Risk Strategies Consulting – What Makes Us Who We Are?

Risk Strategies Consulting was formed in January 2023, as a separate and distinct entity within the Risk Strategies structure. The goal was to create a differentiating, independent consulting entity designed to serve the specific needs of large and sophisticated plan sponsors, payors, providers, regulators, and other governmental entities. Over the last 14 months, the company has successfully integrated our human capital and robust data management paradigm inclusive of data sets, analytical tools, as well as a scalable, operational model. Throughout this integration process, our key focus remains steady on our guiding principles of a client-first collaborative culture, which emphasizes the importance of partnership, dedication, and support to our clients, colleagues, and other stakeholders.

In building out our business model, we recognized the importance of delivering differentiated customer engagement, work product, and actionable innovative solutions to distinguish ourselves in this highly competitive market. We acknowledge that choosing one of the established players is “safe” for many decision-makers, as opposed to bringing in a company like ours that may not have the established “brand recognition.” To demonstrate why sophisticated and prestigious organizations should entertain utilizing our services, we have focused on a multidisciplinary and value-differentiated approach that leverages the following areas:

Real world experience with expertise diversity and cross-discipline depth of our human capital

Our team is comprised of an experienced and multidisciplinary group of clinicians, health economists, actuaries, accountants, coding specialists, financial analysts, researchers, data scientists, auditors, and developers. Our teams have firsthand experience solving the problems our clients face and understand the nuances of those challenges. Our experts work collaboratively in an environment that requires and reinforces a 360-degree view of client needs, strong planning and documentation as well as following the data in a disciplined fashion to the find the “so what” answers that are required to best serve clients. Our team members are measured and compensated based on the quality and depth of their work as well as the satisfaction and retention of the client. No one is compensated for “bringing in” new or additional revenue. We have no salespeople, and every employee of the company touches client work.

Our structure is non-siloed

Our integrated team structure drives a client-first approach that offers distinct value with a multidisciplinary lens. Assembly of the client’s team starts with ensuring that all team members chosen have the experience and expertise on the specific needs and domain challenges. Our diverse and experienced team provides our clients with a distinct advantage in the expert lens that addresses their challenges and provides realizable innovative solutions. Each client or project is assigned a lead consultant and project manager, who enables the team, as constructed, to provide the needed, multidisciplinary approach to the work, ensuring we provide the best solutions to our clients. For example, an “actuarial project” typically mandates the inclusion of data scientists, health economics outcomes reporting specialists, and clinicians in order to provide a full and contextual answer to the questions at hand.

When a client or project enters the door, we utilize our distinct approach to create the needed multiyear business plans, with sophisticated project plans. These become “living” documents available to clients who wish access, along with a corresponding project management tool.

No matter the client or project, we undertake a cadence of intense planning and documentation through a series of stages

Stage One: Definition

Our first stage is to determine, with the client, the definitions of success and goals and objectives to be accomplished. This includes the establishment of baselines and benchmarks as well as the means and methods of measurement for success and its definition.

Stage Two: Discovery

Discovery encompasses a comprehensive assessment of the challenges and/or client needs, whereby based on our collective experience, we evaluate for intended and unintended consequences and identify downstream needs such as data and human capital. We think through the broad and multidisciplinary range of issues and considerations that exist around administration, compliance, finance, and strategy. During this time, our team is asking many deep diligence questions, such as:

• What do we need to learn, and how are we going to learn it?
• What data and other assets do we need to take in?
• What are we trying to answer?
• What is it we have to do?
• What have we not thought of?

During Discovery is when we are also building business plans and project plans and outlining all the workflows, data flows, and process flows – both internally and externally. This process allows us to build out the needed team members and determine if we are meeting the client-driven definition of success.

Stage Three: Specifications and Requirements

In this stage, we reconfirm with the client the definition of success and set the needed qualitative and quantitative specifications and requirements to accomplish the success definition. We leverage benchmarks and baselines for the project specific business plan that is shared with the client.

Stage Four: Reporting and Analytics

In this stage, we determine what resources are best utilized to allow us to define, quantify, qualify, track, and monitor the aligned metrics and measurements of success. These metrics and processes allow us to internally track against the business plan established in the previous stage. We meet regularly with the client to track progress, evaluate new and emerging issues, and discuss additional considerations.

Stage Five: Audit

Our final stage is the creation of a two-tiered audit process. We utilize needed tools and protocols to enable ourselves or other third-parties to audit our calculations, methodologies, and results. The audit stage also demonstrates the accuracy of the completed work product, while also ensuring that the processes utilized are repeatable and scalable, so that the client can realize continuous quality improvement downstream. For Risk Strategies Consulting , this audit process is our means for looking for continuous improvement and growth.

Our economic model is highly distinctive

Unless otherwise required by the client, we undertake engagements on a flat fee basis, enabling us to optimize the quality of work. This revenue/billing model eliminates the typical dynamic, whereby a client wonders if any outreach becomes a billable event. Instead, we can create a dynamic through high-touch and strong, ongoing planning.

The realization of higher touch, being designed to enhance client relations, is reinforced by our statements of works which standardly contain the language “including but not limited to” around the agreed to work product. Our reasoning here is to reinforce that our approach is not a means of “upselling” our services or finding a means to request a change in agreed to fees.

