Overarching risks
Problem being solved (why?)
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.
Inspect & Adapt - revised 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
Risk Catagories
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