Accountable Care Readiness Diagnostic

Before You Begin

Select your organisational perspective

Several questions have provider-specific and payer-specific variants reflecting different positions in the accountable care transition.

Section 1 of 5 0% complete

Section 1 of 5

Population Accountability & Attribution

Evaluates whether your organisation thinks and operates at the level of a defined accountable population, which is the foundational shift the cluster and accountable care model requires.

Tests against: Encounter Thinking · Undefined Population

Question 1

Does your organisation know precisely which population it is, or would be, accountable for under an accountable care model: defined by attribution methodology rather than by whoever happens to present for care?

Strong - 3 pointsA defined attributed population exists with documented attribution methodology, demographic and risk profile, and the data to manage it as a cohort.

Partial - 2 pointsThe concept is understood and partially implemented, but attribution is informal or incomplete.

Weak - 0 pointsThe organisation thinks in terms of presenting patients or covered members by contract, not an attributed accountable population.

Question 2

Has your organisation profiled the health needs, disease burden, and cost drivers of its attributed or target population using longitudinal data?

Strong - 3 pointsA comprehensive population health profile exists, refreshed regularly, identifying disease burden, multimorbidity, and cost concentration.

Partial - 2 pointsSome population profiling has been done but is partial or not regularly updated.

Weak - 0 pointsNo structured population health profiling has been conducted.

Question 3

Strong - 3 pointsThe attribution framework and its implications are well understood and incorporated into planning.

Partial - 2 pointsThere is partial understanding but it has not been translated into planning.

Weak - 0 pointsThe attribution framework and its implications have not been assessed.

Question 4

Can your organisation track an individual across the full care continuum: primary, secondary, specialist, and beyond: rather than only within the encounters it directly delivers or pays for?

Strong - 3 pointsLongitudinal patient tracking across the continuum is operational, supporting whole-person accountability.

Partial - 2 pointsSome cross-setting tracking exists but is incomplete or requires manual reconciliation.

Weak - 0 pointsThe organisation sees only its own encounters, with no continuum-level view.

Question 5

Is there explicit recognition at leadership level that accountable care changes the unit of accountability from the encounter to the population, with strategy adjusting accordingly?

Strong - 3 pointsLeadership has explicitly adopted population accountability as a strategic frame and is adjusting the operating model.

Partial - 2 pointsThe shift is recognised in principle but strategy still operates largely on an encounter or volume basis.

Weak - 0 pointsStrategy remains built on encounter or volume logic without recognition of the structural shift.

Section 2 of 5

Risk-Adjusted Capitation Readiness

Tests whether your organisation has the financial, actuarial, and risk-management capability to operate under risk-adjusted capitation rather than fee-for-service or simple activity billing.

Tests against: Volume Economics · Unpriced Risk

Question 6

Has your organisation modelled what operating under risk-adjusted capitation would mean for its finances: the shift from billing for activity to managing a fixed risk-adjusted budget for a population?

Strong - 3 pointsA formal capitation financial model exists, with scenarios, risk analysis, and the implications for the operating model quantified.

Partial - 2 pointsSome modelling has been attempted but is partial or not used in planning.

Weak - 0 pointsNo financial modelling of capitation has been done.

Question 7

Does your organisation have, or have access to, the actuarial capability required to operate at risk: pricing a population, setting reserves, and managing the variance that capitation transfers onto the provider?

Strong - 3 pointsActuarial capability is in place or contracted, with the organisation able to price and manage population risk.

Partial - 2 pointsSome actuarial capability exists but is not sufficient for full risk-bearing operation.

Weak - 0 pointsNo actuarial capability for risk-bearing operation is available.

Question 8

Is risk adjustment understood and built into your financial planning: recognising that a fixed payment must be adjusted for population acuity to be viable, and that poor risk adjustment is an existential financial risk under capitation?

Strong - 3 pointsRisk adjustment methodology is understood, validated, and central to financial planning under capitation.

Partial - 2 pointsRisk adjustment is recognised as important but not yet rigorously built into planning.

