Use Case 1
New Contract Evaluation
Trigger: Payer contract opportunity received
1.Parse contract term sheet
2.Build base-case financial projection
3.Run scenarios: optimistic, conservative, stress
4.Sensitivity analysis on top assumptions
5.Risk-adjusted expected value calculation
6.Assemble executive decision package
7.Route for executive approval
✓
Contract decisions made with modeled math, stress-tested assumptions, and clear risk sizing.
Use Case 2
Annual Contract Portfolio Review
Trigger: Annual strategy cycle
1.Pull performance across all active contracts
2.Compare actual vs. projected by contract
3.Model renewal, renegotiation, or exit scenarios
4.Recommend portfolio rebalancing
5.Present to executive committee
✓
Leadership manages contracts as a portfolio with continuous learning.
Integrations
Contract & Term Sheet Repository
Claims Data Warehouse
Actuarial Modeling Tools
CMS Benchmark Files
Executive Presentation Generation
Industries
healthcare
See It In Action
A sample conversation with this agent
Payer X offered us a new full-risk MA contract. Model it.
Pulling their term sheet. Running projections across five scenarios: base case, optimistic, conservative, aggressive-growth, and stress. Inputs: proposed attribution volume, benchmark methodology, risk corridors, quality bonuses, stop-loss terms. I'll produce a 15-page executive decision package including 3-year financial projection, sensitivity analysis on top 5 assumptions, risk assessment, and go/no-go recommendation. Full package held pending your review before any leadership distribution.
What happens if our attributed population is 20% smaller than projected?
Running stress test. At -20% attribution: fixed infrastructure costs don't scale down proportionally, so margin compresses from projected 4.8% to 1.2%. Quality-bonus thresholds still achievable but smaller absolute dollars. Risk corridor becomes the binding constraint—one bad cost quarter could flip us into a loss position. Recommendation: negotiate a minimum attribution floor or gradated infrastructure-cost provision into the contract.
Compare this contract to our current MSSP performance.
Side-by-side: Current MSSP at 60% shared savings = $1.44M projected this year on 4,218 attributed lives. Proposed MA full-risk at the terms offered = $3.1M–$4.8M range on same-size population, but with real downside risk up to -$2.2M in stress case. Higher upside, meaningful downside. Risk-adjusted expected value favors the new contract by ~$800K, but capital-at-risk is 3x higher. This is a board-level decision.