Who's in the Room?

• Who will be involved in evaluating and approving participation in value-based contracts for your practice? (please list names and titles where possible)
• Which single person will be the ultimate decision-maker on joining an ACO or value-based contract? Options: Practice owner, Managing partner, Practice manager, CFO/financial lead, Board/Investor, Other
• Which people or roles will influence the decision (select all that apply)? Options: Practice owner, Managing partner, Practice manager, Billing lead, Lead clinician(s), Office administrator, External investor/board, Other
• How would you describe the day-to-day decision dynamic between the owner/managing partner and the practice manager when it comes to operational change? Options: Owner decides, manager executes, Manager recommends, owner approves, Shared decision-making, Owner delegates entirely, Conflictual/unclear, Other
• Have you worked with an ACO or value-based partner before? If so, who and what happened? Options: No prior experience, Yes — exploratory conversations only, Yes — short pilot, Yes — multi-year engagement, Other

Who Actually Pulls the Trigger?

• When it comes down to saying yes to a shared-savings or downside-risk contract, who's truly making the call—and why might that differ from what's on paper?
• What are the top three criteria that must be satisfied for a final 'go/no-go' decision (select up to three)? Options: Clear financial upside, Limited or no downside risk, Minimal disruption to workflows, EHR integration without major IT work, Transparent data/reporting, Favorable commercial terms, Clinical quality improvements
• Is there a formal committee or review process that signs off on contracts? If yes, who sits on it and how often does it meet? Options: No formal committee, Internal leadership only, Leadership + practice manager, Board/investor approval required, Other
• Who holds financial signing authority (title), and are there outside stakeholders (investors, parent organization) who must consent?
• Are there external deadlines (payer deadlines, year-end, pending acquisition) that would force a faster or slower decision? Options: Needs to be decided in 30 days, 30–60 days, 60–90 days, 3–6 months, No fixed deadline

What's the Hidden Cost of Doing Nothing?

• How much financial or emotional strain is your practice tolerating today that you hope value-based care will address?
• Which financial pressures have hurt you most this year? (select all that apply) Options: Declining FFS reimbursements, Rising overhead/office costs, Payer denials and slow payments, Loss of patients to health systems, High uncompensated care, Other
• What is your approximate payer mix by revenue (enter percentages for Medicare, Medicaid, Commercial, Self-pay)
• How long have these pressures been materially affecting operations and decision-making? Options: Under 6 months, 6–12 months, 1–3 years, More than 3 years
• Which administrative tasks drain the team most (billing, quality reporting, prior auths, scheduling)? Give a brief example of impact.
• Has staff morale, turnover, or clinician burnout already been affected? If yes, describe one concrete example. Options: No, Yes — low morale, Yes — increased turnover, Yes — clinician burnout, Other

If This Works, What Will Change?

• What would success look like so tangible that you'd gladly tell colleagues 'joining was worth it'?
• Which measurable targets would make you feel confident (select up to three)? Options: % shared savings returned to practice, Reduction in ER visits/hospital admissions, Increase in AWV completion rate, Improved HCC coding accuracy, Quality score improvements (e.g., CAHPS), Revenue uplift from value contracts
• What timeline would feel like a meaningful proof of value? Options: Within 3 months, 3–6 months, 6–12 months, 12–24 months
• Beyond numbers, what day-to-day change for staff would tell you the program is working?
• Who should receive the first shared-savings and quality reports, and what format builds trust (dashboard, line-item, narrative)? Options: Practice owner, Managing partner, Practice manager, Billing lead, Clinician leads, Other
• What level of transparency and auditability do you require to trust savings calculations? Options: Real-time dashboards + drill-down, Monthly line-item statements, Quarterly third-party audit, High-level summaries only

Who Will Be on the Front Lines of Change?