Weak - 0 pointsRisk adjustment is not understood or addressed in financial planning.

Question 9

Strong - 3 pointsThe organisation is prepared with the necessary design, pricing, contracting, or cost-accounting infrastructure.

Partial - 2 pointsPreparation is underway but incomplete.

Weak - 0 pointsThe organisation is not prepared for risk-adjusted capitation arrangements.

Question 10

Has your organisation assessed how the AR-DRG transition and risk-adjusted capitation interact: understanding which services sit under bundled episode payment and which under population capitation, and the combined financial effect?

Strong - 3 pointsThe interaction between DRG and capitation has been formally analysed with the combined financial effect modelled.

Partial - 2 pointsThe interaction is recognised but not formally analysed.

Weak - 0 pointsThe two payment reforms are treated separately, with no analysis of their interaction.

Section 3 of 5

Integrated Care Delivery

Evaluates whether your organisation can deliver or coordinate integrated care across the continuum, with primary care at the centre, as accountable care under capitation requires.

Tests against: Siloed Delivery · Hospital-Centric Model

Question 11

Is care coordinated across primary, secondary, and specialist settings as an integrated pathway, rather than delivered as separate encounters with the patient navigating between them?

Strong - 3 pointsIntegrated care pathways are operational across settings, with the patient journey actively managed end to end.

Partial - 2 pointsSome integration exists but most care is still delivered as disconnected encounters.

Weak - 0 pointsCare is delivered in silos, with no pathway-level integration.

Question 12

Is primary care positioned as the centre of gravity of the care model, with the capability to manage population health and prevent downstream acute utilisation, as a capitated accountable care system requires?

Strong - 3 pointsPrimary care is strategically central and resourced to manage population health and reduce acute demand.

Partial - 2 pointsPrimary care exists but is not yet the strategic centre of the model.

Weak - 0 pointsThe model remains hospital-centric, with primary care in a subordinate role.

Question 13

Are clinical and administrative data shared across the settings and providers involved in a patient pathway, enabling coordinated care rather than fragmented information?

Strong - 3 pointsData is shared across settings and providers, giving each a coordinated view of the patient.

Partial - 2 pointsSome data sharing exists but gaps force fragmented decision-making.

Weak - 0 pointsData is siloed by setting or provider, with no effective sharing.

Question 14

Does your organisation have, or have access to, the breadth of services an integrated accountable care offering requires, whether delivered directly or through a coordinated network of partners?

Strong - 3 pointsThe full breadth of services is available directly or through a managed network, with coordination across it.

Partial - 2 pointsService breadth is partial, with significant gaps in the continuum.

Weak - 0 pointsThe organisation offers a narrow set of services with no integrated network.

Question 15

Are care transitions, such as hospital discharge to home or primary care, actively managed to prevent readmissions and gaps, recognising that under capitation these transitions are financial as well as clinical events?

Strong - 3 pointsCare transitions are actively managed with structured protocols and readmission tracking.

Partial - 2 pointsSome transition management exists but is informal or inconsistent.

Weak - 0 pointsCare transitions are not actively managed.

Section 4 of 5

Outcome Measurement & Performance

Tests whether your organisation can measure and demonstrate the population health outcomes and total cost of care that accountable care holds it responsible for.

Tests against: Activity Metrics Only · Undemonstrable Performance

Question 16

Does your organisation measure health outcomes for its population, not only activity and process metrics, with the data infrastructure to track outcomes over time?

Strong - 3 pointsPopulation health outcomes are measured systematically over time, alongside activity metrics.

Partial - 2 pointsSome outcome measurement exists but is partial or not population-level.

Weak - 0 pointsOnly activity and process metrics are measured; outcomes are not tracked.

Question 17

Is total cost of care measured at the population level, integrating all care settings and categories, so the organisation knows the full cost of the population it is accountable for?

Strong - 3 pointsTotal cost of care is measured at population level across all settings and categories.

Partial - 2 pointsCost is measured in parts but not integrated into a total cost of care view.

Weak - 0 pointsTotal cost of care at population level is not measured.

