ROI Calculator
Almost every self-insured employer I talk to says some version of the same thing. They know their health plan spend keeps climbing. They don't know exactly why, and nobody at the table has a complete answer for them.
That's not because any health plan stakeholder is dropping the ball. The broker's job is to negotiate the best coverage they can. The TPA's job is to process claims accurately and pay them on time. Neither of those roles was ever built to catch price variance across providers or flag a billing pattern that only shows up once you look at twelve months of data side by side. That gap isn't anyone's fault. It's just nobody's job, so it never gets looked at.
Over the past several years, self-insured employers started asking us to look at their claims data anyway. We're independent. We don't get paid by a TPA, a network, a PBM, or a stop-loss carrier, so we had no reason to see anything other than what was actually there.
What we found was consistent across nearly every plan we looked at. Real, recoverable dollars, sitting in the data the whole time, that nobody happened to be looking for.
That's what the VeriAct ROI Calculator is built to show. What it does is model what applying data-based governance, procurement discipline, waste and abuse mitigation, and a cash network strategy, could realistically save you, provided the underlying data is accurate and well governed. Get the data right, and the savings are real. The calculator gives you a first look at how much.
What the ROI Model does
The calculator takes basic inputs you already know: your employee count, covered lives, and current annual health plan spend. From there, it models three levels of financial governance, light, moderate, and advanced, and shows the projected savings at each level.
Rather than a single vague estimate, you see the numbers broken out so you understand where the savings actually comes from and how much more you could recover by applying stronger oversight.
Why savings depend on the data
None of these four levers work off an assumption. They work off your actual claims, normalized and checked month over month. That's the part that's easy to underestimate: the savings aren't in a spreadsheet formula, they're in the data itself, and the model is only as good as the data feeding it.
The numbers behind the calculator come from VeriAct, the data engine behind our ongoing claims governance work, and they follow the exact process we run for clients.
Ingest. Every month, we pull in your claims data feed directly from your plan administrator and pharmacy benefit manager. No new systems, no disruption to how claims get paid.
Enrich. Every claim gets normalized against provider, procedure, and place-of-service codes, so a service can be compared apples to apples across providers, patients, and time, not just against itself.
Analyze. The normalized data gets checked for pattern and price variance: the same service billed at wildly different rates, the same provider billing the same way on every visit, care that shows up more often than it should.
Document. Every finding is turned into audit-grade documentation. Recoverable dollars stay defensible, not theoretical, so you have something you can actually act on.
Engage. Findings get brought to the parties who can fix them, your TPA, your providers, your broker, with the evidence attached, and tracked until they're resolved.
The ROI Calculator distills that process into a single projection: given your plan's size and current spend, here is what applying this kind of data-based oversight would likely be worth.
Where the savings come from
Every plan we've reviewed shows recoverable spend sitting in four places, each one only visible once the data is in order. Here's what each one means, and roughly what it can yield at a moderate level of governance, based on a sample plan of 994 employees and 1,561 covered lives.
IMAGE TO COME
At moderate governance, those four levers add up to roughly 16% of medical spend recovered. At an advanced level, that climbs to around 20%. None of it requires switching carriers, changing networks, or disrupting the employee experience, and none of it requires your broker or TPA to do anything differently. It requires someone applying data discipline to the claims that are already being generated every month.
Try it yourself
It takes less than five minutes and doesn't require sharing any sensitive plan data. Run your own numbers. What you'll see is a realistic projection, not a promise, of what's possible once the data behind your plan gets the same scrutiny you'd apply to any other major expense.
(placeholder link, swap in the live calculator URL before)