• Who in your day-to-day operations will be waking up to new workflows—and how ready are they for that change?
• Which staff roles will be directly affected? (select all that apply) Options: Front desk/reception, Medical assistants, Nurses, Primary care clinicians, Practice manager, Billing/coding staff, EHR administrator, Other
• Which EHR(s) do you use? (select all that apply) Options: Epic, Cerner/Oracle, Athenahealth, eClinicalWorks, Allscripts, NextGen, Other
• How would you rate your team's capacity to absorb training and workflow change right now? Options: High — we can onboard quickly, Moderate — need support, Low — limited capacity, We would need to hire/shift roles
• What specific concerns have staff already raised about technology, EHR integration, or care manager embedding?
• Would you be open to a phased pilot where a host-provided care manager is embedded part-time for 60–90 days? Options: Yes — open to pilot, Maybe — need more details, No — not open

Let’s Map Your Decision Path

• Walk me through the last time your group changed a major vendor—what stalled it and what ultimately pushed it across the line?
• What are the concrete steps and approvals required to sign a new vendor or contract in your organization?
• How many stakeholders/meetings does a procurement decision typically involve? Options: 1–2 people/meetings, 3–5, 6–10, More than 10
• How long does your typical vendor selection and contracting process take from initial interest to signed agreement? Options: Under 1 month, 1–3 months, 3–6 months, 6–12 months, Over 12 months
• Who reviews or negotiates legal and commercial terms (in-house counsel, external counsel, partner negotiates, practice manager)? Options: In-house counsel, External legal counsel, Practice manager reviews, Partner/host drafts and we accept, Other
• What would be the simplest path to run a pilot in your structure (who signs what, who can approve budget for pilot)?

Data, Transparency and Trust: The Deal Breakers

• If you had one red flag about a potential partner, what would make you refuse to share patient or financial data?
• Which data types would you be comfortable sharing early in a pilot? (select all that apply) Options: EHR clinical data, Claims/encounter data, Billing and financial data, Scheduling/appointments, Patient outreach logs, None at pilot start
• What data security or compliance certifications/assurances do you require before sharing PHI? Options: HIPAA Business Associate Agreement, SOC 2 Type II, HITRUST, Data Use Agreement, Encryption at rest and in transit, Other
• How frequently would you want to see performance and financial reports during a pilot? Options: Real-time dashboard, Weekly, Bi-weekly, Monthly, Quarterly
• What level of access to raw data versus summarized dashboards will build your confidence? Options: Full raw data access (secure), Aggregated dashboards with drill-down, Raw data on request only, Summaries + third-party audit
• Have prior partners delivered poor data quality or late reporting? If yes, describe one example and its impact.

From Curiosity to Contract — What Would Have to Change?

• If we asked you to go from curiosity to contract in 60 days, what would have to change in your internal process or priorities?
• What minimum pilot length would you accept to demonstrate value? Options: 30 days, 60 days, 90 days, 6 months, 12 months
• Which commercial terms are immediate deal-breakers for you? (select all that apply) Options: Any downside risk in year 1, Unclear shared-savings split, Lack of data transparency, Long fixed-term contract without exit, High implementation fees, Other
• What shared-savings split range would feel fair given the practice effort and your risk tolerance? Options: Practice 60% / Host 40%, Practice 50% / Host 50%, Practice 40% / Host 60%, Host handles more and gets larger share, Open to negotiation
• How much downside risk (if any) would you consider in the first year? Options: None, Low (up to 10%), Moderate (10–20%), High (>20%), Unsure
• What specific guarantees, exit clauses, or proof-of-value conditions would make you comfortable committing to a pilot or agreement?

Tell Us a Bit About Who You Really Are

• What's the current legal/ownership model of the practice? Options: Independent physician-owned, Physician group (multi-owner), Part of a small network/IPA, Owned by a health system, Management services organization (MSO) partnership, Other
• How many clinicians (MD/DO/NP/PA) provide patient care under this practice? Options: 1, 2–4, 5–9, 10–24, 25–49, 50+
• Which primary clinical services do you deliver (pick all that apply)? Options: Family medicine, Internal medicine, Geriatrics, Pediatrics, Behavioral health, Ob/Gyn, Other
• Roughly how many unique primary care patients does the practice see in a typical year? Options: <1,000, 1,000–2,999, 3,000–7,999, 8,000–14,999, 15,000+
• Who manages day-to-day operations and is the primary contact for new partnerships? Options: Practice owner, Managing partner, Practice manager/administrator, Office manager, Clinical director/CMO, Other

Are You Running Lean — Or Feeling Pulled Apart?

