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ACO Enablement Services 2021 ACO Enablement Services 2021
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ACO Enablement Services 2021
Enabling Risk and Delivering Outcomes

author - Bradley Hunter
Bradley Hunter
author - Paul Warburton
Paul Warburton
author - Cathy McCabe
Cathy McCabe
April 27, 2021 | Read Time: 8  minutes

The initial explosive growth of ACOs sparked by the Affordable Care Act has since tapered off due to uncertainty about how to move into downside risk. Over the years, several services firms have emerged to help provider organizations with the setup and ongoing management of ACOs. This report shares client feedback on how effectively and quickly these firms drive clinical and financial impact and prepare clients to take on more risk.

Which Firms Have Experience with Organizations Like Yours?

Not all firms cater to the same organization types. Below are the most common client types for each firm (this may not be comprehensive of all clients a firm has). For details on the level of risk clients are taking on, see page 5. For more on the validated scope of firms’ ACO enablement services, see the full report.

aledade icon

Primary care providers

evolent health and premier icon

Evolent Health & Premier
Large to small health systems

caravan health icon

Caravan Health
Rural community hospitals and large clinics

imperium health icon

Imperium Health
Health systems and large clinics

Aledade, Evolent Health & Imperium Health Bolster Financial Outcomes through Data, Expertise & Going At-Risk

impact on financial outcomesClients of Aledade, Evolent Health, and Imperium Health (samples for the latter two are limited) feel that by shouldering risk in the engagement, their firms are incentivized to drive financial success—many clients report significant returns through Shared Savings programs. Aledade respondents, who are highly satisfied overall, say the firm has helped them negotiate better contracts with insurers and collect COVID-19 financial support. Several interviewed Evolent Health clients highlight rich predictive analytics from the firm that, for a few respondents, have resulted in more wellness and chronic care check-ins. Notably, while financial outcomes are strong, Evolent Health receives a low overall score (67.8 out of 100.0); in particular, high costs hurt perceptions of value. Also, in the longer term, the firm’s products fall short of client expectations for providing insights. Imperium Health is noted for excellent engagement with physicians around incentives, resulting in increased organizational buy-in and better outcomes. Caravan Health clients value the firm’s guidance in helping enhance quality, thus improving reimbursements; compared to clients of other measured firms, Caravan clients do not speak to a similar depth of actionable insights to improve financial outcomes. The limited data from Premier clients suggests the firm could do more to address physician buy-in.

Imperium Health & Premier Clients Seek Additional Follow-Up to Help Organizations Stay Accountable to Recommendations

impact on clinical outcomesImperium Health and Premier demonstrate mixed results on clinical outcomes. In some cases, clients say they need additional support to adopt their firm’s recommendations. Clients also want more guidance on dealing with competing priorities and implementing change management for their clinical staff. Respondents would like more communication from the firms to help address these missed expectations. Clients of Aledade, Caravan Health, and Evolent Health attribute their positive clinical outcomes to having targeted goals, ongoing coaching, and constant feedback from consultants to help clinicians track patients throughout the care journey. Clients also feel that the in-person touch they received from these firms when starting up their ACO helped cement a sense of partnership with clinicians, who in turn have driven clinical outcomes.

Aledade, Caravan Health Fastest to Outcomes for (Respectively) Primary Care and Community Providers

speed to outcomesAledade consistently drives fast outcomes for their primary care provider clients thanks in part to their user-friendly app, which gives physicians risk information at the point of care. Clients appreciate that the firm goes above and beyond to partner with them. Caravan Health’s quick outcomes are supported by their strategic approach of identifying outcome opportunities during the analysis and scope phase—these opportunities include KPIs, additional education, and coaching. Evolent Health, Imperium Health, and Premier clients also report strong outcomes, though they come a little less quickly; this is partly because the firms tend to work with larger organizations, entailing broader and more complex processes. Evolent Health clients mention they have to pay the initial startup and implementation costs before they see savings. Imperium Health clients note they need more touchpoints and communication to feel comfortable before they make changes. Premier respondents would like more help and support from the firm in driving organization-wide alignment.

Clients of Evolent Health, Imperium Health & Premier Want More Data for More Complex Risk Agreements 

Many provider organizations have been hesitant about taking on downside risk. Below is a breakdown of what clients feel their firms could do to help make this path more feasible.

