Predictive Modeling for Immediate Savings

A large health plan hired TRICAST to perform a Risk Management Audit.. The goal was to evaluate every aspect of plan design and process to support in-house evaluation of the present program and analyze the results before going to market with an RFP.

An example of the saving realized from this component of an atypical audit was the immediate re-negotiation of allowable eligibility load times. TRICAST validated a savings of $500,000 for each 12-hour improvement in eligibility loading by the vendor. The previous allowance for eligibility load was 48 hours from receipt by the vendor. The new eligibility allowance was within 12 hours of receipt.

This new eligibility load standard quickly and appropriately termed groups and individuals, ultimately resulting in a savings of $1.5 million per year for each 300,000 covered lives.