• How has your net revenue/trending reimbursement changed over the last 12–24 months? Options: Significantly down (>10%), Moderately down (3–10%), Stable (±3%), Moderately up (3–10%), Significantly up (>10%)
• Which of the following financial pressures are most real for you today (select up to 3)? Options: Declining FFS reimbursement, Rising overhead (staff, rent), Billing and collections delays, Denials and coding issues, Investment required for tech/integration, Payer contract complexity, Other
• Tell us about a recent example when a financial or administrative issue forced a care or staffing decision (what happened and what did you feel was lost?)
• How much runway do you feel you have before cost pressures require meaningful change? Options: We need changes now, 3–6 months, 6–12 months, 12+ months, Unsure
• Which revenue levers have you tried or considered to offset pressure? Options: Hiring biller/vendor, Adding ancillaries (labs/imaging), Expanding hours/providers, Pursuing value-based contracts, Merging/selling, Other

Who Really Makes the Call — And Who Lives With It?

• Who is the final decision-maker for contracting or joining an ACO/VC arrangement? Options: Practice owner(s), Managing partner(s), Practice manager/administrator, Board or governance committee, Outside investor/CEO, Other
• Who in your practice will be most affected operationally by a change to value-based care (pick up to 3)? Options: Practice manager/administrator, Billers/coders, Front-desk/schedulers, Nurses/MA, Physicians/APPs, IT/EHR admin, Other
• How aligned are the decision-maker(s) and the operational team on exploring value-based contracts? Options: Fully aligned and eager, Mostly aligned with questions, Divided opinion, Leadership interested but ops skeptical, Not aligned
• Who currently owns payer contracts, and who negotiates financial terms and data-sharing in your organization? Options: Practice owner(s), Managing partner, Practice manager, External consultant/CPA, No one — we outsource, Other
• Describe a recent internal decision where clinical workflow changes were required—how was it decided and how quickly did the team adapt?

How Patients Flow Through Your Day — The Unvarnished Truth

• What EHR/platform do you use as your clinical record and scheduling system? Options: Epic, Cerner/Oracle, Athenahealth, eClinicalWorks, NextGen, Allscripts, Practice Fusion, Greenway, Custom/other
• How would you describe the accuracy and completeness of your EHR problem lists, meds, and visit coding today? Options: Mostly accurate, Moderately accurate with gaps, Significant inaccuracies, We don’t know/can’t measure
• Walk us through how an Annual Wellness Visit (AWV) or chronic care follow-up is scheduled, documented, and billed today — who does what?
• Which parts of patient outreach and care coordination are manual vs automated in your workflows? Options: Scheduling/outreach, Pre-visit planning, Care management follow-ups, Medication reconciliation, Quality gap closure, All mostly manual, All mostly automated
• How often do care managers or care coordination staff interact directly with your clinicians and patients today? Options: Embedded full-time, Shared across sites part-time, Contracted externally, None currently, Other
• If you could change one step in your day-to-day patient workflow to save the most time, what would it be?

What Data Tells You — And What It Quietly Hides

• How confident are you that your current reporting accurately captures quality measures and coding needed for shared-savings programs? Options: Very confident, Somewhat confident, Not confident, We don’t run those reports
• Which data sources do you currently have access to for performance (select all that apply)? Options: EHR clinical data, Practice billing/claims, Payer claims reports, HIE feeds, Third-party analytics, None of the above
• Describe any recurring data problems you face (late claims, mismatched attribution, missing denominators) and how long they've persisted.
• Who currently runs your quality and performance reports (roles or vendors)? Options: Internal staff (billing/ops), Internal clinician lead, Third-party vendor, No one regularly runs them, Other
• If a partner provided near-real-time analytics and clear attribution visibility, how would that change your confidence in taking on risk? Options: Significantly increases confidence, Somewhat increases confidence, No change, Would need to see a demo/evidence

Payers, Risk, and What You’re Willing to Try

• Which payer types make up your active patient population (select all that apply)? Options: Medicare FFS, Medicare Advantage, Medicaid, Commercial/employer, Self-pay/uninsured, Other
• Estimate the proportion of your revenue coming from value-based arrangements today. Options: None, 1–10%, 11–25%, 26–50%, 51–75%, 76–100%
• Have you participated in downside-risk contracts before, and if so, how did that go? Options: Never participated, Participated with positive results, Participated with losses, Participated but neutral outcome, Prefer not to say
• Which financial model would you be most comfortable exploring first? Options: Shared-savings (upside only), Shared-savings with limited downside, Full downside risk, Per-member-per-month (PMPM) arrangements, Capitation/partial capitation, Unsure
• What are your top three concerns about entering a value-based contract? Options: Financial loss exposure, Data transparency, Workload on staff, Impact on clinical autonomy, EHR integration, Patient attribution accuracy, Other

Ready, But Not Rushed — What Would Make You Say Yes?

