ACOs
Shared-savings tracking and quality reporting for accountable care organizations.
Value-Based Care
Value-based care platforms
We build platforms that connect clinical outcomes to reimbursement: quality-measure tracking, risk-adjusted analytics, and contract dashboards that show, in near real time, where a value-based agreement stands against its targets.
HIPAA-ReadyFHIR R4HEDIS-AlignedAudit Logged
Trusted by global innovators
What is value-based care?
Value-based care pays providers for outcomes and cost against agreed targets, while fee-for-service pays for each service delivered. Software for value-based care has to attribute patients, calculate quality measures, adjust for risk and project contract performance during the period. Agnotic Technologies builds that layer for ACOs, health plans and risk-bearing providers.
Generic BI dashboards can chart a number but can't trace it to the measure specification, attributed population and contract term behind it. We build VBC platforms where you can drill from a shared-savings projection to the gaps, patients and measures driving it.
What it is
Software that gets paid for results
A value-based care platform connects clinical outcomes to financial performance under risk-bearing contracts, computing quality measures, adjusting for population risk, attributing patients, and projecting earned reimbursement against contract targets.
Its job is to make performance visible early enough to act on. We build platforms where every outcomes-to-reimbursement number is traceable to its source, so care teams and finance can trust the same dashboard.
Outcomes-to-reimbursement, made visible
Quality measures, risk adjustment, and contract performance in dashboards that trace every number back to its source.
What goes into a value-based care platform?
Each capability ties a value-based outcome to the data standard or measure spec that makes it defensible.
Outcomes-to-reimbursement engine
A model that maps clinical and claims data to contract terms (shared savings, capitation, bundled payments) so you can project earned revenue against benchmarks throughout the performance period, not just at reconciliation.
Quality measure calculation
HEDIS, MIPS, and CMS Star measures computed from FHIR R4 clinical data and claims, with electronic clinical quality measure (eCQM) logic and gap-in-care detection that flags open measures while there's still time to close them.
Risk adjustment & HCC coding
HCC risk-score calculation and suspected-condition surfacing from clinical notes and claims, so risk-adjusted contracts reflect the true acuity of the attributed population.
Contract performance dashboards
Dashboards that show each value-based agreement against its targets (quality, cost, utilization) with drill-down from a top-line number to the patients and measures behind it and role-based views for executives and care teams.
Attribution & population panels
Patient-to-provider and patient-to-program attribution logic, with panel management views so care teams know exactly who they're accountable for under each contract.
Interoperable data foundation
A FHIR R4 data layer aggregating EHR, claims, ADT, and lab feeds via HL7 v2 and bulk FHIR $export, with encryption and audit logging so the analytics rest on governed, traceable data.
Where it runs
Who uses value-based care software?
Health plans
Contract performance and Star-rating management across networks.
Risk-bearing providers
Capitation and downside-risk monitoring for provider groups.
Clinically integrated networks
Cross-organization measure aggregation and attribution.
Medicare Advantage
HCC risk-adjustment accuracy and Star measure closure.
Employer & direct contracting
Outcomes reporting for direct-to-employer arrangements.
Where does VBC software create value?
Value-based performance is won during the period, not at reconciliation. We build for visibility early enough to act: targets are defined against your contracts in discovery.
FHIR R4
Interoperable clinical data foundation
HEDIS
Quality measures computed to spec
HCC
Risk-adjusted outcomes-to-reimbursement
Compliance-First Healthcare App Development Services Backed by Global Standards
15-Minute Scoping Call01
HIPAA
Health Insurance Portability and Accountability Act
Protect PHI with privacy-first architecture, encrypted storage and transmission, strict access controls, and traceable audit logs.
02
GDPR
General Data Protection Regulation
Implement lawful consent flows, data minimization, retention controls, and secure processing for sensitive health data.
03
FHIR
Fast Healthcare Interoperability Resources
Enable standardized health data exchange across apps, care teams, and systems through standards-based FHIR APIs.
04
HL7
Health Level Seven International
Support enterprise-grade interoperability with HL7-based integrations for records, events, and clinical messaging workflows.
05
HITRUST
Health Information Trust Alliance
Align security programs to healthcare-specific control and risk management practices trusted by providers and ecosystem partners.
06
HITECH
Health Information Technology for Economic and Clinical Health Act
Design with breach notification readiness, digital record safeguards, and operational controls that support regulated care programs.
07
SaMD
FDA Software as a Medical Device
Plan software quality, traceability, and documentation pathways for products that may require SaMD review and submission.
08
MDR (EU)
Medical Device Regulation (European Union)
Prepare EU market-ready processes for risk classification, evidence tracking, and lifecycle governance under MDR expectations.
09
SAMHSA
Substance Abuse and Mental Health Services Administration
Apply confidentiality controls and consent-aware sharing models for behavioral and mental health data experiences.
Standards we build against
Which standards does VBC software use?
FHIRHEDISeCQMHCCMIPSHIPAA
Our Process
How do we build a value-based care platform?
Data aggregation, measure logic, and contract modeling run in parallel toward a defensible dashboard.
1.
Contract & measure discovery
We map your value-based agreements, the measures that drive them, and your available data sources, then design attribution and measure logic before building.
Contract-aware
2.
Data foundation
We build the FHIR R4 data layer aggregating EHR, claims, and ancillary feeds, with the governance and lineage the analytics depend on.
Traceable data
3.
Measures & reimbursement modeling
Quality-measure calculation, risk adjustment, and the outcomes-to-reimbursement engine, validated against known reconciliation results.
