Figures shown are simulated for demonstration purposes and do not reflect any real client population or live data.
RAFIQ is designed to support populations ranging from physician groups to regional and national health plans.
One-page executive briefing · 100,000 covered lives · commercial & government-insured book
Composite: clinical · financial · quality
The plan is operating at 84.2% MLR across 100,000 covered lives, with 1% of members driving ~$142M of spend. Disciplined execution against the six-lever opportunity stack moves MLR to 69.9%, generating $101M of net EBITDA contribution and preserving competitive premium positioning for the next renewal cycle.
Program investment of $12.4M unlocks $113.4M in combined cost avoidance and revenue uplift — $24.8M from Chronic Disease Risk Stratification recapture and $14.2M from Quality Performance Metrics. Net EBITDA contribution of $101M translates to a PMPM impact of $84.17.
3,120 avoidable admissions and 18,400 avoidable ER visits represent $43.8M of addressable utilization. Registry-based management of diabetes (14,200), CHF (3,400) and COPD (4,600) cohorts, paired with oncology and dialysis stewardship, drives the clinical case for the financial plan.
Embed care managers across the $142M top-cost cohort. Target $28.6M.
Close suspected chronic disease conditions across the registry. Target $24.8M.
Post-discharge transitions + ED diversion. Target $19.4M.
Site-of-care + biosimilar conversion. Target $16.8M.
Close care gaps across diabetes, CHF, COPD. Target $14.2M.
Steer to top-quartile providers. Target $9.6M.
Projections based on simulated commercial & government-insured book economics. RAFIQ Health is a population health intelligence platform; outcomes depend on operational execution and contracting structure.