You can't manage
what you can't see.
Unlike Quality, where you choose the measures, CMS chooses your Cost measures based on your claims. The same methodology that calculates your MIPS Cost score today will determine your performance in mandatory models like ASM starting January 2027.
Why This Matters Now
For years, Cost was weighted low enough that practices could ignore it. That era is ending. At 30% of your MIPS score, Cost now carries more weight than Promoting Interoperability and Improvement Activities combined.
The Cost category is calculated entirely from claims data—you don't report it, you're measured on it.
And when ASM launches in 2027, cost will account for half your score. The practices that understand their episode costs today will have a two-year head start.
Yesterday's data is your roadmap for today.
The MIPS Cost category often feels like a lagging indicator because it relies on retrospective QPP data. However, for most specialty practices, the patients driving your costs last year are the same patients in your exam rooms today.
From complex attribution logic to actionable insight.
CMS uses complex rules to assign patients and costs to your practice. We translate that methodology into visibility you can actually use.
| The Standard Practice | The VBCA Approach |
|---|---|
| Waiting for the CMS final report 6+ months after the year ends | Year-round monitoring of claims data to intervene in real-time |
| Guessing which patients are attributed to the practice | Clear attribution logic that identifies exactly who is driving your costs |
| Viewing cost as an “uncontrollable” administrative burden | Using cost data as a strategic lever to prepare for mandatory ASM models |
| Reacting to poor performance after the fact | Proactive care coordination strategies that address root causes |
Anatomy of a high-cost episode.
A single clinical event can trigger an episode that spans months and accumulates costs across multiple providers. Here's what practices typically miss—and what VBCA surfaces.
A score on an annual feedback report, months after the performance year ends. No visibility into which patients drove the costs or what could have been done differently.
Patient-level episode costs as they accumulate. Which service categories are above benchmark. Where the “leaks” are occurring—in time to intervene.
Cost performance is a combination of longitudinal patient management and acute surgical outcomes. We help you identify the specific “outlier” events and recurring patterns in your data so you can intervene before the next episode begins.
Path to cost optimization.
Baseline
Understand your current episode-based cost measures. Which episodes are you being scored on? Where do you stand relative to benchmark?
Benchmark
Compare your performance against specialty-specific peers. Identify which service categories and patient cohorts are driving variance.
Optimize
Implement care coordination strategies that address root causes—before the costs hit your score and before ASM makes them mandatory.
See where you stand on Cost.
The same data that determines your MIPS Cost score will drive ASM performance in 2027. Understanding your position now gives you time to act.
Go deeper
Ambulatory Specialty Model (ASM)
Cost will account for 50% of your score under ASM. See how to prepare for the mandatory model launching in 2027.
Learn about ASM →MIPS Value Pathways
MVPs bundle Quality, Cost, and Improvement Activities around a clinical theme. See what the transition means.
Learn about MVPs →MIPS Reporting & Strategy
Understand how Cost fits into the broader MIPS framework and how all four categories work together.
View MIPS Overview →The Platform
See how cost analytics, episode tracking, and patient attribution are built into our platform.
Explore the Platform →