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.
Health Plan — Executive Summary
One-page CEO · CFO · Board briefing · Plan Year 2026
Executive Opportunity Score
0–100 compositeSavings Opportunity by Lever
$ millions, annualizedExecutive Narrative
The health plan book — 100,000 covered lives at a PMPM of $395 — is operating at an MLR of 84.2%, materially above the <78% target for sustained margin. Cost is highly concentrated: the top 1% of members drive $137M (29%) of total medical spend, the classic profile where RAFIQ's care-management economics compound fastest.
RAFIQ has identified $127M of addressable annual opportunity across utilization, pharmacy, risk adjustment, and quality performance — equivalent to 26.7% of total medical spend. Execution at modeled performance would compress MLR to 64.6%, lift risk scores by ~0.15, and add four-tenths of a quality tier — directly improving 2027 network contracting and premium positioning.
Financial Impact
Expected ROI
Top Strategic Priorities
Sequenced for Plan Year 2026Triage 1,000 high-cost claimants into integrated care pathways. Target $18M cost-out in 12 months.
Close 5,200 suspected diagnosis gaps via preventive visits + chart review. Risk score +0.15, $28.4M revenue uplift.
CHF / COPD / Diabetes registry interventions. -15% admits, $34.2M direct savings.
Site-of-care shift + generic conversion. $18.2M annual savings on $71M Rx spend.
Close care gaps to lift quality tier by 0.4 — unlocks $16.8M performance bonus + network positioning.
Urgent care + telehealth steerage for 18.2K avoidable visits. $19.6M savings.
Approve full deployment of the RAFIQ Population Intelligence Platform across the health plan book. Year-1 net EBITDA of $112.6M on a $14M program investment — 8.0x ROI, payback under 5 months, with durable MLR compression and stronger 2027 network contracting.