Physician gainshare program
Delivered a $3M+ gainshare program with reliable rules, pre-run validation, and accurate payouts to 1,200+ members.
Context
An annual ACO gainshare where savings distributions are shared with participating physician members when quality criteria are met.
Incorrect payouts or unclear rules damage trust quickly, so the bar for documentation and review is high.
Small differences in how criteria are defined can change who qualifies and by how much, which makes early alignment on definitions critical.
What I owned
- Structured the full lifecycle from discovery to build to QA to executive review to production payout.
- Worked with stakeholders to translate quality requirements into unambiguous eligibility definitions and cutoffs.
- Coordinated data inputs across sources so reviews were based on a consistent source of truth.
- Ran mock gainshares in advance using an internal tool to validate assumptions and spot anomalies early.
- Supported distribution logic documentation and tradeoffs across different practice structures.
Constraints and complexity
- High-trust, high-scrutiny payouts with limited tolerance for error.
- Eligibility criteria that can shift with small definition changes.
- Multiple practice structures that do not always fit a single distribution approach.
- Hard payout timelines that reduce time for late-stage investigation.
Results
- Delivered the $3M+ annual gainshare program with accurate payouts to 1,200+ members.
- Established clearer eligibility definitions tied to quality criteria, reducing ambiguity in who qualifies and why.
- Improved leadership visibility through repeatable checkpoints and mock validations.
What I learned
- Write the rules down early because definitions are where disputes start.
- Pre-runs and sanity checks are a delivery mechanism, not extra work.
- If stakeholders cannot explain the result, the program is not ready to ship.