1,840
Specialty members governed
58%
RIR (trajectory change)
42%
DAR (documented appropriate)
$1.2M
Governance Signal Value
Specialty pharmacy continuation governed across GLP-1, biologics, and oncology maintenance. 460 members flagged by CGS v1.1 triggers. 423 reviewed by external clinical professionals. 245 trajectory changes recommended (advisory-only). GPR from prior cycle: 52%.
$126K
Documented episode savings
BH episodes routed through quality-gated network. 5 SUD residential, 3 acute psychiatric, 2 IOP, 1 eating disorder, 1 crisis stabilization. PHQ-9/GAD-7/AUDIT-C measured at intake, discharge, and 90 days. Mean PHQ-9 improvement: 7.2 points. Zero readmissions within 30-day warranty window.
$104K
Prevented overpayment (Q1)
87 high-cost claims above $25K verified during TPA hold window. 82 verified accurate. 3 adjusted (CODEVAL, RATEVAL). 1 escalated (DURVAL — 21-day LOS billed, 16 days documented). 1 held pending provider documentation. BGS v1.0 methodology. External CPC-credentialed reviewers.
Portfolio Summary — Q1 2027
3
Governance layers active
$1.43M
Total documented governance value (annualized)
0
Readmission warranty claims triggered
This employer presents documented governance evidence across specialty pharmacy continuation, behavioral health episode quality, and high-cost claims billing accuracy. No other employer in this carrier's stop-loss book produces this combination. The governance value documented in this portfolio exceeds the total PEPM investment by a factor of approximately 2.4x in the first 12 months.