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SEAT · LIVE · HEALTH PLANS

Cost of care analyst

The plan-side seat: is this use case worth a slot?

A health plan’s cost of care team has more candidate programs than portfolio slots. The agent sizes an exposure, classifies the saving, and says what next period would have looked like anyway, all on figures the analyst declares.

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01

The job

Somebody pitches a digital solution and a savings number. The analyst has to decide whether it clears the minimum impact threshold for a line of business and a funding type, whether the saving is hard or soft, and how much of the claimed effect is a selected cohort drifting back to average. Today that is a spreadsheet, a vendor deck and a week.

02

What the agent does

Sizes the exposure
Over a population the analyst declares, on figures they declare, under a stated basis. Ranges rather than points, and which assumption actually moves the answer.
Classifies the saving
Hard against soft, over a closed vocabulary of six mechanisms, against the buyer’s own definitions. The two are never added.
Separates deferred from avoided
Cost that arrives later and cost that never arrives: two totals, never summed.
Prices regression to the mean
What a cohort selected for being extreme will measure next period, before anybody intervened.
Checks the sentence
Before a claim goes in the memo, arithmetic over the served figures decides whether it is entailed.
03

What it does not do

  • Produce a paid amount. The seat opens with that wall. Published rates are not adjudicated claims, and no arithmetic on them makes one.
  • Serve a denial rate or a payment probability. Not from this evidence, by any method.
  • Average across payers without your weights. The payer mix to weight by is yours to declare.
04

How to put it to work

  1. TODAY · PUBLIC EVIDENCE

    Mount the free healthcare world in Claude Code, Codex or any MCP client and ask it how to take this seat. It answers from preserved public record, with a receipt on every figure.

  2. WITH US · YOUR EVIDENCE

    The same seat on your own claims, contracts and definitions, with the same tests, dated record and refusal boundaries. Hosted by us or inside your VPC, built alongside your team until your people run it.

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