Health Plan Cost Assessment & Opportunity Analysis
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Expected Results of Your Healthcare Risk Assessment
At the end of the assessment, you will have:
- Clear visibility into where your healthcare dollars go
- Understanding of what drives your costs and why
- Identification of waste, gaps, and hidden risks
- Specific recommendations ranked by impact and feasibility
- Data to support negotiations with carriers and brokers
- A decision framework for your next renewal
A Healthcare Risk Assessment costs you nothing but a few hours of your team's time. In return, you gain clarity on where your healthcare dollars go and how to take control of one of your largest expenses.
Why Choose Weltrio for Your Healthcare Risk Assessment?
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It is a comprehensive audit of your benefits program. We examine where your healthcare dollars go, which benefits your employees actually use, how your costs compare to national benchmarks, and where waste exists that you may not even know about.
Claims Pattern Analysis
We examine your historical claims data to identify cost drivers that may be hidden in the aggregate numbers. This includes high-cost claimants, recurring conditions, pharmacy trends, and utilization patterns that signal potential risk.
What we look for:
- Concentration of costs among a small percentage of employees
- Chronic conditions that are under-treated or mismanaged
- Prescription drug spending and generic substitution rates
- Emergency room utilization vs. primary care engagement
- Trends that indicate future cost escalation
Plan Design Evaluation
Your plan structure directly affects both your costs and your employees' behavior. We assess whether your current design encourages appropriate care-seeking or inadvertently drives employees toward expensive options.
What we examine:
- Deductible and out-of-pocket maximum alignment
- Copay structures and their impact on utilization
- Network adequacy and provider access
- Coverage gaps that create employee financial risk
- Benefits that are included but rarely used
Benchmark Comparison
How do your costs compare to similar companies in your industry and region? We measure your per-employee-per-month spending, utilization rates, and plan design against national and industry-specific benchmarks.
What we compare:
- Premium costs relative to company size and industry
- Claims experience vs. expected actuarial performance
- Administrative fees and broker compensation structures
- Pharmacy spending relative to medical spending
- Employee contribution ratios
Risk Projection Modeling
Based on current trends and employee health data, we project where your costs are headed over the next 12 to 36 months. This helps you anticipate renewal increases and identify intervention opportunities before problems become expensive.
What we project:
- Expected premium trajectory without intervention
- High-risk employees who may drive future claims
- Chronic disease progression and associated costs
- Impact of potential plan design changes
- Return on investment for targeted interventions
What is a Healthcare Risk Assessment?
A Healthcare Risk Assessment is Weltrio's initial diagnostic service that evaluates your current health plan structure, identifies hidden cost drivers, and uncovers opportunities to reduce financial exposure—all without disrupting your existing coverage or employee experience.
This analysis provides a clear, honest, clinical evaluation conducted by healthcare professionals who understand both the medical and financial sides of employee benefits.
Why Do Healthcare Risk Assessments Matter?
Most employers renew their health plans year after year without questioning the underlying assumptions. Brokers present options, carriers set rates, and leadership approves budgets based on incomplete information.
The result? Companies overpay for benefits employees don't use while missing coverage gaps that create real risk. They accept premium increases as inevitable rather than addressable. They lack visibility into where their money actually goes.
A Healthcare Risk Assessment changes that. It gives you the data and insight to make informed decisions, negotiate from a position of strength, and take control of one of your largest operating expenses.
How It Works
Analysis is just the beginning — we're here for 24/7 plan maintenance, questions, and future enhancements. You and your employee's health is our long-term commitment.
Information Gathering
(Days 1-5)
We start by collecting the documents and data needed for analysis.
This typically includes:
- Current plan documents and Summary Plan Descriptions
- 12-24 months of claims data (de-identified for privacy)
- Census data showing employee demographics
- Current broker and carrier agreements
- Renewal history from the past 2-3 years
- Your HR team provides these materials through a secure portal. Most employers already have this information available from their broker or carrier. We handle the coordination if needed.
Clinical & Financial Analysis
(Days 6-14)
Our team conducts a thorough review of your data. Registered nurses examine claims patterns for clinical insights. Weltrio's benefits specialists evaluate plan design and benchmark performance. Financial analysts assess cost trends and project future exposure.
This assessment isn't an automated report generated by software. Real healthcare professionals review your healthcare plan and apply clinical judgment to the findings.
Findings Presentation
(Days 15-17)
Weltrio will schedule a virtual meeting with your leadership team to present our findings.
