For ACOs
The patients driving your cost and quality need more than a point solution.
A scalable, physician‑led whole person care program for your highest‑complexity attributed patients, built to move quality measures and reduce total cost of care where it’s most concentrated.
Every ACO’s risk arrangement is different. We’ll design a payment and business model with you that fits how you’re paid.
Where ACO performance is decided
Your highest‑cost patients are managing several conditions at once.
ACO performance depends on the attributed patients with the highest complexity and cost. The fragmented point‑solution model that created their situation isn’t equipped to reverse it.
Nudj starts with each patient as an individual, addresses the root causes of their conditions and improves the clinical markers that determine your quality performance, with one program and one care team.
metabolic Behavioral
health Chronic pain One Nudj care team
CDC, National Center for Chronic Disease Prevention and Health Promotion
What Nudj delivers for ACOs
One model, one care team, one whole person approach.
ACOs are accountable for populations no single‑condition program has reached. Nudj addresses cardiometabolic disease, behavioral health and chronic pain together, alongside the primary care relationships in your network.
Scalable lifestyle medicine for your highest‑risk patients
A foundational whole person care model that addresses the behavioral, lifestyle and clinical drivers of chronic disease across conditions, built around each patient’s individual circumstances.
- Cardiometabolic disease
- Behavioral health
- Chronic pain
- Obesity and GLP‑1
- Diabetes
Outcomes that move your quality measures
The clinical markers that determine ACO performance under MSSP, REACH and value‑based contracts. Every result is attributed, reported in real time and formatted for quality reporting and performance review.
- HbA1c reduction
- Blood pressure control
- Medication adherence
- Medication de‑escalation
- Behavioral health integration
Lower utilization where it costs you most
Coordinated care between visits keeps patients out of specialist offices, urgent care and the ER for conditions lifestyle medicine can address. Every remaining appointment is appropriate, reimbursable and high‑value.
Fewer encounters, Corewell Health. Nudj Analytics, May 2025.
Runs alongside your attributed providers
Our team works with the primary care physicians in your network, communicating at key milestones and supporting their care plans. Patients stay with their provider, and your network gains a capability without adding staff.
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01
Attributed PCP Keeps the patient relationship
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02
Nudj care team Treats the whole person between visits
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Your ACO Sees quality and cost move
CMS ACCESS Model
Already aligned with where value‑based care is heading.
Nudj is an accepted participant in the CMS ACCESS Model, the Innovation Center’s outcome‑aligned payment model for technology‑enabled chronic care in Original Medicare.
ACCESS pays for measurable improvement in chronic conditions, delivered by an accountable care team under physician oversight. That is how Nudj already works. ACOs exploring ACCESS, or already operating alongside it, can deploy Nudj without adapting our approach to fit the model.
The four ACCESS clinical tracks. Advancing Chronic Care with Effective, Scalable Solutions, CMS Innovation Center.
The Nudj Intelligence Layer
The data nobody else has.
You have EHR, claims and revenue data. What’s missing is what happens between the doctor and the patient, the gap where care disappears and costs accumulate.
- Office visit In claims and EHR
- Care team visit Nudj
- App check‑in Nudj
- Academy class Nudj
- Labs and vitals Nudj
- Nudge and reply Nudj
- Office visit In claims and EHR
Call transcripts, engagement patterns by time of day, day of week and point in the care journey, referral patterns, barriers, and what drives engagement and drop‑off.
For ACOs, that becomes hyperlocal population intelligence, so you can design programs for your market instead of borrowing a protocol built for someone else’s population. We are building the infrastructure to surface it for our ACO and health system partners.
- A specific neighborhood
- A specific practice
- A specific patient demographic
- Which providers generate the best referral outcomes
- Which populations face the highest barriers
- Where attributed members go when the system can’t reach them
The whole person clinical operating system
Whole person care for your attributed patients, delivered alongside their PCPs.
An evidence‑based treatment program and an interdisciplinary care team, connected by one platform. Nudj provides the clinicians, the program and the technology, working inside each patient’s existing care plan.
treatment
care
Clinical Services
Connected Devices
Technology
Data + Analytics
Nudj Academy
Evidence‑based
treatment
Team‑based
care
Platform
Clinical Services
Connected Devices
Technology
Data + Analytics
Nudj Academy
Proof · Corewell Health
saved per engaged patient, per year, in direct costs.
12 months pre vs. post, patients enrolled 4+ months. Nudj Analytics, May 2025.Better outcomes mean fewer encounters, and fewer encounters move total cost of care.
Obesity
Behavioral health
Also 51% fewer CHF, 38% fewer diabetes and 38% fewer hypertension encounters.
Ready to move the performance metrics that matter?
We’ll help you identify the right attributed population, model clinical and financial outcomes for your risk arrangement and design an implementation that runs alongside your network.