The setting
's is a platform for virtual care that combines care teams, coaching, a mobile app, and connected devices. It supports care for diabetes, prediabetes, high blood pressure, and muscle and joint problems.
The contract needs a single measurement rule, but eligibility and claims tell different stories.
The health plan needs independently verifiable results while clinical leadership needs terms that reflect the members receiving care.
Who you’d be doing this for
“My finance team asked why their claims file drops people your report still counts, and I need an answer this week.”
Ignacio Vargas · Population Health Manager · a character in this brief
Oversees a health-plan population whose chronic-condition program results must stand up to internal finance and clinical review.
What is at stake
A health plan cannot reproduce the savings estimate because its claims file and the eligibility view count different members. You must weigh verifiability, clinical fairness, and capped financial exposure before terms become binding.
Why it isn’t already fixed
Every obvious fix costs something else. That’s the part you’d have to decide.
- independent verification vs. reporting speed
- downside protection vs. clinically representative cohorts
- contract deadline vs. reconciliation rigor
- customer confidence vs. repeatable operating rules
Why Omada Health
Cardiometabolic care contracts increasingly tie payment to outcomes that population health managers must reconcile with their own claims data.
Written with these in mind
Not your kind of problem? 10 more at Omada Health, or browse every organization.
Where the organization context comes fromThe postings this brief was written from, and the reporting read before it.
The organization context comes from public information. The situation and characters are written for the brief.
Job postings it was written from
Public descriptions of the work at Omada Health. They are listed as sources, not as openings. The lines under a posting are its own words, where it meets this brief.
- Senior Manager, Revenue Operations · no longer posted
- You'll own the end-to-end B2B2C enrollment funnel—from eligibility through outreach to member enrollment—building the data, metrics, and operating cadence that drive measurable growth.
- Build and maintain a unified data model linking B2B customer activity to B2C member outcomes, standardizing funnel stages, metrics, and attribution.
- Principal Actuary · no longer posted
- You will bring actuarial rigor to savings and ROI methodology, performance guarantees, and at-risk arrangements.
- Build pricing and exposure models, define clear triggers and measurement terms, and establish actuarial guardrails for customer commitments.
- Senior Director, Capacity Planning, Workforce Operations & Analytics (opens in a new tab)
- Lead cross‑functional initiatives that connect the department’s workstreams to broader company priorities (e.g., cost of revenue and gross margin targets, member experience redesign, AI‑enabled workflows), ensuring care team operations and analytics are integrated into enterprise plans.
- Create and maintain scalable rules for shrinkage, occupancy, and staffing allocation that reduce variation, enable predictable quality, and tie operational decisions directly to cost of revenue and gross margin outcomes.
- Senior Director, Sales and Revenue Operations (opens in a new tab)
- The Senior Director of Sales and Revenue Operations oversees a team of operational talent spanning, Sales Operations, Customer Success Operations and channel operations.
- Serve as a member of the Commercial Operations senior leadership team.
Reporting read before this brief was written
The pieces closest to the situation in this brief.
PHTI's 2026 State of Digital Health Purchasing survey, published September 29, 2026, found that 68% of employers and 55% of health plans currently use performance-based contracts for digital health tools, and 31% of such contracts put more than half of fees at risk.
PHTI Survey Finds Majority of Employers and Health Plans Are Using Performance-Based Contracting to Pay for Digital Health Tools (opens in a new tab) · phti.org · Sep 29, 2026
For the 2026–2027 performance period, ACCESS requires at least 50% of aligned beneficiaries to meet all required outcome targets for a participant to receive full payment, as reported on September 17, 2026.
Counsel Health taps Oura to join CMS ACCESS model (opens in a new tab) · fiercehealthcare.com · Sep 17, 2026
This is the setup. The work is inside.
Running it puts you in the room: the full situation and its constraints, stakeholders who push back in their own words, and the decisions that are yours to make. What you produce becomes a Day One Plan — work you can show someone instead of describing.
Where similar work appears
Other live briefs connected to this one, and what connects them.
Similar problems at other organizations
Like this one, each of these turns on committing to a deal before it checks out.
A 25,000-member program is stalled because clinical and finance leaders reject each other’s pricing model.
You must weigh credible outcome proof against terms the health plan can approve and operate.
Finance and clinical reviewers rejected the first payment schedule because they dispute whether outcomes can be fairly attributed.
You need to weigh downside protection against measures that preserve appropriate member access and withstand validation.
A health plan launch date is fixed, yet member, clinician and session data disagree 22% of the time on 90-day work function.
You have to set the measurement rules now, knowing contracts will lock them in.
The same setting, from another role
Each is set around Omada Health’s Omada Platform, written for a different role. They’re separate briefs, not the same scenario.
Enterprise opportunities are waiting on tailored follow-up while sellers rebuild discovery context and verify claims.
You must decide what AI can prepare and what a seller must review before anything reaches a buyer.
Employers want GLP-1 support but are consolidating chronic-condition vendors.
You must weigh a focused broker package against the proof and flexibility buyers need.
A 180,000-life employer deal is splitting over access, fee risk, and proof of outcomes.
You must weigh contract certainty against the member reach that makes the program commercially meaningful.
Other problems with a similar purpose
In each of these, as in this one, the aim is to find the real question hiding behind incomplete evidence and choose a reversible next step instead of guessing.
Product managers read homeowner, pro and metric evidence on urgent repairs separately and reach different conclusions.
You have to decide where the AI's clustering of that evidence stops and a product manager's framing of the problem begins before a test is shaped.
A major advertiser may move $1.5 million after finance disputes whether reported sales were incremental.
You must weigh a compelling cross-format growth case against the evidence each claim can support.
A 4,000-seat business program may not renew because executives dispute what learner progress proves.
You have to weigh a fast commercial save against claims the evidence cannot support.