How Can Firms Help Encourage Downside Risk?

aledade logo

wrench icon dark blueTop area for improvement: Continued client education

“We are not ready to take on downside risk yet, but I think that Aledade is putting us in a position to do that. The ACO is still pretty new for us and everyone around here. Aledade is getting us accustomed to having our ducks in a row. One thing we are working on is our transitional care visits. We work on those every time I meet with my consultant. The consultant told me how many we had and how many we billed for and helped me figure out why we didn’t capture all of them. We came up with a new workflow. A couple of weeks later, we were checking that workflow.” —Manager

caravan health logo

wrench icon blueTop area for improvement: Continued physician engagement

“One of the vendor’s executives did an educational series for all of the healthcare providers that we have in our organization. The executive did a webinar for them just to teach them and to get across some points that I have been wanting to get across to them for some time now. Physician-to-physician communication tends to come off better than nurse-to-physician communication, and the vendor was willing to do that for us to help get our providers on board and make us more successful.”  —Population health manager

evolent health logo

wrench icon light greenTop area for improvement: Predictive analytics

“In order to support our organization by taking on more downside risk, the vendor could evolve their predictive analytics tool to be the best tool on the market. We are relying on that tool, and there are many factors and data points that the vendor could use to make it more effective. We have thousands of patients to cover, and we need to know which patients to target and how we can best use our staff and resources to help them. We use the tool’s real-time data and projections to make strategic decisions on a monthly and quarterly basis. We only have 12 months for all of our programs to succeed, so we really have to know whether we are making a bad decision.”  —VP of population health

imperium health logo

wrench icon dark greenTop area for improvement: Predictive analytics

“Imperium is building the forecasting for downside risk so that we can see which practices are most inclined based on historical data to be successful with our at-risk model. We haven’t gotten that forecasting yet, but we will.” —VP

premier logo

wrench icon dark greyTop area for improvement: Predictive analytics

“The problem is that Premier is not providing us an assessment of our market. They say we have to go with downside risk without providing supportive information as to why. They aren’t looking into the minimum attribution to take on risk. We don’t know whether we even want to go down that path or whether we are wasting our time, expenses, and resources. Premier doesn’t provide us with the information we need.”  —VP

Evolent Health and Premier Currently Support the Greatest Downside Risk

level of risk clients have taken on

Evolent Health and Premier work with larger health systems, who are taking on the most complex risk with arrangements like provider-sponsored health plans, bundled payments, commercial exchanges, and Shared Savings. Aledade, focused on primary care providers, helps clients with Medicare Advantage and Shared Savings; as a result, clients are largely on Track 3 or are Next Generation ACOs. Caravan Health tends to help organizations new to value-based care, mostly smaller rural health systems. Imperium Health clients tend to be health systems or large clinics that are just starting to take on risk—many are on Track 1 or 1+.

About This Report

Each year, KLAS interviews thousands of healthcare professionals about the IT products and services their organizations use. These interviews are conducted using a standard quantitative evaluation, and the scores and commentary collected are shared in reports like this one and online in real time so that other healthcare professionals can benefit from their peers’ experiences. The questions from the standard evaluation are organized into five customer experience pillars—loyalty, operations, relationship, services, and value.

customer experience pillars services

To supplement the data gathered with this standard evaluation, KLAS also creates various supplemental evaluations that target a subset of KLAS’ overall sampling and delve deeper into the most pressing questions facing healthcare technology today.

The data in this report comes from both evaluation types and was collected over the last 18 months; the number of unique responding organizations for each is given in the chart below.

What Does “Limited Data” Mean?

about this report tableSome services are used by only a small number of facilities, some firms are resistant to providing client lists, and some respondents choose not to answer particular questions. Thus a firm’s sample size may vary from question to question and may not reach KLAS’ required threshold of 6 unique respondents. When a firm’s sample size for a particular question is less than 6, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 3, no score is shown. Note that when a firm has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.

Overall scores are measured on a 100-point scale and represent the weighted average of several yes/no questions as well as other questions scored on a 9-point scale.

author - Amanda Wind Smith
Amanda Wind Smith
author - Madison Moniz
Madison Moniz
author - Natalie Jamison
Project Manager
Natalie Jamison
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.