Overarching risks

The current ERM top tier risks vary from high level long term strategic initiatives to short term tactical issues needing addressed.

While their is agreement they are all critical risks, it revealed the need to refine our risk organization and presentation model.

Define a set of overarching risks that allow us to categorize our risk pool

Align these overarching risks with a clarified risk universe

Utilize this model to improve enterprise level visibility and reporting

Strategic initiatives

These risks are tied to strategic initiatives within the organization.

Failure to effectively deliver on strategic initiatives will cause financial, operational and reputational harm.

Currently identified risks

Operational performance

These risks are tied to operational performance of the services we provide.

Without improving operational performance of the services we provide we will see negative financial, membership and reputational impacts.

Currently identified risks

Provider Experience

System stabilization - HealthRules operations

Reimbursement accuracy

Sapphire Edge/Medicare Advantage

Loss of key group(s)

Operational defense

These risks are tied to defensive operational practices that we perform to protect business operation.

Without appropriate focus on operational defensive practices we will see business impacting events that cause financial, membership or reputational harm.

Currently identified risks

External mandates or legal

These risks are related to external forces that we may have little to no influence over, but must react to.

Failure to implement changes in our business that are driven by external requirements will result in regulatory, legal or licensing penalties.

Currently identified risks

Regulatory changes - TCR/CAA Implemenation

BlueCard Modernization

Regulatory Direction - Preauth Limitations

Regulatory Direction - Impacts of Subsidies

Provider antitrust lawsuit

Human capital

These risks are association with our employees, their performance, compensation, recruitment, retention, etc.

Failure to appropriately manage all aspects of our employees and resources we will see impacts in retention, development and acquisition of our workforce.

Currently identified risks

Workforce and Business Operations - Post Pandemic

High/Low performer turnover rates

Leadership succession planning

Wage inflation, recruitment, retention

Financial

These risks pose possible financial impacts to our business, but are not specifically tied to core business operations.

Failure to monitor and manage financial investments and obligations could result in negative performance of the company.

Currently identified risks