ACOs Turn to AI and Actuarial Science for Proactive Value-Based Care

NEW YORK, NY – November 19, 2025

The Shift from Reactive to Proactive ACO Management

Accountable Care Organizations (ACOs) are increasingly focused on moving beyond reactive performance analysis to embrace predictive analytics for proactive risk management and financial improvement. A new partnership between Lightbeam Health Solutions and Wakely Consulting Group aims to facilitate this transition with the launch of two tools: ACO Optimization Retrosight (AOR) and ACO Optimization Futuresight (AOF). These tools are designed to help ACOs navigate the complexities of value-based care arrangements and optimize their financial and clinical performance.

For years, many ACOs have relied heavily on historical data to understand performance trends and identify areas for improvement. However, this reactive approach often limits their ability to anticipate challenges and proactively address potential risks. “The landscape of value-based care is constantly evolving,” explains one industry consultant. “ACOs need tools that can not only tell them what happened but also predict what will happen, allowing them to take preventive action.” AOR provides benchmarking against current ACO performance, while AOF leverages predictive modeling to forecast outcomes under different network scenarios.

Combining Technology and Expertise

The collaboration between Lightbeam and Wakely represents a strategic alignment of technological innovation and deep actuarial expertise. Lightbeam brings to the table its population health enablement platform and AI-driven analytics capabilities. This technology allows ACOs to analyze vast amounts of data, identify high-risk patients, and personalize care plans. Wakely, an HMA Company, provides specialized actuarial consulting services, including risk adjustment, rate setting, and financial forecasting. Their expertise is crucial for accurately assessing the financial implications of different care pathways and ensuring the sustainability of ACOs.

“The combination of AI and actuarial science is particularly powerful,” notes one healthcare financial analyst. “AI can identify patterns and predict outcomes, but it needs to be grounded in sound financial principles. Actuarial expertise provides that foundation.” The integration of these two disciplines allows ACOs to not only identify potential risks but also quantify their financial impact and develop targeted interventions. “It’s about moving from gut feelings to data-driven decisions,” added the analyst.

Navigating a Complex Landscape

The demand for tools like AOR and AOF is fueled by the growing number of ACOs participating in programs like the Medicare Shared Savings Program (MSSP) and the ACO REACH model. As of January 2024, over 480 ACOs are participating in MSSP, covering more than 10.6 million Medicare beneficiaries. The ACO REACH model is also gaining traction, with 143 ACOs serving approximately 2.2 million beneficiaries as of late 2024. These programs incentivize ACOs to improve quality of care and reduce costs, but they also require sophisticated data analytics and risk management capabilities.

The financial pressures facing ACOs are also increasing. Rising healthcare costs, evolving payment models, and increasing regulatory scrutiny are all contributing to a challenging environment. “ACOs need to find ways to improve efficiency, reduce waste, and demonstrate value,” states a representative from the National Association of ACOs. “Tools that can help them do that are essential for their survival.” According to the companies, early pilots of AOR and AOF have already demonstrated “millions in incremental value” by identifying network inefficiencies and aligning participation with high-performance benchmarks. While specific, publicly available case studies remain limited, the potential for cost savings and improved financial performance is clear.

The synergy between Lightbeam and Wakely is amplified by Wakely's status as an HMA Company. HMA’s broader consulting services and extensive reach within the healthcare sector provide additional resources and support for ACOs. This integration creates a comprehensive solution that addresses both the clinical and financial aspects of value-based care. This collaboration extends beyond the technology; it’s about providing ACOs with the expertise and support they need to thrive in a rapidly changing landscape.