Health Plans & RBOs

Risk Pool Performance Assessment & Auditing

Health plans and risk-bearing organizations (RBOs) face increasing pressure to effectively manage and administer complex, multifaceted risk pool agreements and respond to stakeholder requests for risk pool funding. We can help your organization perform independent risk pool settlement audits and assess risk pool administrative processes.  

A Thorough Approach

Our professionals will perform a comprehensive review of associated revenue and expenses associated with each risk pool and help determine if they’re administered correctly and result in accurate settlements.  

A risk pool audit typically includes:

  • Revenue testing
  • Expense validation
  • Operations assessment

Benefits and Revenue Recovery 

Our cost containment services have resulted in our clients realizing tens of millions of dollars in savings. We can help your organization:

  • Compare your risk pool administration metrics with known industry benchmarks
  • Hold contracted vendors accountable for performance
  • Identify opportunities to strengthen your business
  • Recover identified funding underpayments including quality metrics and incentive payments
  • Recover identified expense overpayments including claims and stop loss
  • Stay confident in the controls you or your contracted vendor have in place to validate risk pool funding and claim expense validation

National Practice Leader