This practice is for organizations that carry medical cost risk and have to defend a number they did not produce themselves. In practice that means Medicaid managed care plans, Medicare Advantage plans, the delegated entities that take risk from them, and the state programs that buy long-term services and supports by the hour.
Inside those organizations it is for the people who get handed the number. The medical director asked to defend a prior authorization list, or shrink it, without an economic basis for either. The utilization or care management lead given a savings target and a code list and told to reconcile them. The finance or actuarial team holding a vendor's claimed savings with no comparison group behind it. The program lead whose hours standard is under dispute in a hearing. The operating leader who has been handed a department and asked what to do with it. If you are being asked to act on a figure, and you would like someone qualified to disagree to read it first, this is for you.
A good fit is a plan carrying a prior authorization list nobody has re-tested end to end. A team facing published turnaround and denial metrics for the first time. A savings claim, yours or a vendor's, that is about to become a budget line. An hours or level-of-care standard that has to survive an appeal. Anyone who has been handed a target and a list and told to make them agree.
Not a fit is looking for a number to justify a decision already made. Expecting the analysis to make clinical calls on its own. Wanting deterrence counted as savings without a way to evidence it. Pharmacy benefit management, which has different economics and needs different instruments.
The instruments on this site are arranged around predicaments rather than departments, because nobody arrives thinking they need a cost-of-care tool. They arrive holding a sentence: a vendor claiming a saving, an authorization list under attack, a child's nursing hours in dispute. If your sentence is not on this page, it is still worth a first message. The second read is the service; the list above is only where it has been needed most.