This presentation includes:
- Executive summary of key findings
- Detailed analysis of each assessment area
- Specific opportunities identified for cost reduction or risk mitigation
- Comparison to relevant benchmarks
- Projected financial impact of recommended changes
- We encourage questions and discussion. The goal is for your team to fully understand the findings, not just receive a document.
Assessment Report Delivery
(Days 18-31)
Following the presentation, you receive a comprehensive written report documenting all findings, data, and recommendations. This report becomes your roadmap for benefits decision-making and can be shared with brokers, carriers, or board members as needed.
The report includes:
- Current state analysis with supporting data
- Identified risks and cost drivers
- Prioritized recommendations with expected impact
- Implementation considerations and timeline
- Benchmarking data and methodology
When Should I Request a Healthcare Risk Assessment?
The best time for an assessment is 90 to 120 days before your plan renewal. This gives you time to implement recommendations before your next contract period.
That said, an assessment provides value at any point in your plan year.
Companies facing unexpected premium increases, experiencing high claims activity, or simply wanting to understand their benefits spending can benefit from this diagnostic. Weltrio completes an initial Healthcare Risk Assessment prior to signing up, but does run assessments periodically throughout the year to ensure the team is performing and addressing all concerns.
Where Do Healthcare Risk Assessments Happen?
The assessment process is conducted remotely. Our team analyzes your plan documents, claims data, and utilization reports without requiring on-site visits or disrupting your daily operations. We schedule virtual meetings at times convenient for your team to discuss findings and answer questions.
Who Conducts the Healthcare Risk Assessments?
Your assessment is led by Weltrio's clinical and benefits team—registered nurses, certified wellness coaches, and benefits specialists with direct experience in employer health plan management. This report isn't outsourced to a third-party analytics firm. The same people who analyze your data are the same people who will explain it to you and help you act on it.
See What Our Customers Are Saying
"What could have been data driven, was soon a conversation. Over 3 years with the best coaches, listeners, advisors you could ask for. If Monique didn't have an answer readily, she would note it, research it, and then update you on the answer. Always a positive meeting. Highly recommend!"
— Sue D.
“Our Medical Insurance Premiums were Out of Control! Thanks to Weltrio and their amazing team of healthcare experts, Weltrio is my single most-profitable cost center!”
— Cayuse CEO
Everything You Need to Know
At Weltrio, we are a medically trained team that works with HR and benefits partners at companies of all sizes to improve healthcare quality, reduce risk exposure, and optimize costs. We work within your existing plan structure—providing employers with clarity, trust, and transparency at every step. Whether you're upgrading your benefits plan or building from scratch, we've got you covered.
How is Weltrio's healthcare risk assessment different from what our broker already provides?
Brokers typically provide plan comparisons and renewal options. They're compensated based on the plans you purchase, which can create misaligned incentives. Our assessment is independent—we don't sell insurance or earn commissions. We're paid to find problems and recommend fixes, not to place coverage. Many employers use our assessment findings to have more informed conversations with their existing broker.
What if our claims data shows sensitive employee health information?
All data we receive is de-identified and handled in compliance with HIPAA regulations. We analyze patterns and trends at the population level, not individual employee records. Our team includes healthcare professionals bound by clinical confidentiality standards. Your employees' personal health information remains protected throughout the process.
How much time will this require from our HR team?
Most HR teams spend 2-4 hours total on the assessment process. This includes gathering existing documents (which your broker or carrier can often provide directly), a 60-minute findings presentation, and any follow-up questions. We designed the process to minimize disruption to your team's daily responsibilities.
What size company benefits most from a healthcare risk assessment?
Companies with 50 to 5,000+ employees typically see the greatest value. Smaller employers often lack the claims volume to identify meaningful patterns. Larger employers have more complexity and greater opportunity to find hidden costs. That said, any employer experiencing significant premium increases or wanting better visibility into their benefits spending can benefit from the diagnostic.
Does completing an assessment obligate us to use Weltrio's services?
No. The assessment is a standalone service. Many employers use the findings to make improvements with their existing partners. Others choose to engage Weltrio for ongoing support. The assessment provides value regardless of what you decide to do next. We believe that if we do good work, you'll want to continue the relationship—but that's your choice.
How soon before our renewal should we start the healthcare risk assessment?
Ideally, 90 to 120 days before your renewal date. This gives you time to implement recommendations, negotiate with carriers using the findings, or make plan design changes for the upcoming year. However, an assessment provides value at any point. Companies mid-cycle can use findings to prepare for their next renewal or address immediate concerns like high claims activity or employee confusion about benefits.
