ACO-OS is the operating system for a value-based care organization: raw CMS and clinical feeds in, an analytics-ready core data model in the middle, and a 360-degree view at every level of the hierarchy — beneficiary, provider NPI, participant TIN, and the ACO as a whole — out the other side.
At the heart of the platform sit the CPA segments: eleven analytic sub-modules, each computing one well-defined slice of ACO operations, each persisted to its own data mart, and each consumed by a matching domain intelligence persona — the role-aware analytic lenses (Performance, Financial, Risk, Network, Continuum, and Quality Intelligence, plus the Atlas senior-analyst persona) through which the platform's AI analyst answers questions. A care manager, a CFO, and a network director all read from the same numbers — each through the lens their role needs.
Beneficiary identity, eligibility dates, enrollment type, population segment, RAF baseline — and a full 24-month historical trail of provider and TIN attribution, not just the current snapshot.
The 24-month attribution trail turns a static roster into a living map of where every beneficiary actually receives care — the foundation of network management.
Per-patient benchmark valuation and actual-versus-expected performance: benchmark before and after performance-year rate adjustments, actual cost by claim source, medical loss ratio, PBPM and PMPY.
Settlement math at per-patient grain — see which beneficiaries drive benchmark variance months before reconciliation tells you.
Inpatient, ED, SNF, home health and hospice utilization with industry-standard clinical groupers: preventable admissions via AHRQ PQI, ED avoidability via the NYU classifier, readmission detection with penalty risk, length-of-stay, and post-acute care chains.
Separates what admissions cost (Performance) from how patients move through post-acute care (Continuum) — two answers most platforms blur into one.
Professional services analysis: E&M intensity, specialty leakage, high-cost drug spend, site-of-care opportunities (ASC vs. office), and referral patterns — built on BETOS 2.0 and episode grouping.
Finds the avoidable spend hiding in professional claims — site-of-care shifts, leakage, and coding drift you can act on this quarter.
HEDIS/Stars compliance, preventive screening, chronic-condition follow-up, medication adherence (PDC), and guideline variance — prioritized by upcoming visit opportunities.
Not a list of gaps — a prioritized worklist, with each gap paired to the visit at which it can be closed.
Documented, suspected and chronic HCC analysis under CMS-HCC V28: coefficient-aware by population segment, hierarchy and trumping applied, RAF gap projection — with provider attribution for every open condition down to the individual NPI, audit-traceable to the source claim.
Every open HCC becomes an assignable task for the exact clinician who can document it — risk accuracy with an audit trail.
Annual Wellness Visit eligibility with the 12-month rule applied across the AWV code family (G0402, G0438, G0439 and welcome-visit variants) — who is due, who is overdue, who has never had one.
The AWV is the front door to gap closure and risk documentation — knowing exactly who is due converts outreach into quality scores and revenue.
Synthesizes segments 1–7 plus real-time ADT events into composite risk scores, 30/60/90-day readmission probability, intervention ROI ranking, and plain-language narrative summaries — routed to each staff role's dashboard.
The integrator — ten analytic feeds become one prioritized, human-readable story per patient.
A unified batch processor runs every per-patient analyzer and persists the results to one comprehensive member-level table. Provider, TIN and ACO rollups are aggregated from the patient-level cache — never computed separately.
One-direction aggregation is what makes the 360-degree view trustworthy: the board sees exactly what the care manager sees, summed.
Program eligibility determination directly from claims: developmental criteria, high-risk RAF, moderate-risk with admissions, frailty/DME indicators, and extended SNF/HHA utilization — the criteria that drive high-needs program participation and risk-sharing tiers.
Eligibility and tier determinations that are defensible, repeatable, and auditable — straight from the data, not a spreadsheet.
Cohort PMPM, risk stratification, benchmark comparison, trend analysis, and utilization and quality aggregation — composable calculators that roll any cohort up through the hierarchy.
The rollup engine that makes the 360-degree view real — the same metrics, coherent from a single beneficiary to the whole ACO.
Each segment does one thing, reads from declared sources, and writes to its own mart — so every number on every dashboard traces back to source claims. The persona layer means the platform meets each user in their own domain: a quality director gets Quality Intelligence, a CFO gets Financial Intelligence and Atlas-grade benchmark depth, a network director gets attribution intelligence — all from the same single source of truth, refreshed as CMS data arrives.
D∑VHE∆LTH designs, deploys and operates this stack for ACOs, IPAs and risk-bearing groups — as a platform, as a managed service, or as the blueprint for your own team.