Health plan audit delivers insight and improved oversight for PrimeWest Health
A rural managed care organization enhanced reserving practices and uncovered opportunities for long-term financial improvement.
Client background
PrimeWest Health, a managed care organization formed in 1998, provides health coverage to 30,000 residents across 13 rural counties. As a county-based health plan, it was created to serve local communities with accessible, high-quality care while maintaining strong fiscal responsibility.
Over time, PrimeWest Health outsourced its accounting function to a third-party provider. While the arrangement delivered adequate service, leadership began to question whether “adequate” was enough. Executives and the Board of Directors wanted to know if a more specialized health plan audit could provide deeper insights and stronger financial oversight.
As expectations from regulators, members and the Board continued to rise, PrimeWest Health recognized the need for a higher level of quality, accountability and industry-specific guidance in its financial reporting.
Client challenge
For the CFO and the Board, outsourcing had created stability but not necessarily growth. The organization wanted more than accurate numbers; it needed an auditor who could deliver industry-specific insights, ensure compliance with evolving standards and provide recommendations for operational improvement. The challenge was to find an advisor that could:
- Understand the unique demands of a health plan operating in rural communities.
- Provide confidence to the Board that controls, reserves and processes were appropriate.
- Communicate consistently and proactively to prevent last-minute surprises.
- Offer a perspective grounded in health insurance industry experience, rather than generic accounting knowledge.
Executives were concerned that continuing with the status quo might limit opportunities to strengthen oversight and efficiency. The Board wanted assurance that PrimeWest Health was getting the maximum value from its health plan audit relationship.
Baker Tilly solution
PrimeWest Health turned to Baker Tilly for financial statement audit services. Several factors shaped this decision:
- A dedicated financial services team with deep specialization.
- A proven track record in the insurance industry, with knowledge of unique accounting and regulatory requirements.
- Experience coordinating with outsourced accounting providers and actuarial firms.
- A focus on controls, testing and identifying operational improvements as part of the audit process.
In the first year, Baker Tilly went beyond delivering an audit opinion. The team worked directly with an external actuarial firm to evaluate reserves, providing management with opportunities to refine and enhance the reserving process. By bringing multiple stakeholders together, Baker Tilly helped PrimeWest Health strengthen its financial governance and align its practices with industry best standards.
The audit approach was built around communication and transparency. Information was shared proactively, expectations were clarified upfront and deadlines were consistently met. This style of engagement gave both executives and the Board confidence in the process and its outcomes.
Results
The decision to engage Baker Tilly quickly demonstrated value. The CFO reported several improvements in the first year, including:
- Industry-specific insight: Audit findings and recommendations were framed in the context of insurance industry practices, giving leadership practical advice rather than generic commentary.
- Reliability and delivery: Promises made during the proposal process were honored, ensuring that expectations were not only set but consistently met.
- Clear communication: Information flowed proactively, reducing uncertainty and allowing executives to make timely decisions with confidence.
Perhaps most importantly, the engagement fostered a stronger relationship between the audit team, management and the Board. By combining technical knowledge with consistent communication, Baker Tilly demonstrated its commitment to delivering lasting value, not just a compliance exercise.
In addition, the collaboration with the external actuarial firm highlighted specific opportunities for PrimeWest Health to refine its reserving process. This work created both immediate improvements in accuracy and longer-term benefits in financial planning.
John Klein, Chief Financial Officer, PrimeWest HealthIt’s extremely easy working with Baker Tilly and we are receiving a lot more value. The professionals we work with are interested in our success and provide the insight and expertise we need to help meet our goals.
Conclusion
For PrimeWest Health, switching audit providers was more than a change in service; it was a step toward stronger governance, improved communication and greater confidence in financial oversight. With Baker Tilly’s dedicated financial services team, the organization gained industry-specific knowledge, actionable recommendations and the assurance that its accounting and actuarial processes could support its mission of serving rural communities.
The engagement demonstrates how a specialized health plan audit can deliver more than compliance. By aligning technical knowledge with industry insight, Baker Tilly continues to help PrimeWest Health meet its financial goals while supporting the broader mission of providing quality care to the communities it serves.