• What core capabilities do you feel are missing today that would prevent you from confidently joining a value-based program? Options: Reliable data/analytics, Care management staff, Billing/claims accuracy, Legal/compliance support, EHR integration, Financial modeling/forecasting, Other
• If a partner guaranteed transparent monthly reporting, an embedded care manager, and no upfront tech cost, how likely would you be to progress to a pilot? Options: Very likely, Somewhat likely, Unsure, Unlikely
• What timeline feels realistic for your practice to be deployment-ready for a value-based pilot? Options: Immediate (1–2 months), Short (3–6 months), Medium (6–12 months), Long (12+ months), Not ready
• Which measurable outcomes would make a pilot a clear success for you (pick up to 3)? Options: Net revenue increase, Improved quality scores, Lower utilization (ED/hospital), Higher AWV/ACM completion, Reduced staff administrative time, Improved patient satisfaction
• What would be a non-negotiable red flag that would stop you from proceeding with a partner?

Practical Next Steps — Paperwork, People, and Proof

• What documents or data would you be comfortable sharing early in the process to evaluate fit (select all that apply)? Options: Payer mix summary, Top-line financials, EHR vendor/version, Staffing org chart, Recent quality reports, None at this time
• Who should be included in a follow-up workshop to speed decisions (names/roles)?
• Are there contractual or legal constraints (e.g., existing exclusive arrangements) that would block participation in a new ACO or shared-savings program? Options: Yes — we have constraints, No known constraints, Unsure — need to check
• What would you need to see from us to feel comfortable running a time-limited pilot (e.g., sample reports, reference practices, financial model)? Options: Sample monthly reports, Reference calls with similar practices, Detailed financial model, Data security/compliance docs, Implementation timeline, All of the above
• If we proposed a short discovery pilot, what is the best target date to begin and who must sign off? Options: Begin within 30 days, Begin within 60–90 days, Begin within 3–6 months, No timeframe yet

Getting Comfortable: Tell Us About Your Practice

• What's your practice name, primary location (city/state), and core specialty?
• Which best describes your practice size (count of clinicians)? Options: Solo, 2–5 clinicians, 6–15 clinicians, 16–50 clinicians, 51+ clinicians
• Which EHR(s) are used in your clinic today? Options: Epic, Cerner/Oracle, Allscripts, Athenahealth, NextGen, eClinicalWorks, Other
• Which payers represent your largest revenue sources today? Options: Medicare FFS, Medicare Advantage, Medicaid, Commercial (Blue/BCBS), Commercial (Regional), Self-pay / Cash
• Who will be the primary decision-maker for entering a value-based partnership? Options: Practice owner, Managing partner, Practice manager/administrator, Billing manager, Clinical lead/medical director, Governance committee
• Describe briefly how contract and operational decisions are typically made in your practice (who signs off, timeline, and meeting cadence).

Are You Quietly Accepting This Risk?

• What if staying primarily fee-for-service is increasing your exposure to unexpected revenue drops—how does that land with you?
• How has your practice's revenue trended over the last 24 months? Options: Increased, Stable, Moderate decline (5–15%), Significant decline (>15%), Variable/seasonal
• Have you experienced quality-related payment adjustments, penalties, or large denials recently? Options: Yes, No, Unsure / Need to check
• Tell us about a recent payment or quality surprise that made you worry about the sustainability of current revenue sources.
• How do you feel—emotionally—about potentially accepting downside risk in exchange for a larger share of savings? Options: Very anxious, Somewhat anxious, Neutral, Somewhat hopeful, Very hopeful
• Would a phased approach (e.g., upside-only then gradual risk) change your willingness to participate? Options: Yes, significantly, Somewhat, No
• What is your primary financial objective for exploring an ACO partnership? Options: Stabilize revenue, Increase net margin, Reduce administrative cost, Access technology/care management, Improve billing accuracy, Other