Defensible math
4.
Dashboards & go-live
Role-based contract dashboards with drill-down, gap-in-care worklists, and ongoing tuning as measure specs and contracts change year over year.
Always audit-ready
Fee-for-service vs value-based care
How do fee-for-service and value-based care differ?
Most organizations run both payment models at once. The table shows what each one asks of the software, so you can see which parts of your stack already exist and which a value-based contract adds.
| Criteria | Fee-for-service | Value-based care |
|---|---|---|
| What is paid for | Each service billed on a claim | Outcomes, quality and total cost against contract targets |
| When payment settles | Claim by claim, after adjudication | Claims during the year, then shared savings or losses at reconciliation, or a fixed amount per member under capitation |
| Who carries financial risk | Mostly the payer | Shared with providers under one-sided or two-sided models |
| Patient attribution | Not needed to get paid | Decides which patients count toward each contract |
| Data the software needs | Charges, codes and claims | Claims plus clinical data, attribution lists and quality measure inputs |
| Core software functions | Charge capture, coding, claim submission and denial management | Attribution, quality measures, risk adjustment, gap-in-care worklists and contract modeling |
| Reporting rhythm | Per claim and month-end revenue reports | Running performance views, so teams act before the period closes |
| Where AI helps | Coding suggestions and denial prediction | Risk suspecting from notes, gap prediction and outreach priorities, with clinician review |
Contract terms differ by payer and program. We map your agreements in discovery before modeling any of them.
Facts and sources
Which rules shape value-based care software?
Short facts we design value-based care platforms around, each linked to its primary source.
The Medicare Shared Savings Program rules in 42 CFR Part 425 cover how Medicare fee-for-service beneficiaries are assigned to ACOs, quality performance standards and data sharing, and one-sided and two-sided payment models.
Source: 42 CFR 425.10 (eCFR)The HIPAA Security Rule requires administrative, physical and technical safeguards for electronic protected health information.
Source: 45 CFR Part 164 Subpart C (eCFR)A HIPAA covered entity may share protected health information with a business associate, such as a software vendor, only under a business associate agreement that commits the vendor to safeguard it.
Source: 45 CFR 164.502(e) and 164.504(e) (eCFR)The NIST AI Risk Management Framework is a voluntary framework that organizes AI risk work into four functions: Govern, Map, Measure and Manage.
Source: NIST AI 100-1
Featured case study
Read Case StudyLera Health: compliant women's health platform
Related proof of compliant delivery: Lera Health isn't a VBC platform, but building its outcomes-driven data layer and auditable insights workflow shows how we turn clinical data into trustworthy, traceable analytics, the foundation any value-based platform stands on.
Why Partner With Us
15-Minute Scoping CallWhy do risk-bearing organizations choose Agnotic?
We combine measure-spec fluency, data-engineering depth, and compliance-first design so your VBC numbers hold up in reconciliation and audit.
Defensible & Auditable
Every outcome and dollar traces back to its measure spec, attributed population, and source data, built to survive payer reconciliation.
Measure & Risk Fluency
HEDIS, MIPS, eCQM, and HCC logic are our baseline, so measure calculation is engineered correctly rather than approximated.
Act Before the Period Closes
Near-real-time gap and projection views so teams influence results while they still can, not after reconciliation.
Payer & Provider Perspective
We build for both sides of a value-based contract, aligning how outcomes are measured with how they get paid.
Our relevant experience
Analytics that hold up when the money is on the line
Frequently Asked Questions
Because the value is in correct measure and reimbursement logic, cost follows scope: the number of contracts, measure sets and data sources, and whether risk adjustment is included. We scope against your agreements in discovery and give a fixed estimate.
The data foundation and measure logic drive the timeline, along with how many contracts the first release covers. We put an initial contract and measure set live first so teams can act on gaps, and we validate calculations against known reconciliation results before relying on them.
Yes, and most organizations need both. Claims and clinical data feed fee-for-service billing and value-based contracts alike, so we build one governed data layer and add attribution, measures and contract logic on top of it.
Start with the claims and clinical data you already have and one contract. We add attribution and that contract's quality measures first, then risk adjustment and shared-savings projections, so existing billing keeps running while the value-based layer grows.
AI in value-based care mostly ranks and suggests: it can surface possible undocumented conditions from notes for risk adjustment, predict which patients will miss a measure, and prioritize outreach. A clinician or coder confirms every suggestion, and we document model risks using the NIST AI Risk Management Framework.
Buy when a standard population-health vendor covers your contracts and you can accept their measure library. Build when you have unusual contract structures, need outcomes-to-reimbursement modeling specific to your agreements, or want to own the data layer feeding multiple downstream tools.
We aggregate clinical data via FHIR R4 and HL7 v2, pull population-level data through bulk FHIR $export, and ingest claims feeds directly. The result is a governed FHIR data layer that feeds attribution, measures, and dashboards with full lineage back to each source.
We implement HEDIS, MIPS, and eCQM logic to their published specifications, version the measure definitions, and validate results against reconciliation data. Every number on a dashboard can be traced to the patients, measures, and source records that produced it.
Yes. PHI is encrypted at rest and in transit, access is role-based and audit-logged, and the data layer is governed with full lineage. That record supports payer and regulatory audit review.
Ready to see your contracts in real time?
Tell us your value-based agreements and data sources. We'll return a VBC platform plan with measure scope, risk-adjustment approach, and a realistic timeline.
contact@agnotic.com
Partnerships
contact@agnotic.com