Case Study: Provider Organization (5,000 global‑risk members) achieves higher Tier 1 facility utilization and reduced medical & administrative expenses with Conifer Health Solutions' Financial Risk Management

Increase timely referral determinations, improve claims payment accuracy and expand operational oversight with Conifer’s Financial Risk Management solutions

Financial Risk Management Solutions Providing Company, a provider organization managing 5,000 global‑risk members, needed clearer data transparency and stronger operational governance to succeed in value‑based payment models — improving timely referral determinations, claims accuracy and coordination between health plans, hospitals and physicians. They engaged Conifer Health Solutions, using Conifer’s Management Services Organization and Financial Risk Management solutions to streamline business functions and set a foundation for sustainable growth.

Conifer Health Solutions implemented a governance committee structure, a comprehensive concurrent review program with daily inpatient rounding, and dashboard‑style reporting supported by its Network Management, Administrative Operations and Clinical Operations offerings. The work improved referral and claims workflows and operational oversight, producing measurable impact: a 26.1 percentage‑point increase in Tier 1 facility utilization, a 4.9% decrease in medical expense ratio and a 14.7% reduction in administrative expense ratio.