Built for the Health Plan Ecosystem

Workflow Economicsfor Clinical Operations

What if the granularity of operational control, one case at a time, met the rigor of financial planning and cost control, from the model to the monthly variance?

The Shift Is Here

The clinical operations model already changed.

AI tools, delegated vendors, and automation landed across every workflow.

The infrastructure to see what's actually happening didn't.

10xMore Complexity
ZeroMore Control
5-day bootcamp

Your data. Your team at the keyboard. Real PA, CM or Quality cases.

Live scoreboard
on your real operational data, not slides
Your team drives
your ops leads, not our consultants
Decide by Friday
go live, extend, or walk away
Live, not quarterly

Run Clinical Operations on One Ledger
Priced, controlled, and proven, case by case

Today the cost lives in a quarterly allocation, the work lives in the queue, and the AI claim lives on a vendor slide. None of them can tell a clean case from a messy one.

Platform Overview

Model It. Control It. Prove It.

Three lenses on the same recorded work, so finance and operations read from one ledger.

Workflow Economics

Price the work. Set the target. Control the gap.

Give each kind of recorded fact one price: a case exists, it visits a step, an exception happens, automation does the work. Every case then prices itself from its own history. Set a cost-per-case target, give each step its share, and read the gap by step, by action and by case, every month.

  • Model

    A price list, not a time study. Reprice the same history under a vendor rate or an AI-first design.

  • Target

    One figure per case, a share per step, a date. The step owner gets a number for their step.

  • Control

    Month → cohort → case. Every count opens the cases behind it; every case opens its ledger.

Cost ModelsTargets & BenchmarksFinancial PerformanceCase Ledger
Illustrative cost model. Configuration values, not customer results.
Model

Cost model · Current Process Model

One-pass cost with Extra and Saving effects on a shared $0–$40 scale.

Base cost per case
$6.00
+ Standard visit costs · 4 States
+$21.00
= One-pass cost
$27.00
+ all Extra effects · 3 rules
+$9.00
− all Saving effects · 3 rules
−$7.00
Unreviewed · 2 rules
unpriced

One-pass cost with all Savings / all Extras: $20.00$36.00

Configuration only: one visit per state, each rule at most once. Not a forecast; replay results live in Financial Performance.

Illustrative goal and modeled cost compositions. Both bars use the same $0–$31.50 scale.
Target vs modeled

Goal vs modeled result

Two aligned compositions on one scale. Goal State Targets + Unallocated Target = $30.00; modeled State contributions + Base Cost per Case = $31.50.

Operational Goal · targets$30.00 per case

$30.00

Current Process Model · modeledreconciles to $31.50

$31.50

Scroll to view all steps.

Explore Workflow Economics

Operational Control

See where every case stands, and who has it, right now

Live heatmap of every case across every stage. Know which SLAs are about to breach, where rework loops concentrate, and which queues need intervention. Every resource ranked by throughput, handle time and cost, internal teams, vendors and AI side by side.

Control TowerSLA ExposureResource LeaderboardLoop Atlas
Control Tower dashboard showing friction matrix and SLA exposure
Operon.Cloud Control Tower. Example workflow data.

Operational Control Tower

Operon.Cloud Control Tower. Example workflow data.

Explore Operational Control

AI Adoption & ROI

Prove what AI changed, in the same ledger

88% of health plans use AI in at least one workflow. ~5% can prove it's delivering value. Operon prices AI-touched cases with the same cost model as the humans and vendors around them, so the business case is a line in the ledger, not a slide from the vendor.

ROI Impact ExplorerAI vs. Human ComparisonAdoption Map
ROI Impact Explorer showing AI adoption metrics and cost savings
Operon.Cloud ROI Impact Explorer. Example workflow data.

ROI Impact Explorer

Operon.Cloud ROI Impact Explorer. Example workflow data.

Explore AI Adoption & ROI
Budget to case

The CFO's number, priced from the operations record.

Budget vs actual by the month the work started, modeled cost against last year’s baseline and this year’s target, with every dollar traceable to a workflow step and an action. Every count opens the cases behind it; every case opens its ledger.

Total modeled cost
$60.5M
1.64M Cases · Jan – Aug 2026
Cost per Case
$36.90
$39.40 in Jan → $34.40 in Aug
Cases by first touch
1.64M
196k in Jan → 208k in Aug
Implied budget · Operational Goal
$52.5M
$32.00 × 1.64M · over by +$8.0M
Effort in window
$57.9M
work dated Jan – Aug · $2.6M of first-touch cost falls after Aug

Illustrative figures · Monthly detail: Mar–Aug 2026

Cases by first touch · full modeled cost

Each Case booked whole to its first-touch month, beside the budget the target implies.

$10M $7.5M $5M $2.5M $0M $7.8 $6.6 Mar 205k $7.5 $6.4 Apr 201k $7.7 $6.7 May 210k $7.7 $6.8 Jun 214k $7.8 $7.1 Jul 221k $7.2 $6.7 Aug 208k Cases
Illustrative modeled cost and implied budget by first-touch month, March–August 2026
MonthModeled costImplied budgetCases
Mar$7.8 million$6.6 million205 thousand
Apr$7.5 million$6.4 million201 thousand
May$7.7 million$6.7 million210 thousand
Jun$7.7 million$6.8 million214 thousand
Jul$7.8 million$7.1 million221 thousand
Aug$7.2 million$6.7 million208 thousand

Cost per Case by first-touch month

Modeled cost against last year’s baseline and the targets you set.

