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Ive done hundreds, Ive used Silhouette and PDO and I find the results are weak at best

Lancet Diabetes Endocrinol (2019) 7:51527

A commenter expressed concern that including spending on necessary services in EBCMs could inadvertently reward clinicians for reducing spending on essential care, potentially leading to worse patient outcomes that may not be reflected in quality measures, noting that average spending on patients could increase due to factors outside a clinician's control, such as rising drug prices or services ordered by other physicians, which could unfairly penalize clinicians

Every protocol starts with a clinical intake, not a sales pitch.