1Know what this number is, and what it is not.
Every input has an ⓘ: what to enter, an example and where to find it. All prefilled values are illustrative.
2Path A · Quick intervention scenario
3Path B · What changed beyond the comparison trend?
All four inputs must measure the same outcome, unit and aligned periods.
4MSSP truncation: when medical savings shrink before the ACO gets paid
A large medical-cost difference became a much smaller ACO-level figure.
The authors reported an ACO-level adjustment, not an actual CMS payment. Annual figures above are derived ×12 illustrations; the report followed participants for an average of 14 months.
Read the original report and its limits
The 2022 author report describes a comparison group, 335 treated patients, and a financial stop-loss adjustment. It does not provide enough detail to independently reconstruct that adjustment or establish randomized allocation. Authors disclosed employment and financial interests in Aledade. Do not apply 29.4% as a universal factor or subtract costs already included in a total-cost result.
Truncation means CMS caps extreme annualized spending in its ACO calculations. The cap can limit the financial value of preventing dollars that were above it.
Show me the simple $150,000 → $35,000 story
They budgeted around $150,000 of medical savings. Only $35,000 survived the cap.
Imagine one beneficiary would cost $400,000 without the program, but $250,000 with it. Use an illustrative $285,000 CMS spending cap.
The missing $115,000 was above the cap. It can be real medical spending avoided, but it was not fully counted in this ACO spending comparison to begin with.
Same full-year beneficiary, one enrollment type, nonnegative included expenditures, common cap. The $285,000 cap is invented for teaching. The $35,000 is still not the shared-savings check.
Try the same calculation with your numbers.
Enter total included A/B spending for one full-year beneficiary, not a whole population and not just hospital costs.
Calculation receipt and assumptions
For partial years, changing enrollment type, completion adjustments, negative expenditures or a patient cohort, use the full CMS method. Apply truncation at the beneficiary/enrollment-type level before aggregation, not once to an ACO total.
5Program support after the FFS revenue credit
6Net change across the included spending categories
Use total dollars for the same cohort and period. Category totals must not overlap.
7Where the inputs usually live
| Need this input? | Start here | Do not assume |
|---|---|---|
| Assigned people / eligible time | ACO-MS assignment package; current-year report instructions; program roster for your subset. | Headcount equals person-years, or everyone with CCLF claims is assigned. |
| Actual expenditure and utilization | Quarterly expenditure/utilization report, often QEXPU; final reconciliation for finalized values; claims extract for cohort detail. | Quarterly estimates are settlement, or a whole-ACO rate describes your selected group. |
| Thresholds and method | Applicable report parameters and current-year methodology. PY2026 v14 §3.1.3 describes truncation. | A hypothetical cap or a different enrollment type’s cap is current and applicable. |
| Engagement / program fee / FFS collections | Program roster, contract, operating budget and RCM collections ledger. | CMS supplies these program-specific assumptions. |
| Expected intervention effect | A relevant controlled evaluation or a clearly marked scenario assumption. | A pre/post decline proves causality. |
Report structures change by performance year. No universal CMS worksheet cell is asserted here; an exact year-specific cell has not been independently verified. Source directions are intentionally general where an exact locator is not established. Older CMS tie-out examples are background, not current calculation instructions.