Milliman ACO Builder - Participant-Level ACO Performance Analytics

**Milliman ACO Builder**

Drive smarter growth and stronger financial performance for ACOs and Medicare Advantage plans.

Milliman ACO Builder gives health systems, ACO aggregators, and Medicare Advantage plans the provider-level intelligence they need to recruit high-performing physicians, optimize networks, structure effective contracts, and identify savings opportunities. Built on 100% Medicare claims data and validated by Milliman actuaries, ACO Builder goes beyond CMS public reports to deliver actionable insights for every provider in your market.

**Why ACO Builder?**

**Recruit high-value physicians**: Use objective, physician-level performance data to strengthen recruitment and retention strategies.

**Optimize networks**: Identify the right mix of providers to maximize revenue and quality while minimizing cost, to intelligently expand market presence.

**Guide contract strategy**: Compare financial impacts across MSSP, ACO REACH, and MA programs to support negotiations and program selection.

**Project financial results**: Model pro forma outcomes using precise CMS methodologies to forecast shared savings and downside risk.

**Identify cost savings**: Benchmark performance against peers and uncover improvement opportunities at the provider and ACO level.

**Available Modules**

**ACO Builder Forecast**: Project financial outcomes under MSSP and ACO REACH with a CMS-replicated pro forma model. Understand how participant list and program changes affect benchmarks, risk scores, and shared savings. Excel-based model with traceable logic, complete ACO and regional benchmark calculations, CMS-HCC v24 and v28 risk scores, provider-level trend forecasts, and all other information need to accurately forecast shared savings.

**ACO Builder Explorer**: Identify the best providers to target for network expansion using participant-level performance metrics with unique provider identifiers. Flat files optimized for business intelligence platforms, cross-ACO comparison capabilities

**ACO Builder Opportunity**: See how providers in any market perform relative to peers using provider performance benchmarks with quality and cost metrics. Power BI visualizations with interactive dashboards, regional average and well managed benchmarks, percentile rankings, and savings opportunity metrics.

**Medicare Advantage Network Intelligence (MANI)**: Evaluate Medicare Advantage (MA) network cost, revenue, and quality performance by payer and provider. Quantify the impact of network changes on ACO and MA plan performance.

**Data Sources & Methodology**

* **Primary Source**: CMS Research Identifiable Files (RIFs) - 100% Medicare claims data
* **Provider Attribution**: CMS attribution models refined by Milliman actuaries
* **Risk Adjustment**: AD and ESRD CMS HCC models, including v28 models, with all CMS normalization and coding adjustment applied.
* **Validation**: Accuracy validated against published CMS ACO financial results and other CMS sources
* **Standards Compliance**: Fully replicates CMS shared risk model methodologies. Data and models undergo actuarial review per Actuarial Standards of Practice (ASOPs)

**Why Milliman?**

With over 70 years of actuarial leadership, Milliman is trusted by payers, providers, and policymakers to interpret and apply CMS methodologies. ACO Builder combines this actuarial credibility with transparent, provider-level insights—delivering tools your team can rely on for high-stakes decisions.

**Limitations**
Sample data and queries are for illustrative purposes only. Please contact Milliman if you would like a demonstration using specific ACOs, providers, or markets.