Free Template · 32 Questions · Benchmarked vs. Innovaccer, Arcadia, Epic Healthy Planet, WellSky
Population Health Management Software RFP: 32 Questions Every ACO Should Ask
These questions were built by asking health system CIOs what they wish they'd asked before signing a PHM contract. Some of them are uncomfortable questions. Ask them anyway.
Section 1: Data Integration
- What is the latency between a clinical event in our EHR and its appearance in your platform's risk model?
- Do you receive direct claims feeds from CMS and commercial payers, or do you require us to upload data? What formats do you accept?
- Which EHR systems do you have pre-built bidirectional integrations with, and can you provide reference sites for our specific EHR vendor?
- How do you handle data governance when we have patients seen across multiple EHR systems?
- What is your approach to data reconciliation when claims and EHR data conflict for the same patient event?
- Can you ingest and incorporate SDOH data from our community health worker screener?
- What does your data integration SLA guarantee, and what are the contractual remedies if you miss it?
Section 2: Risk Stratification & Analytics
- What risk stratification algorithm do you use? Is it proprietary or based on a validated model (HCC, DxCG, ACG)? Provide a validation study.
- How does your model perform on complex comorbid patients vs. single-condition predictions? What is your AUC score on a comparable ACO population?
- Can risk models be condition-specific — separate models for CHF, COPD, diabetes, and behavioral health?
- How does your platform handle attribution changes — patients who move between payer programs or leave and re-enter our panel?
- Can we customize risk score weightings for our specific population characteristics?
Section 3: Care Management Workflow
- Show us a care manager's work list for a panel of 400 high-risk patients on a typical Monday morning. Walk us through the actual workflow, not a slide.
- How does a care manager document their interaction with a patient within your platform, and does that documentation write back to our EHR?
- What automated patient outreach capabilities do you offer — SMS, phone, portal — and what is the compliance and consent management approach?
- How do you handle care manager panel assignments and reassignments when staff turns over?
Section 4: Quality Measure Reporting
- Which quality measure sets does your platform support natively? (HEDIS, MSSP, MIPS, Stars, VBP) — provide a complete list, not a "we support most measures" answer.
- Can your platform generate care gap alerts at the patient level, with the specific evidence needed to close each gap?
- Does your platform support direct QCDR or CMS submission for MIPS or MSSP reporting, and what is the error rate on submissions?
- How frequently are your measure specifications updated when CMS or NCQA releases specification changes?
Section 5: Financial Analytics
- Can your platform model my MSSP shared savings or bundled payment financial performance in real time — not just at reconciliation?
- Does your total cost of care analysis break down spend by service category, provider, and care setting — not just total spend?
- Can we view and compare performance across multiple VBC contracts — CMS and commercial — in a single view?
Section 6: Implementation, Pricing & Support
- What is your contractual go-live SLA, and what are the penalties — financial or otherwise — if you miss it?
- Provide an all-in Year 1 and Year 3 cost projection that includes implementation, integration, training, and any module-specific fees. No hidden fees.
- What does your pricing model look like as our attributed panel grows 20% year over year?
- Who owns our data if we exit the contract? Can we export it in a format we can actually use?
- What is your client retention rate over the past 3 years? (If they won't share this, that's your answer.)
- Provide 2 references from organizations within 15% of our attributed panel size and using the same EHR. We will call them.
- What does your standard support model include post-go-live, and what triggers additional support fees?
- How do you handle HIPAA Business Associate Agreement (BAA) requirements and SOC 2 Type II audit availability?
- What product roadmap developments are planned for the next 12 months, and how do customers influence the roadmap? (Ask for a written roadmap, not verbal promises.)
Need help shortlisting PHM vendors for your RFP?
SolvEdge will build you a shortlist of 3 vendors matched to your panel size, EHR, and VBC model — and help you interpret vendor responses. Free for ACOs in active evaluation.
We never share your information. No spam, ever.
Got it. A SolvEdge advisor will be in touch within 24 hours.