payer-value-based-care-manager

payer-value-based-care-manager is an agent for Claude Code from ajhcs/healthcare-agents. It costs 36 tokens per session (7,623 once invoked), scanned A, original, Apache-2.0.

A healthcare operations advisor focused on value-based care, where healthcare organizations are paid partly for patient outcomes and total costs rather than only for individual services.

In plain words
What is it for?
Use it for accountable care organization planning, patient attribution, quality reporting, shared-savings or loss calculations, risk-based contract work, care-management design, and total-cost analysis.
Why use it?
It helps organizations plan and run contracts that link payment to quality, patient populations, shared savings, or financial risk.

Agent for Claude Code

Written for Claude Code: a Claude Code subagent (agents/*.md). Also seen: positional $N argument.

Good fit Use it for accountable care organization planning, patient attribution, quality reporting, shared-savings or loss calculations, risk-based contract work, care-management design, and total-cost analysis.

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Install with agentmods
npx agentmods add agents/ajhcs/healthcare-agents/payer-value-based-care-manager
Install

Getting it into your agent

One page per mod, every tool's command on it. A separate URL per tool would split the same page into five that compete with each other.

Clone the repo
git clone --depth 1 https://github.com/ajhcs/healthcare-agents

Made for: Claude Code.

Wrote this? Show the measurements

A badge with what this costs and how it scanned, read live from this page, so it follows the numbers instead of freezing them. Markdown for a README, HTML for a documentation site or a project page.

agentmods badge for payer-value-based-care-manager

README.md
[![agentmods](https://agentmods.dev/badge/agents/ajhcs/healthcare-agents/payer-value-based-care-manager/github.svg)](https://agentmods.dev/agents/ajhcs/healthcare-agents/payer-value-based-care-manager)
Your own site
<a href="https://agentmods.dev/agents/ajhcs/healthcare-agents/payer-value-based-care-manager"><img src="https://agentmods.dev/badge/agents/ajhcs/healthcare-agents/payer-value-based-care-manager/github.svg" alt="Measured on agentmods" height="20"></a>

Or the 80×15 button, for a site that already has a row of RSS and ATOM ones. Only the verdict fits; the numbers stay here.

agentmods 80×15 button for payer-value-based-care-manager

Your own site · 80×15
<a href="https://agentmods.dev/agents/ajhcs/healthcare-agents/payer-value-based-care-manager"><img src="https://agentmods.dev/badge/agents/ajhcs/healthcare-agents/payer-value-based-care-manager.svg" alt="Reviewed on agentmods" width="80" height="20"></a>
Per session 36 Only the description is in the session, so the agent can decide to use it. The body loads when it is invoked.
When invoked 7,623 The whole file, excluding the scripts and references it only reads on demand.
Security scan A 0 findings. A grade says what 26 rules found in the file — not that it is safe.
Origin original No closer match found in the catalogue.
Token cost

What it costs to keep this loaded

Counted locally with the o200k_base tokenizer, which is exact for GPT models; Claude uses its own tokenizer and its counts differ. Treat this as one consistent yardstick across the catalogue rather than a bill. Prices are per million input tokens.

ModelPer sessionOnce invoked
Fable 5.1 $0.00036 $0.07623
Opus 5 $0.00018 $0.03811
Sonnet 5 $0.00007 $0.01525
Haiku 4.5 $0.00004 $0.00762

Measured 12d ago against content hash 934fdd58c900, method: parsed. Prices are Anthropic first-party input rates as of 2026-09-12, from the pricing page.

Security

Grade A, and why

payer-value-based-care-manager scanned grade A with 0 findings against 26 rules in 11 categories — prompt injection, anti-refusal, data exfiltration, privilege escalation, supply chain, agent snooping, system-prompt leakage, SSRF and excessive agency — measured 12d ago.

A static scan of the body, not an audit. Every finding is printed with the line that produced it so you can judge whether it matters here. A mod is markdown that instructs an agent; that is exactly why what it instructs is worth reading.

Nothing flagged

None of the 26 patterns this scan looks for appear in this file: no shell pipes, no recursive deletes, no credential paths, no hidden text, no instruction-override or anti-refusal phrasing, no agent-config snooping. That is not a guarantee, it is the absence of the things that are checkable.

agents/payer-value-based-care-manager.md · 452 lines

How it starts

The opening of the file, as written. The whole thing — 452 lines — stays where its author put it; the contents beside it link to each section on GitHub.

Value-Based Care Manager

You are ValueBasedCareManager, a senior value-based care operations leader with 12+ years building and running ACOs, managing risk-based payer contracts, and navigating the transition from fee-for-service to population health. You have led an MSSP ACO through its first shared savings distribution, managed the transition from BASIC Track to ENHANCED Track with downside risk, operationalized ACO REACH participation with capitated payments, and negotiated commercial risk-based contracts with major national payers. You operate at the level of someone who presents at NAACOS conferences and advises health system C-suites on value-based strategy — not someone who reads about it in a newsletter.

🧠 Your Identity & Memory

  • Role: End-to-end value-based care program operations — ACO governance, beneficiary attribution, shared savings/losses calculations, quality measure reporting, risk-based contract negotiation, care management program design, total cost of care analysis, and MIPS/APM participation strategy
  • Personality: Data-driven but strategically minded. You know that value-based care is both a financial model and a clinical transformation. You speak in specifics — attribution methodology, not "patient panels"; minimum savings rate, not "savings threshold"; quality gates, not "quality metrics." You push back when leadership wants to take on risk without the infrastructure to manage it.
  • Memory: You track CMS rulemaking cycles, MSSP performance year results, ACO REACH model updates, commercial payer VBC program evolution, and which quality measures are being added or retired. You remember which ACOs in your market earned shared savings and which owed losses. You know the difference between prospective and retrospective attribution and why it matters operationally.
  • Experience: You built an MSSP ACO from 47 participating providers to 210+ across 14 TINs, generating $8.2M in shared savings in PY2024. You managed the transition to ENHANCED Track with a 40% shared loss rate and implemented stop-loss protections. You've negotiated commercial VBC contracts with United, Anthem, Aetna, and BCBS plans. You've dealt with the attribution volatility that comes with CMS methodology changes and built care management programs that actually moved the needle on ED utilization and readmissions.

Read the full file on GitHub · 452 lines

Changes

What this file has done since we first saw it

Hashed on every crawl. A supply-chain change to an agent config is a question of when, not whether, so the history is kept rather than the latest state alone.

  1. 12d ago First seen · 452 lines · 36 tokens per session scan A 934fdd58c900

Subscribe to this mod's changes

payer-value-based-care-manager is an agent published in the GitHub repository ajhcs/healthcare-agents (51 stars, last pushed 1mo ago), licensed Apache-2.0. It adds 36 tokens to every session and 7,623 once invoked, about $0.0002 per session on Opus 5. A static security scan graded it A with 0 findings. No closer match exists in the catalogue, so it is treated as the original; first seen 2026-08-30.