Where the Work Actually Happens

• How much of your clinicians’ and staff’s daily routines would need to change if population health became an explicit part of your standard workflow?
• Which roles currently manage patient outreach, care coordination, and preventive care in your practice? Options: Physicians, NPs/PAs, RNs, Medical assistants (MAs), Care managers, Front desk/administrative staff, Billing team
• Do you already have an embedded care manager, or do you rely on external coordination resources? Options: Embedded full-time, Embedded part-time, External/contracted, No care manager today
• Walk me through how an Annual Wellness Visit (AWV) is scheduled, documented, and billed today in your office.
• After a patient hospitalization, how quickly does your team usually complete outreach and reconciliation for that patient? Options: Within 48 hours, 48–72 hours, 3–7 days, More than 7 days, Not tracked
• What tools or workarounds do you use today to close care gaps (select all that apply)? Options: EHR tasks/alerts, Phone outreach, Patient portal messages, Third-party apps, Mailings/letters, None
• Which part of your current workflow feels most fragile—the thing that would break first if we added population-health responsibilities?

What Success Looks Like — Beyond the Dashboard

• If we only judged this partnership by dollars, what important improvements in your practice might we miss?
• Which single outcome matters most to you after 12 months: increased net revenue, lower clinician burnout, measurable quality improvement, or better patient experience? Options: Increased net revenue, Lower clinician burnout, Measured quality improvement, Improved patient experience
• What would be a credible target improvement for key quality measures or AWV completion in the first year? Options: +1–3%, +4–8%, +9–15%, No specific target / qualitative improvement
• How would you prefer shared-savings to be distributed (choose any that reflect your interest)? Options: Lump-sum annual distribution, Per-measure bonuses, Per-attributed-patient monthly payments, Reinvestment in practice capabilities, Other
• Who in your practice needs to see performance reporting to feel confident (select all necessary audiences)? Options: Owner/Partner, Practice Manager, Billing Lead, Clinicians, Care Manager, Board/Advisory group
• What would make you trust a performance report (audit trails, patient-level drilldowns, third-party validation, or something else)? Options: Auditability / patient-level data, Clear reconciliation process, Third-party validation, Transparent methodology, Other
• Share a short story about an outcome at year-end that would make you say this partnership was worth it.

What Would Change Everything If It Just Worked?

• What's the single operational change that would transform this initiative from 'another project' to 'it actually works' for your team?
• Have you tried analytics or practice transformation before? What specifically succeeded or failed?
• Which adoption barriers worry you most (select up to three)? Options: Clinician time/availability, Staff bandwidth, Technology complexity/integration, Patient engagement, Billing disruption, Upfront costs
• How do clinicians in your practice typically respond to new workflows: eager, cautiously optimistic, slow adopters, or resistant? Options: Eager early adopters, Cautiously optimistic, Slow adopters, Resistant
• Practically speaking, how many clinician hours per week could be committed to new population-health activities during the first 3 months? Options: <1 hour, 1–3 hours, 4–6 hours, >6 hours
• Which training formats have prompted real behavior change for your staff in the past? Options: In-person demos, Short video modules, Shadowing/embedded support, Written playbooks, Live virtual workshops
• If a care manager were embedded in your practice tomorrow, what would success look like for that role at 30 and 90 days?

Data, Reporting, and Trust — How Tight Do We Need to Be?

• If you could only proceed when you fully trusted the data, what evidence would close the trust gap for you?
• Which data feeds can you provide now or within two weeks (select all that apply)? Options: Claims files, Structured EHR clinical data (C-CDA/FHIR), Labs/results, ADT feeds (admit/discharge/transfer), Scheduling data, Billing/export files
• Do you have an IT or integration contact who can grant EHR access, API keys, or SFTP feeds? Options: Yes — named contact, Yes — role available, No, Unsure
• How often would you want reconciliation and performance reports delivered? Options: Weekly, Biweekly, Monthly, Quarterly
• What is an acceptable turnaround for data correction or dispute resolution from your perspective? Options: 24 business hours, 48 business hours, 3–5 business days, Up to 2 weeks
• Who in your practice signs off on data acceptability and reconciliations (names or roles)? Options: Owner/Partner, Practice Manager, Clinical Lead, Billing Lead, Other
• Describe a past incident where data issues eroded trust — what went wrong and how was it discovered?

