The Gap
Your clients spend $7,000–$500,000+ per member per year on specialty continuation therapies. PA governs initiation. PBMs manage formulary. Nobody governs whether ongoing therapy is still clinically appropriate. No artifact exists. No stop-loss carrier has ever seen documented continuation oversight at renewal.
60%
RIR — trajectory change identified
40%
DAR — confirmed appropriate
50%
GPR — signals persisted
~19:1
Cost-to-signal ratio
What You Say at the Stop-Loss Table
"Our client conducted a structured continuation governance cycle on their specialty population — independently reviewed by credentialed external PharmDs under a published standard. Here is the Governance Certificate. It documents a 60% Reviewer Influence Rate, a 40% Documented Appropriateness Rate, and an immutable audit trail. No other plan sponsor you're underwriting can show you this."
A 1–2% stop-loss term improvement on a $3–4M premium = $30,000–$80,000/year. The governance cycle costs ~$180,000 at $6 PMPM for 10,000 members. One favorable renewal and governance pays for itself. Break-even RIR: ~3.1%. The methodology found 60%.
What Your Client Holds
Governance Artifact
Configuration fingerprint, measured RIR/DAR, outcome distribution, immutable audit trail. Sealed and versioned. Board-ready.
Governance Certificate
The credential your client hands the carrier at renewal. Documented continuation governance no other plan sponsor can produce.
How It Works
One de-identified claims CSV (4 fields). 90-day governance cycle. Qualified external PharmD/MD reviewers. Advisory-only — no denials, no clinical authority. $4.50–$6.00 PMPM based on cohort size. Governance Certificate included. No IT integration. No software. Your client's effort: approximately 4 hours in week one, then zero until artifact delivery.
Two independent cohorts. 25,000-member commercial payer + 9,500-member self-funded employer. Four therapy categories. The governance shape converged across both independent cohorts. RIR 58–60%. DAR 40–42%.
pilot@showyourwork.health
showyourwork.health
The gap nobody's named.
The artifact nobody else produces.