How HarmonyCares Unified Complex Data Sources
to Power Quality and Value-Based Care
Overview
HarmonyCares is the nation’s largest provider of in-home physician services for individuals with complex medical needs and a proven leader in Medicare value-based care. In addition to operating a Medicare Shared Savings Program (MSSP) ACO and participating in the ACO REACH model, HarmonyCares is deeply engaged in Medicare Advantage through value-based partnerships that support complex, medically fragile beneficiaries in the home. Across these programs, HarmonyCares dependably delivers strong clinical and financial outcomes for high-need populations. HarmonyCares is recognized as one of the top-performing Medicare ACOs
in the country, consistently achieving over 10% medical expense savings rates in MSSP and generating $9.1 million in annual savings in its ACO REACH program — a net savings rate of 23% in performance year 2023.
As HarmonyCares continued to expand its value-based footprint, the organization undertook a major operational transformation, transitioning to a new electronic medical record (EMR) system and quality registry while integrating multiple additional data sources, including extracts from their legacy EMR. Each of these initiatives carries significant risk on its own; executing them simultaneously heightened the stakes, particularly given the need to preserve continuity, accuracy, and trust in quality and performance data that directly impact shared savings outcomes.
Through its partnership with Ursa Health, HarmonyCares successfully navigated this transition while maintaining the integrity of its analytics and reporting. With a modern, transparent analytics foundation in place, HarmonyCares is able to sustain high performance across both MSSP and ACO REACH programs, ensuring that trusted data continues to support quality measurement, regulatory reporting, and long-term success in value-based care.
The Challenge
HarmonyCares was navigating several simultaneous pressures:
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• A major EMR migration
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• A transition to a new quality registry
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• The need to maintain trust in data throughout the process
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• Imminent regulatory and reporting deadlines
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• The integration of additional new data sources
Maintaining continuity and confidence across quality, analytics, and operational teams during this period was critical.
The Starting Point: Legacy Constraints and a Vision for More
HarmonyCares had outgrown its existing data infrastructure. Prior vendors relied on opaque, black-box systems that produced outputs without transparency into the underlying logic. Without clear attribution rules, customizable measure definitions, or accessible registries, teams struggled to confidently operationalize data or respond to change.
HarmonyCares needed more than a reporting tool. The organization was seeking:
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• A unified, trusted analytics platform
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• Transparent and auditable measure logic
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• Flexibility to support payer-specific metric definitions
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• A partner with deep experience in value-based care and complex attribution models
Implementation in Action: Three Months to a New Foundation
1. Consultative Design from the Beginning
Ursa worked with HarmonyCares to anticipate and address common challenges associated with EMR transitions, particularly around encounter mapping, visit identification, and diagnosis logic.
2. Multi-Source Integration and Rapid Onboarding
Within weeks, Ursa was ingesting and standardizing data from HarmonyCares’ new and legacy EMRs, along with multiple supplemental sources. Despite variability
and complexity in the source data, Ursa’s modular data model and transformation logic aligned inputs into a cohesive foundation.
3. Defining What Matters: Cohort and Measure Logic
Attribution logic varied across Medicare Advantage, MSSP, and other payer programs. Ursa collaborated closely with HarmonyCares to:
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• Tailor attribution logic for each value-based care program
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• Iteratively refine cohort definitions based on real-world feedback
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• Create transparent, editable, and governed definitions
4. Quality Program Continuity During Registry Migration
HarmonyCares’ quality registry transition posed risks to reporting continuity and historical tracking. Ursa ensured a smooth transition by:
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• Mapping registry-specific logic alongside custom metrics
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• Delivering accurate, patient-level gaps-in-care data to downstream tools such as Navina
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• Managing the creation of Medicare Advantage supplemental clinical files across payors, ensuring consistent, validated submissions
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• Supporting audit readiness by maintaining transparent documentation and assisting HarmonyCares throughout the MA audit and validation process
5. Avoiding Common Pitfalls with Embedded Expertise
Ursa helped HarmonyCares proactively avoid issues that often derail fast implementations by:
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• Addressing encounter mapping and visit-type classification early
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• Distinguishing active and inactive patients across complex attribution rules
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• Providing version control and full documentation for auditability
Results & Impact
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• Three months from kickoff to initial operational use
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• Seamless transition across EMR and quality registry environments
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• Custom metric tooling deployed across multiple quality programs
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• Increased confidence among leadership, analytics, and quality teams
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• A strong foundation for continued analytics innovation
By preserving confidence in quality measurement and reporting throughout the transition, HarmonyCares has strengthened its position within the MSSP ACO program.
Current quality measure performance indicates the organization is on track for maximum shared savings, underscoring the value of trusted analytics during complex system changes.
Conclusion: Expertise Meets Execution
This implementation was defined by careful planning, close collaboration, and a shared commitment to maintaining trust in the data throughout a period of significant change. HarmonyCares now operates on a modern, extensible analytics foundation built on transparent logic, reliable insights, and a strong partnership with Ursa Health.
“What stood out was the level of partnership,” Mayer shared. “We weren’t just handed reports — we could see how metrics were constructed, understand the assumptions, and trust the outputs. That clarity made it much easier for our teams to stay focused on quality performance throughout the transition.”
For organizations navigating complex data migrations or quality transformations, this case study demonstrates how the right partner can help preserve confidence, continuity, and clarity — ensuring that critical analytics remain dependable even as systems and programs evolve.
Read additional success stories from some of our other clients:
- Atlas Oncology Partners – we built precise scenario models and payor-specific logic to power full-risk, value-based oncology contracting with confidence.
- IntoValue – we created a shared, demo-ready analytics environment to support direct contracting between health systems and self-insured employers.
- Matter Health – we unified claims, EHR, quality, and risk-adjustment data to drive high-touch care and performance gains for seniors in affordable housing.
- Altitude – we paired Ursa's data foundation with clinician activation tools to turn analytics into personalized, within-workflow actions that drive behavior change.
- Cityblock – we built a multi-source quality engine to move beyond compliance and focus care teams on closing real gaps for complex Medicaid and Medicare populations.