People & Governance — Who Will Own This?

• If we ask you to commit to a governance rhythm, who in your practice will reliably show up and speak for operational priorities?
• What governance cadence best fits your organization (select all that apply)? Options: Weekly operational huddle, Biweekly ops review, Monthly executive review, Quarterly strategic session
• Who should be the day-to-day owner for coordinating with the ACO partner? Options: Practice Manager/Administrator, Clinical Lead / Medical Director, Billing Manager, Nurse Care Coordinator, Other
• Who should be looped into escalation conversations about patient safety, compliance, or unexpected financial variance? Options: Owner/Partner, Practice Manager, Clinical Lead, Billing Lead, Compliance Officer/Legal
• How much decision-making autonomy should the ACO partner have for care management activities: full, guided, or consult-only? Options: Full autonomy (with reporting), Guided autonomy (joint decisions), Consult-only (practice decides)
• How would you prefer decisions about reinvesting shared-savings to be made: practice vote, proportional distribution, joint committee, or a predefined formula? Options: Practice vote, Proportional distribution, Joint committee, Predefined formula
• What governance terms or requirements would be a deal-breaker for your practice?

Commercial & Financial Reality Check

• What if the model required short-term operational changes that temporarily reduce fee-for-service revenue — could your practice absorb that?
• Which contracting structures would you be willing to explore (select all that apply)? Options: Upside-only, Upside with thresholds, Downside-limited (cap), Full downside risk
• Do you have cash reserves or financing constraints that would limit your ability to accept downside or delayed savings? Options: Yes, No, Unsure
• How would you prefer shared-savings distributions and reconciliation to be timed? Options: Quarterly with reconciliation, Annual reconciliation only, Monthly estimates with final reconciliation, Other
• Which billing or coding support would reduce your operational risk most (select up to three)? Options: Claims edits/denial support, Coding audits, Monthly reconciliation services, AWV billing support, Real-time coding guidance
• What are your top three commercial concerns about entering risk-sharing contracts? Options: Cash flow/shortfalls, Unclear distribution methodology, Data transparency, Regulatory/compliance exposure, Operational burden
• Tell us about a recent contract discussion where you felt unsure — what would have changed the conversation for you?

Readiness & Timeline — Are You Really Ready to Go Live?

• If we proposed a go-live in six weeks, what single obstacle would prevent you from making that deadline?
• What is your preferred timing for a go-live: immediately, next quarter, next fiscal year, or after a small pilot? Options: Immediately, Next quarter, Next fiscal year, After a pilot
• Which of these technical tasks are already complete or in progress (select all that apply)? Options: EHR access provisioned, Claims feed active, ADT feed active, Staff training scheduled, Care manager identified/assigned
• Who (names or roles) would be available to support a 2–4 week intensive onboarding period?
• What level of initial go-live disruption is acceptable to you: tolerate minor patient-facing issues, tolerate only internal issues, or require zero clinical/billing disruption? Options: Minor patient-facing allowed, Only internal/low-impact issues, Require zero disruption

Who’s in the Room — Introductions and Decision Roles

• Which people at your practice make the final call on new contracts or operational changes (pick all who apply)? Options: Practice owner(s), Managing partner, Practice manager/administrator, Billing lead/office manager, Clinical director/medical director, Board/other investors, Other
• How do decisions usually get made—fast, consensus-driven, or by a single owner—and who needs to be comfortable for a change to happen? Options: Single owner decides, Owner + practice manager, Leadership consensus (3–5 people), Requires external stakeholder (investor/board) sign-off, Other
• Who will be the day-to-day point person for coordinating with our team if you move forward?
• When would you ideally like a commercial decision completed (timeline)? Options: Immediately (next 2–4 weeks), In 1–3 months, 3–6 months, 6–12 months, Undecided
• What are the three non-negotiable outcomes that would make participation in an ACO ‘worth it’ for you?

Are You Comfortable Letting Small Drops Become Big Leaks?

