What you get

90-Day Governance Cycle
Structured continuation review across your specialty population. Every flagged member reviewed by a credentialed PharmD.
Governance Certificate
Third-party attestation that structured governance occurred. Verifiable, presentation-ready, and built for your board, your carrier, and your regulator.
Full Governance Artifact
Population-level outcome data. RIR, DAR, GSV, outcome distribution, configuration fingerprint, and immutable audit trail.

The artifact is a sealed, versioned governance record with a presentation-ready executive summary. It proves that continuation was governed at the population level. Nothing in your current vendor stack produces it. See a sample certificate →

What it costs

Governance is priced per member per month on the specialty members under governance. Not total membership. Not total claims.

Tier Specialty Members PMPM
Tier 1 Under 10,000 $6.00
Tier 2 10,000 – 50,000 $5.00
Tier 3 50,000 – 100,000 $4.50
Tier 4 100,000 – 250,000 $3.50
Tier 5 250,000 – 500,000 $2.75
Tier 6 500,000 – 1,000,000 $2.00
Tier 7 1,000,000+ Contact for Strategic Partnership

PMPM applies to specialty members under governance, not total plan membership. At the reference case (5,000 specialty members, $6 PMPM), the governance investment is approximately 1% of the therapy cost it governs. The cost-to-signal ratio improves at scale.

Timeline

Week 1
Data extract + configuration
Weeks 2–11
Governance cycle
(you do nothing)
Week 12
Certificate delivery

From signed engagement to artifact in hand: 90 days. The first week is data onboarding. The next ten weeks are the governance cycle. Your team does nothing during the review period. Week 12 is certificate delivery and executive walkthrough.

What we need from you

What we need

  • De-identified specialty pharmacy claims (CSV)
  • Member count for specialty cohort
  • Therapy categories of interest
  • One point of contact for data questions

What we do not need

  • Protected health information (PHI)
  • Provider contracts
  • PBM integration or IT resources
  • EHR access or clinical staff

The data extract is 4 required fields and 6 optional fields. No EHR integration. No provider network disruption. No IT project. A benefits analyst can produce the extract in a single afternoon.

Documents

Ready to see what governance finds.

One conversation. We will tell you whether your population is a fit, what the economics look like, and what the first cycle would produce.

Challenge us →
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joe.nalley@showyourwork.health | (502) 489-1771