Treat catastrophic risk as a plan-management decision

When catastrophic risk scores low, the concern is not simply whether stop-loss coverage exists. It is whether the employer understands the exposures it retains, the protection it buys and the operational decisions that influence both. A policy can be in place while the underlying risk strategy remains unclear.

Start in the Roadmap’s Diagnose phase with a practical review of large-claim history, current specific and aggregate protection, laser provisions, contract terms, reporting access and the circumstances in which leadership needs to be informed. This establishes a baseline for evaluating protection before a market proposal drives the conversation.

In the Design phase, connect risk protection to the organization’s financing strategy, cash-flow tolerance and clinical approach. Consider how claims monitoring, case support, specialty-drug management and high-cost-care pathways can work alongside coverage. The goal is not to predict every large claim; it is to build a prepared response around the risks the plan chooses to retain.

Make catastrophic risk part of the recurring governance agenda. Set the reporting cadence, identify the decisions the review should support and document accountability for renewal, claims and vendor performance. This turns a high-priority Score result into an ongoing Roadmap capability rather than an annual insurance purchase.