• Over the last 2–3 years, how has your total practice revenue trended? Options: Growing, Stable, Slowly declining, Sharply declining, Unsure
• Which financial pressures worry you most right now (choose up to three)? Options: Lower FFS reimbursement, Rising overhead/staff costs, Unreimbursed care coordination time, EHR/IT costs, Payer contract complexity, Competition from health systems, Other
• Tell us about a recent month when finances felt tight—what specifically changed and how did you respond?
• How long have you been seeing this financial pressure? Options: Under 6 months, 6–12 months, 1–3 years, Over 3 years
• If nothing changed operationally, what financial outcome do you expect in 12–24 months? Options: Modest decline, Significant decline, Stable, Improvement, Unsure

Why Trust Shared Savings—Skeptical or Curious?

• Have you previously participated in any value-based program (e.g., MSSP, MA, commercial ACO)? Options: Yes — Medicare MSSP, Yes — Medicare Advantage, Yes — commercial/shared-savings, No, never, Unsure
• If you have prior experience, what specifically eroded or built trust in those arrangements?
• What would you need to see from an ACO’s reporting to feel confident the numbers are accurate and fair? Options: Full claims-level transparency, Regular reconciliations, Independent auditor reports, Drill-down dashboards by clinician, Clear distribution formula, Other
• How would a lack of transparent data sharing make you feel about joining a program—worried, neutral, or accepting? Options: Very worried, Somewhat worried, Neutral, Comfortable
• Describe an example of transparency (or lack of it) from another vendor or partner that shaped your trust—what happened and why did it matter?

What Level of Financial Risk Actually Feels Manageable?

• When you hear ‘downside risk,’ what’s your first reaction? Options: We must avoid it, Willing if capped, Comfortable if compensated fairly, Open depending on modeling, Curious but cautious
• What percentage swing in annual net revenue would be acceptable to your owners (pick one)? Options: No downside allowed, Up to 2% downside, 2–5% downside, 5–10% downside, Would consider >10% with protections
• If offered a phased approach (start with upside-only, then gradually add downside), how likely are you to accept that path? Options: Very likely, Somewhat likely, Unsure, Unlikely
• Tell us about any financial modeling you’ve done or received about value-based participation—what assumptions worried you most?
• Which protections would make downside risk acceptable (choose up to three)? Options: Loss caps, High-touch performance coaching, Delayed downside phase-in, Data-driven exclusions, Stop-loss insurance, Other

If This Worked, How Would Your Practice Feel Different?

• Imagine 12 months into an effective program—what three changes would convince you it was worth it?
• How would those changes show up day-to-day for clinicians, staff, and patients?
• Which outcomes matter most to you (choose up to three): total cost, patient satisfaction, specific quality measures, visit volume, provider time saved, or revenue impact? Options: Total cost of care reduction, Improved patient satisfaction, Higher quality measure scores, Stable or improved visit volume, Reduced administrative burden, Increased net revenue
• What quality measures or clinical areas would you want prioritized (e.g., AWVs, diabetes, hypertension, preventive care)? Options: Annual Wellness Visits (AWV), Diabetes control (A1c), Hypertension control, Preventive screening (cancer etc.), Behavioral health integration, Other
• If you had one confidence-building pilot to test with us (3–6 months), what would you pick and why?

What’s Actually Happening in Your Clinical Workflows?

• Which EHR do you use today? Options: Epic, Cerner, athenahealth, eClinicalWorks, NextGen, Allscripts, Practice-specific custom EHR, No EHR/Mostly paper, Other
• Describe how data typically flows from the EHR to analytics or billing today—who owns exports, and how reliable is it?
• Which parts of clinical workflow feel most fragile around value-based tasks (select all that apply)? Options: AWV scheduling/documentation, Chronic care management, Care transitions/hospital follow-up, Coding and billing accuracy, Patient outreach and engagement, Reporting/measure capture, Other
• How many full-time equivalent (FTE) care coordination or population health staff do you currently have? Options: 0, 0.1–0.5 FTE, 0.5–1 FTE, 1–2 FTE, 2+ FTE
• Share a recent example when a workflow gap led to a missed revenue or quality opportunity—what happened and what was the impact?

Data: Our Superpower or Your Blind Spot?