Question 18

Can your organisation demonstrate its performance, on both outcomes and cost, against a defensible baseline or benchmark that would withstand scrutiny from a purchaser or regulator?

Strong - 3 pointsPerformance is demonstrable against a defensible baseline or benchmark with sound methodology.

Partial - 2 pointsSome performance reporting exists but the baseline or methodology is weak.

Weak - 0 pointsPerformance cannot be demonstrated against any credible baseline.

Question 19

Are quality and outcome metrics aligned with the measures the national purchaser and regulator are using or signalling for accountable care, rather than internally defined metrics that may not match?

Strong - 3 pointsMetrics are aligned with the emerging national accountable care and quality framework.

Partial - 2 pointsSome alignment exists but metrics are largely internally defined.

Weak - 0 pointsMetrics are internally defined with no alignment to the national framework.

Question 20

Does outcome and cost performance data actively drive operational and clinical decisions, rather than being reported and filed without changing how care is delivered?

Strong - 3 pointsPerformance data is embedded in a continuous improvement loop that changes how care is delivered.

Partial - 2 pointsData is reported but only loosely connected to operational change.

Weak - 0 pointsPerformance data does not drive decisions.

Section 5 of 5

Governance & Strategic Positioning

Evaluates whether accountable care is governed as a board-level strategic matter, with the organisation positioned relative to the restructured system and a transition plan in place.

Tests against: Reform-by-Reform Response · Strategy Without Structure

Question 21

Has your board or leadership explicitly assessed the accountable care transition as a strategic matter, distinct from the individual payment and regulatory reforms, and defined a position on it?

Strong - 3 pointsThe board has assessed accountable care as a strategic structural shift and defined an explicit position and plan.

Partial - 2 pointsLeadership is aware but has not formally assessed it as a distinct strategic matter.

Weak - 0 pointsThe accountable care transition has not been assessed at board level.

Question 22

Strong - 3 pointsA clear strategic position has been defined and is guiding decisions.

Partial - 2 pointsStrategic positioning is under discussion but not resolved.

Weak - 0 pointsNo strategic position relative to the restructured system has been defined.

Question 23

Does your organisation understand how the separate reforms (AR-DRG, risk-based capital, NISS expansion, population health, data governance) fit together inside the accountable care structure, and sequence its preparation accordingly?

Strong - 3 pointsThe reforms are understood as an integrated whole within the accountable care structure, with sequenced preparation.

Partial - 2 pointsThe reforms are understood individually but not as an integrated structural whole.

Weak - 0 pointsThe reforms are being addressed in isolation with no integrating view.

Question 24

If your organisation is considering investment, expansion, acquisition, or partnership in Saudi care delivery, are those decisions evaluated against the accountable care model the system is becoming rather than the fee-for-service model it is leaving?

Strong - 3 pointsInvestment and partnership decisions are explicitly evaluated against the accountable care model.

Partial - 2 pointsSuch decisions partially account for the structural shift but not rigorously.

Weak - 0 pointsDecisions are evaluated against the current fee-for-service model, not the accountable care one. Not applicable if no such decisions are contemplated.

Question 25

Is there a defined transition plan with capability-building milestones to move the organisation towards accountable care readiness, rather than an intention without an operational pathway?

Strong - 3 pointsA documented transition plan with capability milestones and resourcing is in place and being executed.

Partial - 2 pointsThere is intent and some planning but no full transition plan.

Weak - 0 pointsNo accountable care transition plan exists.

Accountable Care Readiness Diagnostic - Results

Your Accountable Care Readiness Profile

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Domain Breakdown

Population Accountability

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Capitation Readiness

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Integrated Care Delivery

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Outcome Measurement

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Governance & Positioning

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Indicative Findings

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This self-assessment shows the methodology. The facilitated diagnostic goes further.

A facilitated HealthElevate accountable care diagnostic includes independent capability assessment, capitation readiness modelling, and a board-ready transition roadmap sequenced against the cluster rollout and the converging reforms.

Rapid Brief

£1,200

Full Diagnostic

£4,000

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