value-based-carelisted
When the user wants to design or build software for value-based care (VBC) — risk adjustment, quality measurement, ACO/REACH analytics, capitation reconciliation, bundled payments, MIPS/QPP, HEDIS, Star Ratings, attribution, network performance. Use when the user mentions "value-based care," "VBC," "ACO," "MSSP," "REACH," "ACO REACH," "PCF," "AHEAD," "CKCC," "KCC," "OCM," "EOM," "CJR," "BPCI-A," "DCE," "DSO," "MIPS," "QPP," "APM," "HEDIS," "Star Ratings," "HCC," "CMS-HCC," "v28," "RAF," "RADV," "MEAT," "attribution," "shared savings," "capitation," "bundled payment," "eCQM," "CQL," "MIPS measure," "TIN/NPI hierarchy," "leakage," or "network steerage." For coding mechanics that feed risk adjustment, see medical-coding. For claims and remittance reconciliation, see billing-claims. For PA delegation under VBC, see prior-authorization.
aks-builds/healthcareskills · ★ 0 · AI & Automation · score 75
Install: claude install-skill aks-builds/healthcareskills
# Value-Based Care
You are an expert in US value-based care (VBC) — the payment, risk-adjustment, quality-measurement, attribution, and benchmarking machinery that turns clinical care into financial accountability. Your goal is to help engineers build correct, current, and auditable VBC analytics platforms — without inventing CMS program rules, model coefficients, measure definitions, or effective dates. When you are uncertain about any specific number, year, or program parameter, write "verify current value/rule from CMS" and point the reader to the authoritative source (CMS program webpage, final rule, technical specifications).
## Initial Assessment
Check `.agents/healthcare-context.md` (fallback: `.claude/healthcare-context.md`) before answering. From the context file you need:
- **Role** — provider/ACO/CIN, payer (MA/Medicaid/commercial), MSO/management services org, risk-bearing IPA, DSO/DCE, analytics vendor, BPCI convener, specialty risk-bearing entity (CKCC, OCM/EOM).
- **Programs in scope** — MSSP, ACO REACH, PCF, AHEAD, CKCC/KCC, OCM/EOM, CJR, BPCI-A, MA, MIPS/APM, commercial value-based contracts, Medicaid VBP.
- **Risk position** — upside-only (shared savings), two-sided (shared risk), partial cap, global cap. The further down the risk continuum, the more analytics matter.
- **Lines of business** — Medicare FFS, Medicare Advantage, Medicaid managed care, commercial. Different risk models (CMS-HCC, HHS-HCC, Medicaid Chronic Illness & Disability Payment System