Unlike other competitors, we do not receive any direct or indirect third-party monies tied to any project, client, or our book of business

This ensures not only our objectivity, but even the perception or misperception of any potential conflicts of interest. Additionally, we do not sell any services other than consulting, and we have no preferred arrangements with anyone in any market segment. For instance, while we are employed by a highly prestigious employer-owned pharmacy coalition, we do not own a pharmacy coalition. This fact distinguishes us from nearly all of our competitors and ensures our objectivity while also enabling us to avoid perceived or actual conflicts of interest.

Similarly, we research, examine, and evaluate emerging and distinctive players/potential vendors in a number of market segments, which relate to the needs of our clients. Although we are well-versed and have a deep understanding of these offerings, Risk Strategies Consulting does not own or have an interest in any solution. This differentiates us from the market standard within the consulting industry, whereby often, some form of renumeration occurs between the consultant and the vendor when the vendor is selected to serve a client.

The customer “isn’t always” right

As part of being customer-focused, we do not always say “yes” if we believe the client hearing about alternatives, other industry conditions, or views could benefit their decision-making process. Our aforementioned commitment to objectivity, deep diligence, and high-touch approach enables us to foresee and forewarn our clients of both intended and unintended consequences.

Indeed, we believe providing the client with a full view of the likelihood of knowable gains and pitfalls around any recommendation or decision is our foundational responsibility. We work hard to achieve alignment and accountability amongst our clients, their vendor partners, and ourselves. This means “bad news does not age well” and that we have a responsibility to avoid situations where our clients may become a “planning hero and execution goat.” It is essential to underpromise and overdeliver.

We recognize we do not know everything

Rarely does a single “right answer” exist. We are known in the market for our openness, diligence, collaboration, and deep curiosity. Not infrequently, we are told by bidders and vendors that “no one else has asked that question.” Our typical response is “does that make this a bad question?” We recognize and embrace the dynamic nature of the market, and this results in continuous evolution and investment around our human capital, technology, processes and cadence. In fact, our foundational curiosity is further reflected in each of our RFPs, whereby we ask the following questions to better understand context.

• What have we neglected to ask that should have been included?
• What are your distinct value propositions that would benefit this client?

We collaborate and encourage direct dialogue

We have a reputation for being direct and complete in our communication with vendors and operating with no hidden agenda. Vendors appreciate our objectivity and sole focus on the needs and expectations of our clients. We reinforce this dynamic by ensuring that vendors and bidders are not surprised by our findings prior to meeting with the client. Also, unlike most consultants, we encourage direct communication between the vendor and the client, rather than functioning as the “gatekeeper” to the client.

The consultant community is the primary distribution channel for vendors to realize new business and/or maintain existing business. Therefore, we realize vendors viewing the consultant as the customer is common. We do not accept that role or responsibility. In fact, we are recognized for holding the vendor responsible for their direct accountability to the client.

We have built distinctive intellectual property

Risk Strategies Consulting has built out a number of market-leading solutions that enable us to better serve our clients. In a number of cases, these models and solutions have been built with direct involvement of clients, along with the involvement of the client’s vendor partners. These solutions include but are not limited to the following:

• A comprehensive, network valuation model that accurately examines financial competitiveness at an above market level and the development of distinct high performance provider criteria as well as applicability and outcomes of clinical/care management programs and solutions. This set of tools exceeds the market standard, where consultants utilize data received through the Uniform Data Specifications submission to estimate discounts by metropolitan service area.
• A return on investment (ROI) framework and model that measures and analyzes financial gains or losses, clinical implications and outcomes, member and provider experience, and elements of health equity of any given product or solution being developed or offered in the marketplace.
• A comprehensive audit platform, which provides our team with context and content, to understand not only if someone is succeeding, but how and why. This platform goes far beyond present practices and existing audit functions, which are designed around addressing a vendor’s contractual performance guarantees, claim payment accuracy, and processes around clinical management.

While our audit function goes deeply into the aforementioned traditional audit practices, we go far beyond in accurately accounting for and auditing all direct and indirect revenue streams realized by vendors and how they are charged to our clients. More importantly, our audit platform is the mirror to our ROI model, telling us on a retrospective basis if and how the audited vendor or situation has succeeded or failed. This also ensures that the ROI, as stated, is accurate and complete in its methodologies and calculations. The audit function becomes a needed control mechanism to ensure the quality and depth of recommendations being derived from the ROI model.

The above philosophies and approaches have allowed us to structure ourselves into the following practices.

• Health and Welfare
• Actuarial
• Reporting and Analytics
• Innovation and Solutions
• Clinical Strategies and Operations
• Audit
• Retirement
• Pharmacy

Each practice and team member is accountable to one another within the organization, and none of our practices have separate profit responsibility. Although this may not be typical, we do not measure the financial gain and loss of any one practice area, given that clients require the services of multiple areas. We believe this not only reinforces our integration and collaboration within the organization, but also serves as our guiding reminder that we are all accountable to the client.

Risk Strategies Consulting is known by our clients as well by the payors and various vendor partners in the market for our objectivity, diligence, collaboration, and commitment to creating value propositions that ensure short- and long-term gains for all stakeholders. Email us at riskstrategiesconsulting@risk-strategies.com