● Public CMS data · Zero PHI

We can already see your risk book.

Agilon's eight ACO REACH entities, reconstructed entirely from public CMS data inside the Talon lake — no data sharing, no PHI. Built on seven years of Medicare history (Part B & D, PY2018–PY2024) and a 9.5M-provider registry, refreshed on CMS's publication schedule.

$1.006B

Total cost of care across the 8 REACH ACOs (PY2023, latest published)

$115.2M

Gross savings (PY2023) — up 36% from PY2022

93,852

Aligned beneficiaries reconstructed at ACO grain

8 of 8

REACH ACOs identified, scored, and trended — zero cooperation required

The Book · PY2022 → PY2023

Texas turned around. Coastal collapsed. Your own CMS data shows both.

Every figure below is reconstructed from the CMS ACO REACH Financial & Quality PUF — the latest published performance year (PY2023; PY2024 publishes ~late 2026). Texas swung from break-even to a top performer; Coastal flipped negative.

ACO · Region	Savings rate PY22 → PY23	Aligned benes	Cost of care	% dual
Ohio D0116	10.7% → 14.4% ▲ best	9,579	$106.8M	9.6%
Mid-Atlantic D0156	11.5% → 12.1%	10,254	$111.8M	4.1%
NE Ohio D0056	7.6% → 12.1% ▲	11,007	$110.8M	5.1%
Texas D0033	0.7% → 11.9% ▲ turnaround	7,904	$91.2M	3.7%
Northeastern D0109	5.1% → 11.7% ▲	13,047	$147.5M	10.6%
Columbus OH D0114	9.4% → 9.7%	30,338	$309.1M	3.4%
Pennsylvania D0113	7.7% → 3.1% ▼	5,746	$64.9M	6.1%
Coastal D0107	7.6% → −0.8% ▼ collapse	5,977	$64.2M	2.3%

PY2022PY2023PY2023 negative

Source: aco_reach_finqual_puf (CMS ACO REACH Financial & Quality PUF), live in the Talon lake, verified 2026-07-01. 100% public — no Agilon cooperation, no PHI. REACH is the publicly-measurable slice; the core MA book (≈426,000 members) is larger and not reported at this grain.

The Blind Spot

You manage a billion dollars of risk on an 18-month delay.

REACH and MSSP results publish once a year, far in arrears. PY2023 is the latest available; PY2024 won't land until ~late 2026. Between data drops, the only signal on cost trend is the payer's own reconciliation feed — itself months behind.

−8.4 ptsCoastal savings-rate swing, PY22→PY23

7.6% → −0.8% on a $64.2M ACO. The performance year was over before the number was visible.

≈ $5.4MGross savings erased at Coastal — invisible until the PUF dropped

Caught in-quarter, that cost spike is an intervention. Caught in a PUF 15 months later, it is a write-off.

This is structural, not an execution failure. No outside party — and arguably not Agilon itself — could see Coastal turning until the year had closed. On a $1B book, one point of cost trend is roughly $10M.

The lake already reconstructs the retrospective picture from public data, today. The missing half is velocity — making spend visible while the quarter is still open. That's the build below.