Know your attribution methodology cold
Plurality, primary care assignment, claims-based lookback, declared PCP, geographic assignment — every payer attributes differently, and the rules change. Before any growth investment, map exactly how each contracted payer attributes members to your TIN, and what behavior triggers reassignment away from you.
Most leaks happen because no one on the team can answer this. Make attribution methodology a one-page reference document, owned by population health, reviewed quarterly, and required reading for anyone in a growth or care management role.
- Attribution algorithm and lookback window for each payer
- Triggers that reassign attribution (new PCP visit elsewhere, contract change, eligibility loss)
- Notification timing — when do you find out a member moved?
- Appeal or correction process when attribution looks wrong
First visit completion is the attribution event
A newly attributed member who never completes a visit is at high risk of reassignment within 12 months. The visit is the signal to the payer that you're the responsible PCP. Without it, the algorithm starts looking for one.
Build a 30-60-90 day onboarding workflow for every new attributed member: welcome outreach in the first 30 days, scheduled AWV or initial visit in the first 60, gap-closure plan documented in the first 90. The clinics that do this hold attribution at 90%+. The ones that don't churn 25-40% annually and wonder why their panel is flat.
“We built a single dashboard showing every newly attributed member with days-since-attribution and visit status. It became the most-watched dashboard in the practice within a quarter.
Don't market to members you can't attribute
Open-market marketing in VBC is mostly wasted spend unless your geography and payer mix mean those members will route to you. Running brand campaigns that drive commercial-payer patients to a Medi-Cal-attributed VBC practice generates volume you don't get paid for and ties up clinical capacity you need for your panel.
Reallocate that spend to the three growth channels that compound inside a VBC contract: PCP-to-PCP referral relationships in your network, MCP co-marketing where allowed by the contract, and existing-member retention and gap closure.
Population segmentation is now a marketing function
In VBC, marketing's job isn't 'awareness' — it's making sure the right intervention reaches the right member at the right time. That requires segmentation that looks more like clinical risk stratification than like a CRM persona doc.
- Rising-risk: light-touch nudges to schedule overdue care
- Newly attributed: 30-60-90 onboarding sequence
- High utilizer: care manager warm handoff, not a marketing email
- Stable chronic: annual touch + birthday + AWV reminders
- Disengaged: re-engagement campaign before reassignment risk
Quality measure performance drives next-year economics
In most VBC contracts, this year's quality measure performance determines next year's shared savings, capitation rate, or contract renewal. Marketing's role is to make the gap-closure campaigns visible, urgent, and compliant — and to support the clinical team in actually closing the gaps before the measurement window closes.
What to do with this.
- Document attribution methodology and reassignment triggers for every contracted payer
- Build a 30-60-90 onboarding workflow that drives first-visit completion
- Reallocate spend from open-market marketing to PCP, MCP, and retention channels
- Treat segmentation as risk stratification, not persona work
