Use Case 1
Monthly Attribution Forecast
Trigger: Claims run-out refresh
1.Replicate CMS attribution algorithm (MSSP/REACH/MA)
2.Score each currently-attributed member's retention risk
3.Classify loss drivers
4.Quantify revenue at risk
5.Predict year-end attribution total
6.Generate retention outreach worklist
7.Reconcile predicted vs. CMS official attribution
✓
Attribution managed proactively month-to-month instead of discovered at annual reconciliation.
Use Case 2
Retention Campaign Execution
Trigger: At-risk members identified
1.Segment by loss driver and clinical context
2.Personalize outreach per segment
3.Route complex cases to care managers
4.Schedule wellness visits and chronic follow-ups
5.Track re-engagement and E/M pattern restoration
6.Measure recovered attribution
✓
Attribution loss gets prevented, not explained post-hoc.
Integrations
CMS Attribution Files (MSSP, REACH)
Claims Data Warehouse
EHR Encounter Data
Patient Messaging
Care Management Platform
Scheduling System
Industries
healthcare
See It In Action
A sample conversation with this agent
Who are we at risk of losing attribution on next quarter?
Running CMS MSSP attribution algorithm against current claims patterns. 214 currently-attributed members at risk: 87 haven't had a qualifying PCP visit in 14+ months (approaching the 24-month attribution window expiration), 62 had their most recent primary care encounter with an out-of-network PCP in the last 6 months, 41 have a specialist (not PCP) as their plurality of E/M visits, 24 recently switched PCPs to non-ACO provider. Total revenue at risk: ~$780K. I'll prioritize outreach by risk tier and expected value.
Generate retention outreach for the 87 patients approaching window expiration.
Segmenting: 34 can be scheduled for annual wellness visits (routine re-engagement), 28 are chronic-disease patients overdue for follow-up (clinically and attribution-relevant), 18 are generally healthy with no visits (need relationship re-establishment), 7 are complex cases flagged for care manager warm contact. Drafting personalized outreach for each segment with provider name, visit type, and scheduling link. Care manager queue prepared for the 7 complex cases. Ready for your review before launch.
How close are we tracking to our attribution plan for year-end?
Current attributed lives: 4,218. Annual plan: 4,400. Projection at current trend: 4,287 at year-end, ~113 short of target. Main drivers: 47 losses from PCP changes, 38 from E/M plurality shifts to specialists (common with our cardiology and endocrinology populations), 28 from window expiration we can still save. If we execute the retention plan above, we recover ~65 patients and land at 4,352—closer to plan but still short. Additional new attribution acquisition needed.