$44 $39 $34 $29 $24 HISTORICAL FY2025 · $41.20 OPERATIONAL GOAL $32.00 · DEC 31, 2026 FY2027 GOAL $27.50 $38.10 Mar 205k $37.20 Apr 201k $36.60 May 210k $35.90 Jun 214k $35.10 Jul 221k $34.40 Aug 208k Cases
Illustrative modeled cost per case by first-touch month, March–August 2026
MonthModeled cost per caseCases
Mar$38.10205 thousand
Apr$37.20201 thousand
May$36.60210 thousand
Jun$35.90214 thousand
Jul$35.10221 thousand
Aug$34.40208 thousand

How These Blind Spots Play Out
Across Your Organization

Cost precision, process control, AI proof. The same three gaps show up in every leadership meeting, but hit each role differently.

Workflow Economics, Operational Control and AI Adoption blind spots by leadership role
Who's askingWorkflow EconomicsOperational ControlAI Adoption & ROI
Finance & MeasurementCFO, VP Finance, VP Performance Measurement

Cost per case is an average, not an account

Total spend divided by volume, refreshed quarterly. No cost per touch, per rework loop, or per step. The $2 improvement cannot be attributed, so it cannot be defended.

Rework loops are invisible cost drivers

Cases loop 2-3x through the same stages. Nobody quantifies the cost of each loop or the margin it consumes.

AI spend has no measurable return

Millions allocated to AI vendors. Budget reviews ask for ROI numbers. All finance has is vendor-reported "efficiency gains."

Clinical LeadershipCMO, VP Clinical Ops, VP Quality

The step owner has no number for their step

Targets are set per program, per year. Clinical Review has no share of the target and no way to see its contribution to the gap.

SLA breaches surface after the damage is done

Cases cross 10+ stages. Failures show up in monthly reports, weeks too late. No live view of which cases are at risk right now.

AI touches cases but clinical impact is unclear

Told AI reduces turnaround. Can't verify from clinical workflow data. No audit trail for AI-driven decisions.

Operations & Vendor MgmtCOO, VP Vendor Management, VP Transformation

A vendor rate card cannot be tested before signing

No way to reprice last year's cases under the proposed rate and compare it to today's staffing on the same work.

Operating model is a black box

20 resources, 3 vendors, AI. No unified view of who performs, who underperforms, or that 56% of cases are unassigned.

Can't baseline before vs. after AI

Transformation projects need before/after proof. Without operational baselines, there's no way to measure what AI changed.

IT, Digital & InnovationCIO, CTO, Chief AI Officer, VP Digital Transformation

Human vs. AI cost comparison doesn't exist

Can't compare what a case costs when handled by AI vs. human vs. hybrid on one price list. No data to optimize the mix.

No workflow-level data for AI to learn from

AI metrics live in vendor dashboards. Not tied to actual case outcomes, stages, or process context.

Can't prove AI ROI to the board

AI deployed across 4+ workflows. Board asks for numbers. All you have is "we think it's helping."

Finance & Measurement

CFO, VP Finance, VP Performance Measurement

Workflow Economics

Cost per case is an average, not an account

Total spend divided by volume, refreshed quarterly. No cost per touch, per rework loop, or per step. The $2 improvement cannot be attributed, so it cannot be defended.

Operational Control

Rework loops are invisible cost drivers

Cases loop 2-3x through the same stages. Nobody quantifies the cost of each loop or the margin it consumes.

AI Adoption & ROI

AI spend has no measurable return

Millions allocated to AI vendors. Budget reviews ask for ROI numbers. All finance has is vendor-reported "efficiency gains."

Clinical Leadership

CMO, VP Clinical Ops, VP Quality

Workflow Economics

The step owner has no number for their step

Targets are set per program, per year. Clinical Review has no share of the target and no way to see its contribution to the gap.

Operational Control

SLA breaches surface after the damage is done

Cases cross 10+ stages. Failures show up in monthly reports, weeks too late. No live view of which cases are at risk right now.

AI Adoption & ROI

AI touches cases but clinical impact is unclear

Told AI reduces turnaround. Can't verify from clinical workflow data. No audit trail for AI-driven decisions.

Operations & Vendor Mgmt

COO, VP Vendor Management, VP Transformation

Workflow Economics

A vendor rate card cannot be tested before signing

No way to reprice last year's cases under the proposed rate and compare it to today's staffing on the same work.

Operational Control

Operating model is a black box

20 resources, 3 vendors, AI. No unified view of who performs, who underperforms, or that 56% of cases are unassigned.

AI Adoption & ROI

Can't baseline before vs. after AI

Transformation projects need before/after proof. Without operational baselines, there's no way to measure what AI changed.

IT, Digital & Innovation

CIO, CTO, Chief AI Officer, VP Digital Transformation

Workflow Economics

Human vs. AI cost comparison doesn't exist

Can't compare what a case costs when handled by AI vs. human vs. hybrid on one price list. No data to optimize the mix.

Operational Control

No workflow-level data for AI to learn from

AI metrics live in vendor dashboards. Not tied to actual case outcomes, stages, or process context.

AI Adoption & ROI

Can't prove AI ROI to the board

AI deployed across 4+ workflows. Board asks for numbers. All you have is "we think it's helping."

Next Step

Let's See If We Can Help

No pitch deck. No pressure. Just a conversation about what you're trying to solve and whether we're a fit.

Good fit if you're:

  • Trying to answer 'what does a case cost?' without a 3-week spreadsheet
  • Setting a cost target and needing each step owner to carry a share of it
  • Running clinical workflows and can't see where cases stall or why
  • Running AI in production but can't prove the ROI

Book a Call

  • 30 minutes with our founding team
  • Discovery, not a demo
  • Honest assessment of fit

Or email us at sales@operon.cloud