Written by the work, for the people who do it.
Long-form explanations for the people who run value-based care every day: what each piece of the work is, who owns it, what the calendar looks like, and where it breaks. The hub explains the whole, each branch guide takes one figure or one program apart and links to the module that does the job, and the last guide explains the structure the services run inside.
- HUBThe hub · Population health
Population health management, explained by the work.
What the work is, the five branches, who owns each, the calendar, where it breaks, and where a platform and a management partner fit.
About 12 minutes · Updated September 10, 2026Read the guide 
Branch · Risk IQThe HCC recapture rate: what it measures, how it is calculated, and what moves it.
What the rate counts and leaves out, why it resets every January, what good looks like at each point in the year, and the six things that raise it.
About 9 minutes · Updated September 10, 2026Read the guide- Branch · Risk IQ
The V28 transition: what changed, what still counts, and what to recapture first.
What the V28 model changed, how the phase-in moved scores, which of last year's conditions still count under it, and what to recapture first.
About 9 minutes · Updated September 10, 2026Read the guide 
Branch · Q-TrackThe MIPS checklist: what to do for the 2026 performance year, in the order it happens.
Eligibility, the traditional-or-MVP choice, the four categories and their windows, the year in order, and the filing itself, as a checklist with owners.
About 10 minutes · Updated September 10, 2026Read the guide
Branch · Data ManagementMedicare Advantage payer files, explained: what the MAO-004, MOR, and MMR contain, and what the plan sends on top.
How a diagnosis becomes a paid risk score across the MAO-004, the MOR, and the MMR, what the plan's roster, claims, and gap files add, and where the data breaks.
About 10 minutes · Updated September 10, 2026Read the guide
Branch · Work ListPutting care gaps to work: why gap reports fail, and what a work list has to do instead.
Why gap reports fail to close gaps, what a gap needs before it can be worked, who owns each kind, how the visit closes it, and how closure and productivity are measured honestly.
About 9 minutes · Updated September 10, 2026Read the guide
Branch · Panel 360Patient attribution: who is on your panel, how they got there, and why the list moves.
How members are assigned to you under rosters and claims-based methods, why the panel moves every month, what a wrong panel does downstream, and the monthly reconciliation.
About 8 minutes · Updated September 10, 2026Read the guide
Branch · Care BridgeTransitions of care: turning a discharge into a follow-up before the window closes.
Where discharge events come from, who owns the follow-up, the two-day and seven-day windows, how the work is measured, where it breaks, and what Care Bridge is meant to do when it ships.
About 8 minutes · Updated September 10, 2026Read the guide- MSOTopic · The MSO
What a management services organization does, and what it does not.
What an MSO is and is not, what it takes off a practice and what stays with the clinicians, how the fee should work, and what to look for in the agreement.
About 8 minutes · Updated September 10, 2026Read the guide
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