Give Finance and Clinical Operations the Same Basis for a Decision
A $79M operation already has its record, its cost figures and its targets, in three systems and two meetings. Operon keeps them together so the people responsible for the work and the budget examine the same decision: the target, the current figure and the gap between them.
Both teams see the same gap, the step behind it and what closing it is worth. The conversation moves from whose number is right to what to change first.
One prior authorization case, each cell = $0.10: per case, the target, the current cost and the gap. The cells above the $30.00 target line lift into the gap.
- Target per case: $30.00.
- Current per case: $31.50.
- Gap per case: +$1.50.
- Intake: $3.20 against a $3.00 target, +$0.20.
- Triage: $2.60 against a $2.50 target, +$0.10.
- Clinical Review: $16.40 against a $15.00 target, +$1.40.
- MD Review: $6.40 against a $6.50 target, −$0.10.
- Decision & Letters: $2.90 against a $3.00 target, −$0.10.
× 250,000 cases a month: $375,000 / month.
≈ $4.5M a year: Improvement Opportunity.
Your Systems Hold the Answer. In Two Places.
Your workflow systems hold the operational records. Your finance systems and reporting support budgeting and review. Your analytics and vendor tools each contribute a perspective. None of that needs replacing.
What is usually missing is one place where the cost model, the target and the recorded work are the same objects for both teams. Without it, a cost-per-case gap is a finance figure, repeat reviews are an operations observation, and the conversation about which one to act on happens across two decks. Operon’s contribution is that shared basis, maintained as a product workflow rather than rebuilt for each review.
Case UM-2026-000731
what happened- 1IntakeJul 3
- 2Clinical Review · human reviewJul 3 – 8
- 3Clinical Review · re-entry · AI-assistedJul 11 – 14
- 4Decision · automated preparationJul 14 – 18
Visits, re-entries and actions from the workflow system. No dollars yet; recorded activity supplied by the workflow data.
Agreed prices
applied to each recorded fact- Base cost · once per case$6.00
- 4 visits · standard cost per step$31.00
- Human Review · 2 occurrences+$7.00
- AI-assisted, automated · 2 occurrences−$6.00
- Modeled case cost$38.00
Prices reviewed by finance, tied to the workflow version they were set against. Change a price and every case reprices the same way.
Cost per case by month
against the goalInspect the recorded work, the cost rules and the selected target behind the +$1.50 gap.
The economics are finance’s. The facts underneath are operations’. One record carries both, so a +$1.50 gap arrives with the cases, cost rules and target behind it.
The Model, the Target and the Record, Kept Together for the Same Decision.
Each of these may exist somewhere in your stack today. Together they let you examine a cost target, investigate its operational drivers, or evaluate proposed rates using the same recorded work.
Cost figures in finance reporting; targets in a planning spreadsheet
Cost models and targets as product objects
A price list per kind of recorded fact and a cost-per-case target with step shares, reviewed by finance and tied to a workflow version, rather than recomputed for each meeting.
When the target is debated more than once a year and the step owner needs a number for their step, not a program average.
Case status and queue reports from the workflow system
Recorded operational evidence, priced
Ownership, waiting, repeat work and service risk stay visible as management facts. The same recorded activity carries its modeled cost.
When operations sees repeat reviews and finance sees a cost gap, and both need to examine whether that pattern contributes to the variance before choosing an improvement priority.
Drilldowns in BI, built per request
Case-level explanations, on demand
Every monthly figure opens the cases behind it; every case shows base cost plus each recorded visit and action, in order.
When “why did August move?” has to be answered in the meeting, not three weeks after it.
Vendor proposals and AI business cases in their own spreadsheets
Model comparison on the same recorded history
Copy the price list, change an assumption, reprice last year’s cases. Same-history repricing compares cost assumptions; it does not simulate how a new process would perform.
When a rate card or an AI step is being evaluated and finance and operations want it priced on your own cases before anyone commits.
A $1.50 Gap. Is It the Prices, the Work, or Both?
Modeled cost per case is $31.50 against a $30.00 target. Read by step, Clinical Review contributes $16.40 against its $15.00 share. The same row is what finance and the review owner both look at next.
Gap to goal, by workflow step
Modeled contribution against each step’s share of the $30.00 goal.Modeled, not reconciled. Prices reviewed by finance applied to recorded activity. Not reconciled expense or medical spend; a lower modeled cost is not, by itself, a verified saving. In this example finance set the $30.00 goal and the Clinical Review owner carries the $15.00 share.
Checks the price model and the target
Is $15.00 the right share for Clinical Review? Are the prices for a standard review and a re-entry still the ones the plan agreed? Two of eight actions are unpriced; does that change the reading?
Inspects the case activity behind $16.40
Which cases re-entered review, from where, and how often. Which of those patterns merit investigation and which reflect clinically necessary second looks. Service risk and clinical judgment stay with the owner.
What Has to Be in Place. And When It Already Is.
Identifiable workflow history
Cases, steps and actions that can be followed across the systems involved. Coverage and freshness set which questions the record can answer.
A workflow owner
Someone responsible for the step or workflow who will look at the evidence and decide what merits investigation. The tool does not make that call.
Reviewed cost-model inputs
Prices finance has reviewed. A flat model is a legitimate first model; missing prices and coverage need review before the result is read.
Discuss Where Operon Would Add Value
Bring one decision and how you answer it today. We will talk through the evidence you already have, whether the connected approach changes that decision, and what a useful next step would require, if there is one.