How ACOs use this

Your CFO uses this to walk into the board meeting with shared savings projected to a confidence interval — not a guess. Real-time benchmark vs. expenditure with what-if modeling for investment decisions.

Financial Performance & MLR Monitor

Total Revenue

$360M

↑ 3.2% YoY

Medical Loss Ratio

85.2%

Compliant

Admin Cost Ratio

12.8%

↓ 0.5%

Underwriting Margin

$7.2M

↑ 5.1%

PMPM Premium

$1,000

↑ 2.8%

PMPM Claims

$852

↑ 1.9%

MLR Gauge

Premium vs Claims - 12 Month Trend

Premium

Claims

Margin Waterfall Analysis

MLR by Line of Business

Cost Category Breakdown

Inpatient (35%)

Outpatient (22%)

Pharmacy (18%)

Professional (15%)

Behavioral (5%)

Other (5%)

3-Year Financial Trend Analysis

Metric	2024	2025	2026 YTD	Trend
Revenue	$348.2M	$354.7M	$360M	↑ Steady Growth
Claims	$295.4M	$302.1M	$307.2M	↑ Controlled Growth
MLR	84.8%	85.2%	85.2%	→ Stable
Admin Ratio	13.8%	13.2%	12.8%	↑ Improving
Net Margin	$16.8M	$18.2M	$19.5M	↑ Strong Performance
PMPM Premium	$948	$973	$1,000	↑ Positive Growth
PMPM Claims	$804	$829	$852	↑ Within Targets

Rebate Exposure Analysis

Current Status

Compliant

All thresholds met

Buffer Above Threshold

2.8%

Healthy margin

3-Year Rolling MLR

85.1%

Below 90% threshold

Rebate Exposure

No exposure