For Accountable Care Organizations

Every Patient Who Moves to MA Is a Shared Savings Dollar You'll Never See.

ACOs invest heavily in care management, quality programs, and risk analytics. But Medicare coverage decisions happen outside your control. Connie Health operates as your structured Medicare engagement layer — stabilizing attribution, reducing unintended plan switching, and protecting shared savings performance under MSSP and ACO REACH.

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1,500–2,500
Lives shifting coverage annually on a 25,000-life panel at 6–10% switching rate
15–25%
Estimated shared savings revenue leakage from unmanaged attribution volatility
~80%
of switching is unintended — driven by confusion, not dissatisfaction
The Mechanism

How FFS-to-MA Migration Erodes ACO Performance

The financial damage from unmanaged Medicare enrollment isn't dramatic — it's structural. Each year, beneficiaries make quiet coverage decisions that systematically remove value from your ACO's model.

Patient switches to MA

During AEP, a beneficiary enrolls in an MA plan — often after seeing a TV ad or hearing from a broker

Attribution removed

That patient is immediately removed from your ACO's attributed population and excluded from your benchmarks

MA plan captures value

The plan collects capitated premium + risk adjustment revenue. Your care management work goes uncompensated

Benchmark erodes

As healthy patients leave, your remaining population skews sicker — making future benchmarks harder to beat

The Financial Exposure

Attribution Volatility Erodes Shared Savings at Scale

You've built high-functioning care management infrastructure. Your MSSP or ACO REACH contract hinges on performance and attribution stability. Yet beneficiary coverage decisions — made annually, at scale, outside your visibility — can quietly restructure the financial foundation of your ACO.

The problem is compounding. Low-risk, healthy patients are disproportionately attracted to MA's $0 premiums and extra benefits. When they leave, your remaining FFS population skews toward higher complexity and higher cost — making it progressively harder to beat your benchmark year over year.

And when a patient moves to MA, the claims data disappears. You can't manage what you can't see.

"Most plan switching is unintended. Beneficiaries enroll in plans misaligned with your network because they lack licensed, objective Medicare education — not because they want to leave your care."

Direct impact on ACO performance

Lost
Shared savings calculations for every patient that moves to MA — permanently, for as long as they stay
Distorted
Risk benchmarks as low-cost patients cream off into MA, skewing your denominator toward complexity
Disrupted
Care management continuity as patients shift into MA plans with their own conflicting protocols
Invisible
Claims data once a patient enters MA — creating blind spots in your population health programs
The Adverse Selection Dynamic

The Patients Leaving Are the Ones You Can Least Afford to Lose

Medicare Advantage's most attractive features — $0 premiums, dental, vision, and fitness benefits — disproportionately appeal to younger, healthier beneficiaries. Which is precisely the population that anchors your ACO's cost performance.

Healthy patients migrate to MA

Lower-risk beneficiaries attracted by extra benefits leave your FFS panel for MA plans — taking their low-cost status with them.

Remaining population grows costlier

Your attributed FFS population skews toward older, higher-risk, higher-utilization patients — widening the gap against your benchmark.

MA captures the upside you created

If your care programs kept a patient healthy and low-cost before they switched, the MA plan collects the risk-adjusted premium. You receive nothing.

Risk coding shifts to MA plans

MA plans aggressively document HCCs to maximize capitation. This changes the risk profile across your market — and creates benchmark complications.

Impact at Scale

What Even Modest Switching Looks Like on a Real Panel

The financial impact doesn't require dramatic shifts. Single-digit switching rates create meaningful and compounding variability under MSSP and ACO REACH.

Scenario: 25,000-Life ACO Panel
25,000
Attributed Medicare lives in your panel at the start of the performance year
6–10%
Of beneficiaries switch plans annually — often without realizing the impact on their care team
1,500–2,500
Lives shifting coverage annually — many moving to MA plans outside your contracted arrangements
$2M–$5M+
Estimated annual shared savings exposure across a panel this size, depending on risk profile and contract terms
Structured Medicare engagement reduces avoidable misalignment before it reaches your bottom line. Even a modest reduction in unintended switching delivers measurable performance value.
Connie Health for ACOs

Three Integrated Capabilities to Protect Performance

We operate as your structured Medicare engagement layer — proactively reducing preventable attribution volatility while giving your leadership team visibility into Medicare movement across your panel.

1

Attribution Stabilization

Licensed Medicare guidance aligned to your network strategy. Proactive enrollment engagement during AEP and OEP. Beneficiary education designed to reduce unintended plan switching, protect PCP continuity, and preserve attributed population stability across contract years.

Outcome
Reduces preventable plan switching and stabilizes attributed lives year over year
2

Year-Round Panel Engagement

Beyond enrollment season — coverage optimization reviews, quarterly touchpoints, Annual Wellness Visit support, and prescription adherence education. Moving from reactive enrollment management to continuous, proactive Medicare engagement that supports quality and utilization improvement.

Outcome
Improves retention and supports MSSP quality and utilization performance
3

Performance Visibility

Enrollment analytics, referral tracking, attribution movement dashboards, and quarterly executive reviews. Structured reporting purpose-built for MSSP and ACO REACH management — giving your team the visibility to proactively manage attribution rather than react to it at year-end.

Outcome
Enables proactive management of attribution and improves shared savings predictability
Strategic Impact

From Reactive to Proactive Attribution Management

Risk-bearing ACOs have invested in analytics, care management, quality optimization, and risk stratification. Structured Medicare engagement is the missing layer that protects all of it.

Without structured engagement
  • Panel unpredictability each enrollment cycle
  • Attribution loss discovered after it happens
  • Low-risk patients cream off to MA undetected
  • Care management data goes dark when patients switch
  • Benchmark erodes as population complexity increases
  • Leadership lacks visibility into Medicare movement
With the Connie Health platform
  • Panel predictability improves measurably
  • Attribution protection becomes proactive and strategic
  • Low-risk patient retention improves
  • Care continuity maintained through enrollment transitions
  • Benchmark stability improves over time
  • Real-time visibility into Medicare trends at panel level

Platform supports performance under: MSSP · ACO REACH · Medicare Advantage Risk Arrangements · Episode-Based Payment Models

Strengthen Your ACO's Competitive Position

If shared savings protection and panel stability are priorities for your ACO, we welcome a strategic conversation about Medicare engagement as a core performance lever.

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