Attribution may not be the flashiest topic in value-based care, but it’s one of the most consequential. It’s how CMS and other payers decide what patients you’re responsible for and which count toward your quality, cost and performance metrics. But what do you do when those patient assignments aren’t exactly clear?
Unfortunately, that challenge is attribution volatility. For ACOs, Direct Contracting Entities and ACO REACH provider group participants, it can quietly erode the very foundation of your performance strategy.
One moment, your focus is building care plans for a defined population and the next, your high-risk patients shifted out of your panel into the care of out-of-network providers. This scenario is too common. It sends your care teams scrambling to adjust, wrecks outcomes and jeopardizes your main financial objective: shared savings.
Attribution volatility impacts financial performance, care delivery and data integrity. In the sections ahead, we’ll dig into how leading value-based healthcare organizations are getting ahead of it.
What is attribution volatility?
Attribution is the process of assigning patients to a provider or organization for the purpose of managing care and measuring outcomes. In value-based care models, this determines who you’re accountable for and who directly affects your performance metrics.
But there’s a common misconception – attribution isn’t static.
Models such as traditional ACOs use prospective attribution, assigning patients at the start of the performance year based on prior visits. Others, like MSSP and REACH, typically use retrospective attribution, finalizing assignments after the year ends based on who delivered the bulk of primary care.
Neither approach prevents volatility.
Patients move, miss visits or decide to seek care from another practitioner. This creates a model of fragmented care. Add data lag, payer variability and a lack of visibility, and the patient population your strategy is built upon may not be the one you’re ultimately judged on.
Attribution volatility often leads to the loss of high-risk patients right as necessary interventions begin. It can also lead to the sudden appearance of patients you’ve never engaged, presenting new challenges to beginning new care interventions. Either way, your population metrics suffer and ultimately, your financial performance takes the hit.
Why does attribution volatility happen?
There are several reasons attribution volatility occurs, often for predictable reasons that could be prevented if provided the right insight.
Engagement gaps
Patients who don’t consistently see their assigned PCPs may be attributed elsewhere or not at all. All it takes is one missed Annual Wellness Visit or a delayed follow-up can to trigger a reassignment.
Data delays and discrepancies
Claims lag, inaccurate coding and inconsistent provider identifiers can interfere with timely updates to attribution. Unfortunately, by the time issues are discovered, it’s often too late to act.
Multi-provider environments
Since most patients receive care from a mix of specialists, urgent care providers and other networks, attribution algorithms can become confused as to their primary assignment. These algorithms typically assign these patients to the provider they saw most, regardless of quality or intent.
Population churn
Patients change insurance plans, relocate and disengage from care. Attribution logic doesn’t always account for these real-world shifts with enough precision to provide adequate control to your assigned patient population.
Model variability
Since each value-based care model handles attribution differently, volatility exposure can increase due the lack of standardization pertaining to attribution rules, lookback periods and triggers.
What consequences does attribution volatility carry?
Attribution volatility isn’t just a data issue, it’s a performance risk that falls across all domains of a healthcare organization: clinical, financial and operational.
Financial uncertainty
Fluctuating patient populations make it difficult to forecast shared savings, manage capitation and/or model PMPMs accurately. This sends financial teams into reactive planning and execution, undermining long-term strategic focus and goals.
Disrupted care coordination
Whenever your attributed populations changes, care is disrupted. If your attributed population changes mid-year, care teams lose visibility into who to target, who to prioritize and who to follow up with. This breaks continuity of care and undermines favorable outcomes.
Quality score dilution
Quality scores due to attribution can be challenging. For example, attributing patients you never engaged means you’re evaluated on care you never delivered. This results in drops in key quality metrics like HEDIS or preventive screenings because of attribution misalignment, not care failure.
Risk adjustment instability
Patients lost due to attribution changes often take their HCC codes with them translating to lower risk scores, a lack of resources and inaccurate benchmarks for patient complexity.
Strategic misalignment:
Leadership may believe one population is being managed while operations are targeting another. Attribution volatility leads to mismatched KPIs, poor resource allocation and missed contract targets.
How can healthcare organizations reduce attribution volatility?
Mitigating the threat and repercussions of attribution volatility starts with access to enriched, contextualized data, accurate and functional workflows and timely receipt of signals. Here’s how top-performing healthcare organizations reduce attribution volatility:
Track attribution indicators early and often
Rather than wait for CMS reports, leading ACOs monitor patient behavior across claims, EHR and SDOH to anticipate attribution patterns before they become official.
Maximize Annual Wellness Visits
AWVs are a powerful anchor for attribution. Organizations that prioritize them early in the performance year retain more patients, mitigate risk and improve continuity of care. Access to the right data can produce actionable lists for effective care management.
Build care continuity strategies
Utilizing integrated call centers, care navigators and PCP-led outreach can help maintain patient engagement throughout the year, closing care gaps and leading to less attribution hiccups.
Unify clinical and administrative data
Volatility thrives in siloed environments. By combining payer data with clinical workflows, care teams can act in the moment, not after the fact.
Use predictive attribution tools
Advanced analytics, specifically those with AI, can model and identify, down to the patient level, which patients are likely to fall off the attribution panel. It can also identify those at risk of reassignment, providing the foresight for healthcare organizations to proactively maintain stable patient attribution.
Why does attribution intelligence matter?
Attribution volatility is one of the most overlooked risks in value-based care. It distorts financial projections, disrupts care delivery and weakens quality performance. And here’s the kicker – it’s preventable.
With most healthcare organizations monitoring attribution retrospectively, they miss out on avoidable challenges. Performance in value-based care depends on the ability to see beyond assignments and anticipate what’s coming next. True attribution intelligence requires in-the-moment visibility, predictive risk modeling and integrated insights that connect attribution with action.
Organizations that invest in attribution intelligence, patient engagement and early signal monitoring don’t just reduce volatility, they improve confidence, coordination and contract performance across the board. The success of value-based care depends not only on managing patients and their care, it requires knowledge of who they are and how to retain them.