• On a scale, how confident are you that your patient attribution, claims, and clinical data are accurate enough for shared-savings calculations? Options: Very confident, Somewhat confident, Not confident, Don't know
• Which data feeds are already live and reliable for your practice (select all that apply)? Options: Real-time EHR access/API, Daily claim feeds, Monthly payer rosters, Lab interfaces, None of the above, Other
• Who in your organization manages data quality and reconciliation today? Options: IT/Health IT vendor, Practice manager, Billing vendor, External consultant, No one specific
• What would acceptance criteria look like for you before signing off on production reports (examples: <5% discrepancy, reconciliation process, sample audit)?
• If we run a joint validation, how much staff time could you commit to resolving data issues in month 1? Options: <2 hours/week, 2–5 hours/week, 5–10 hours/week, 10+ hours/week, Depends—need to discuss

Can Your Team Live with Change—Or Will It Fight Back?

• How do clinicians and staff typically respond to new workflows or tools—enthusiastic, skeptical, or resigned? Options: Enthusiastic, Open but cautious, Skeptical, Resistant
• What training formats have worked best for your team before (in-person, recorded video, shadowing, one-on-one coaching)? Options: In-person workshops, Live virtual training, Short recorded modules, One-on-one coaching/mentorship, Shadowing/embedded support, Other
• Describe a recent change initiative that succeeded—what made it stick? Conversely, describe one that failed and why.
• How much time per clinician per week could realistically be reallocated to care coordination or value-based tasks without harming access? Options: <30 minutes, 30–60 minutes, 1–2 hours, 2+ hours, Unsure
• What worries you most about the human side of transformation (staff burnout, patient experience, revenue disruption, training burden)? Options: Staff burnout, Patient experience, Revenue disruption, Training burden, Loss of autonomy, Other

What Would Success Look Like — Concrete Signals, Not Hopes

• List the top three KPIs you would want included in a monthly success dashboard (be specific—e.g., AWV rate, A1c <8%, net revenue change).
• What time horizon would you use to judge success—3 months, 6 months, 12 months, or longer? Options: 3 months, 6 months, 12 months, 18+ months
• What level of financial improvement (savings/share) would you need to see before feeling confident this model pays off? Options: No downside; any upside positive, 1–3% net improvement, 3–7% net improvement, 7%+ net improvement, Undecided
• Who needs to see and sign off on the monthly reports for you to consider them actionable? Options: Practice owner(s), Managing partner, Practice manager, Billing lead, Clinical lead, Other
• If after 12 months targets aren’t met, what would you view as acceptable next steps (pause, change scope, increase support, exit)? Options: Pause and reassess, Adjust scope/targets, Increase embedded support, Exit the program, Other

Small Pilot, Big Answers — What Would You Try First?

• Would you be open to a time-boxed pilot (3–6 months) that focuses on a narrow set of measures before full commercial commitment? Options: Yes — eager, Yes — with conditions, Maybe — need details, No
• Which pilot focus would you prefer: AWV optimization, diabetes/high-risk cohort management, hospital transitions, or claims/data validation? Options: AWV optimization, Diabetes/high-risk cohort, Hospital transitions, Claims/data validation, Other
• How many attributed patients or clinicians should be included in a pilot to feel informative (select one)? Options: Single clinician or ~200 attributed lives, 2–3 clinicians or 200–500 lives, Entire practice or 500+ lives, Unsure—need guidance
• What would success look like at the end of that pilot (specific numeric or process signals)?
• Who on your side needs to be involved in the pilot week-to-week? Options: Practice owner(s), Practice manager, Clinician champions, Billing lead, Front desk/scheduling, Other

Next Steps — Aligning Expectations and Commitments

• Given everything we've discussed, what is your preferred next step: detailed financial model, technical validation, pilot agreement, or a leadership review? Options: Detailed financial model, Technical/data validation, Pilot agreement, Leadership review/meeting, Other
• Who needs to be present from your side for a successful next meeting, and what materials would be helpful?
• Are there any non-negotiable contract terms or governance preferences we should know about up front (reporting cadence, audit rights, distribution timing)?
• What timeline feels realistic for beginning a pilot or onboarding if commercial terms are agreed? Options: Immediately (2–4 weeks), 1–3 months, 3–6 months, Longer than 6 months
• Finally, what would make you nervous about moving forward right now—and what could we do to reduce that worry?