formalize empanelment with quarterly panel-size reviews. These three changes shift the practice from VBC-participating to VBC-performing within 12-18 months in published industry benchmarks.

Why This Matters

VBC requires operational infrastructure, not just a contract

CMS Innovation Center reports consistently show that practices entering value-based contracts without panel-level analytics, care-coordination workflow, and quality-measure tracking systematically underperform on quality and cost. Bolting VBC onto a fee-for-service workflow rarely sustains.

Risk progression compounds infrastructure value

Practices that build VBC infrastructure for upside-only programs (MIPS, MSSP Track 1) can move to upside-and-downside arrangements with materially better economics. The infrastructure compounds because the analytics, care coordination, and quality tracking serve every progressive VBC program.

Common Mistakes

❌ Taking on downside risk without panel-level analytics

Entering upside-and-downside arrangements without total-cost-of-care reporting and risk-stratified panel analytics is the most common cause of avoidable losses in VBC contracts. The practice cannot manage what it cannot see; the analytics investment usually precedes the risk progression.

❌ Treating care coordination as a shared part-time role

Care coordination as a duty shared across MA and front-desk staff rarely produces the consistent outreach and follow-through that VBC payment models require. Practices succeeding in VBC consistently invest in dedicated care-coordinator roles even at modest scale.

Industry Benchmarks

Category	Good	Average	Poor
CMS Innovation Center VBC participation	In multiple upside-only arrangements moving toward downside	MIPS only	No VBC participation
Quality measure review cadence	Monthly with provider dashboard and improvement plans	Quarterly	Annual for payer reports only
Care-coordinator staffing (primary care)	0.5-1.0 FTE per 1,500-2,000 attributed patients	Part-time dedicated role	Shared responsibility no dedicated role

Source: CMS Innovation Center reports, HFMA value-based care maturity research, and Bain VBC infrastructure benchmarks

Benchmark data sourced from CMS Innovation Center reports, HFMA value-based care maturity research, and Bain VBC infrastructure benchmarks.

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One of the most common mistakes we see when working with clients: taking on downside risk without panel-level analytics. Entering upside-and-downside arrangements without total-cost-of-care reporting and risk-stratified panel analytics is the most common cause of avoidable losses in VBC contracts. The practice cannot manage what it cannot see; the analytics investment usually precedes the risk progression.

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Frequently Asked Questions

How do I know if my practice is ready for value-based care?

CMS Innovation Center reports consistently identify three readiness signals: panel-level risk analytics, a documented care-coordination workflow with dedicated staff, and active quality-measure tracking with monthly review. Practices weak on these three typically underperform on quality and cost in VBC contracts; bolting VBC onto a fee-for-service workflow rarely sustains.

What is the difference between fee-for-service and value-based care?

Fee-for-service pays the practice per visit, procedure, or service delivered. Value-based care ties payment to quality measures, patient outcomes, and total cost of care for an attributed patient panel. VBC payment models range from upside-only (shared savings) to upside-and-downside (risk for cost overruns); the operational requirements increase substantially with the level of risk.

Should a small practice participate in value-based care?

Small practices can participate in value-based care, typically through upside-only programs (CMS MSSP Track 1, MIPS, some commercial-payer arrangements) while building the analytics and care-coordination foundation. Moving to upside-and-downside arrangements requires more substantial infrastructure investment; many small practices participate through ACOs or MSOs that provide shared infrastructure.

What tools does a practice need for value-based care?

Practices succeeding in VBC consistently invest in a population-health analytics layer (risk stratification, care-gap identification, total cost of care reporting), a registry-driven care-coordination workflow, dedicated care-coordinator staff, and quality-measure tracking integrated with the EHR. The specific platform choice depends on practice size and EHR; the operational pattern is consistent across vendors.

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