Executive Dashboard
Population health intelligence · Plan year 2026 · 3,600 covered lives · Q1 actuals
Covered Lives
↗3,600
+128 YoYactive eligibility
View members →
Total Medical Spend
↗$42.6M
+5.4% YoYPY26 annualized
View claims drivers →
PMPM
↗$987
+3.1% MoMbenchmark $1,042
View PMPM detail →
Total Opportunity
↗$910K
+8.2%identified YTD
View savings stack →
Expected Shared Savings
↗$546K
60% of opp.net of MLR floor
View MSSP model →
Expected RAF Revenue
↗$180K
+0.17 RAFv28 projected
View HCC capture →
Total Medical Spend, Identified Opportunity & Realized Savings
$ in millions · trailing 8 months1 · Top 25 High-Cost Claimants
Showing top 12 · >$100K annualized allowed
| # | Member | Dx | Annual | YTD |
|---|---|---|---|---|
| 01 | M. Alvarez MBR-48201 · 67y | ESRD · CHF | $482K | $211K |
| 02 | R. Chen MBR-30911 · 58y | Oncology Stage III | $391K | $188K |
| 03 | T. Johnson MBR-72104 · 62y | Post-transplant | $287K | $142K |
| 04 | P. Singh MBR-19883 · 49y | Multiple Sclerosis | $244K | $128K |
| 05 | L. Okafor MBR-55620 · 44y | Crohn's · biologics | $211K | $114K |
| 06 | K. Müller MBR-66712 · 38y | Hemophilia A | $198K | $102K |
| 07 | A. Rivera MBR-22091 · 71y | CHF · COPD | $176K | $94K |
| 08 | D. Ferreira MBR-83310 · 64y | COPD · CHF · OSA | $164K | $88K |
| 09 | S. Nakamura MBR-40118 · 52y | RA · Osteoporosis | $152K | $78K |
| 10 | J. O'Brien MBR-77645 · 55y | DM2 · Neuropathy | $141K | $74K |
| 11 | H. Karim MBR-58102 · 60y | Cardiomyopathy | $134K | $68K |
| 12 | O. Park MBR-91230 · 47y | Lupus · CKD 3 | $128K | $62K |
4 · Pharmacy Cost Drivers
Top therapeutic spend · $310K addressable
| Drug | Members | Annual | Opportunity | Value |
|---|---|---|---|---|
Humira Biologic / Anti-TNF | 14 | $412K | Biosimilar switch | $96K |
Ozempic GLP-1 | 86 | $384K | PA + adherence | $64K |
Eliquis Anticoagulant | 122 | $318K | Generic warfarin candidates | $41K |
Trulicity GLP-1 | 52 | $244K | Therapeutic switch | $38K |
Stelara Biologic / IL-12/23 | 9 | $228K | Site of care | $31K |
Enbrel Biologic / Anti-TNF | 11 | $196K | Biosimilar switch | $44K |
2 · Frequent ER Users
5+ ED visits in last 90 days · $420K avoidable
| Member | Visits | Last | Primary Dx | Cost |
|---|---|---|---|---|
| A. Rivera MBR-22091 | 8 | 3d ago | CHF exacerbation | $43K |
| D. Ferreira MBR-83310 | 7 | 6d ago | COPD exacerbation | $38K |
| M. Alvarez MBR-48201 | 6 | 11d ago | Fluid overload (ESRD) | $35K |
| C. Patel MBR-19200 | 6 | 2d ago | Sickle cell crisis | $31K |
| B. Adeyemi MBR-70881 | 5 | 9d ago | Asthma exacerbation | $22K |
| E. Vasquez MBR-66012 | 5 | 14d ago | DKA | $29K |
3 · Members At Risk For Admission
AI-predicted 30-day inpatient probability
- Maria AlvarezESRD, recent ED, missed dialysis92%
- Daniel FerreiraCOPD, O2 sat <90%, polypharmacy88%
- Alicia RiveraCHF NYHA III, weight +6lb / 7d85%
- Tyrone JohnsonCKD 4, K+ trending up79%
- Robert ChenNeutropenia post-chemo74%
- Patricia SinghMS relapse, biologic gap 22d71%
- Hassan KarimCardiomyopathy, BP volatility68%
- Olivia ParkLupus flare, CKD progression64%
5 · HCC Recapture Opportunities
CMS-HCC v28 · 255 open · $147K revenue
6 · Care Gap Opportunities
HEDIS / Stars · 1,229 open gaps
- 66% closedHbA1c control (NQF 0059)142 open of 412 eligible · due in 30d
- 68% closedAnnual Wellness Visit (Medicare)318 open of 980 eligible · due in 60d
- 63% closedColorectal cancer screening224 open of 612 eligible · due in 90d
- 65% closedBreast cancer screening188 open of 540 eligible · due in 60d
- 64% closedStatin therapy — diabetes96 open of 268 eligible · due in 30d
- 64% closedControlling High BP (NQF 0018)261 open of 720 eligible · due in 45d
Source: Eligibility + Medical + Rx claims · ingested 2h ago
Model: RAFIQ-Risk v2.4 · AUC 0.87 · last calibrated Feb 12, 2026
Attestation: Suitable for Cigna · ACO · IPA · MA board review