JR
JR Advisory Group
Healthcare P&L, Distribution & Venture Advisory

Executive Guidance for Complex Healthcare & Commercial Markets

JR Advisory Group partners with health plan leadership, growth-stage platforms, and institutional investors to solve high-stakes margin, distribution, and governance challenges.

$150M
Validated Margin Turnaround
3,000+
Counties Mapped in ROI Model
20-Year
Cohort LTV Frameworks
$1.2B
Asset Scope Governance
Track Record of Execution

De-Identified Flagship Engagements

All case studies represent completed strategic advisory or leadership initiatives. Proprietary entity names have been masked in accordance with confidentiality standards.

Enterprise Health Plan Strategy & P&L Turnaround

Multi-State Joint-Venture Payer: Portfolio Rationalization & Footprint Redesign

$150M Margin Recovery

Compounding regulatory payment headwinds and geographic overextension left a multi-state joint venture facing severe margin erosion, unsustainable product concentration in a single plan, and misaligned pricing across divergent markets.

$150M Margin Recovery
~140 → ~60 Counties Focused
~5 → ~15 Local PPOs Built
Dual-Firm Actuarial Audit
The Core Strategic Threat
  • Solvency Risk: No viable mathematical path to profitability across ~140 counties under existing product rules.
  • 85%+ Product Concentration: Membership sat almost entirely in one broad footprint plan, exposing the balance sheet to severe regional volatility.
  • Asymmetric Value Mismatch: One uniform benefit meant products were over-featured in unprofitable rural areas in order to remain competitive in metro markets.
Diagnostic & Re-Engineering
  • Zero-Base Market Baseline: Eliminated sunk-cost bias, evaluating all ~140 counties as a clean-slate market entry.
  • Benefit Utilization Elasticity: Correlated supplemental utilization (e.g., dental) with claims MLR to spot loss-making benefit designs.
  • AV Growth Elasticity: Analyzed multi-year competitor bid data to identify the exact Actuarial Value threshold that maximizes margin without triggering churn.
Deliverables Handed Off & Board Action
Turnaround Strategy & Presentation:

Presented strategic roadmap directly to the company CEO and Joint-Venture Board of Directors, accompanied by a dynamic county-by-county financial model.

Independent Dual Actuarial Validation:

Because strategy was non-actuarial-led, the entire math model was submitted to, and fully validated by, two top independent actuarial firms with deep Medicare Advantage experience.

Enterprise Takeaway "Monolithic regional plan designs create severe margin volatility by over-subsidizing low-margin geographies while leaving profitable markets vulnerable. Micro-segmenting local PPO products allows health plans to protect margin and align benefit richness directly with local provider economics."
Strategic Footprint Redesign & Portfolio Margin Brief NDA Protected
De-identified methodology brief detailing AV elasticity modeling and county rationalization.
National Partnership Strategy

National Digital Health Distributor: County-Level Carrier ROI & Resource Allocation

3,000+ Counties Evaluated

A national digital distributor with 50+ carrier contracts faced inbound demand from 60+ additional carriers seeking platform entry, but held operational capacity to integrate only 8. Lacking objective unit economics, leadership risked misallocating finite FTE bandwidth and diluting sales conversion yields.

60 → 8 Pipeline Filtered
3,000+ Counties Mapped
Dynamic Excel ROI Engine
FTE Cap Bandwidth Protected
The Capacity Bottleneck
  • Severe Inbound Pressure: 60+ regional and specialized carriers actively lobbying for onboarding against a strict cap of 8 implementations.
  • Cross-Functional Friction: IT integration, contracting, agent training, and QA oversight were bottlenecked by subjective partner selection.
  • Unquantified Incumbent Book: Zero visibility into whether 50 existing carrier contracts generated profit or consumed administrative overhead.
Economic Modeling & GTM
  • Full Cost Accounting: Audited cross-functional hours to quantify the true dollar cost of onboarding and maintaining carriers year-over-year.
  • County Conversion Gap Analysis: Mapped call conversion against missing carrier networks across every U.S. county (e.g., closing a 10% conversion delta due to missing a key carrier in a county).
  • Cross-Channel Partner Lift: Modeled co-branded healthcare system and retail pharmacy volumes directly into carrier yield projections.
Deliverables Handed Off & Structural Results
Dynamic Excel Valuation Engine:

Engineered a plug-and-play Excel model that instantly evaluates any prospective carrier’s footprint, market position, and compensation to project marginal conversion yield and overhead payback.

Producer Certification Framework:

Overhauled agent certification to slash recurring onboarding costs and established an operational co-investment gating requirement for onboarding new carrier partners.

Enterprise Takeaway "Sales capacity and enterprise FTE bandwidth are strictly finite, perishable assets. Without granular, county-level unit economics that account for local competitive density and true operational friction, organizations burn valuable FTE resources on sub-scale partnerships instead of protecting that capacity for their highest-value commercial opportunities."
National County-Level Carrier ROI & Allocation Model NDA Protected
Executive overview detailing capacity allocation formulas, variable Excel architecture, and conversion metrics.
Business Line Expansion & Feasibility Analysis

Multi-Billion-Dollar Financial Institution: Healthcare Distribution Insource vs. Outsource Feasibility

$63M–$84M 20-Year LTV Valuation

A multi-billion-dollar credit union and wealth advisory practice sought to capture near-retiree member transitions into Medicare, but faced stark operational mismatches between lean wealth management models and individual health distribution. Leadership required a defensible evaluation of insourcing versus outsourcing before committing capital or board governance.

$63M–$84M 20-Yr Asset Valuation
$100 vs $700+ Payout Per Member
5 → 20 FTE Headcount Lift Mapped
Unanimous Capital De-Risking
The Distribution Divide
  • Model Asymmetry: Wealth advisory operates on high AUM with lean teams (<15 staff), while insurance distribution requires individual transactional enrollment.
  • Regulatory Referral Cap: Outsource analysis showed strict state/federal compliance caps payouts to a one-time ~$100 fee with zero renewal rights.
  • FMO Leverage Architecture: Mapped an insource agency model using an FMO backbone to supply quoting engines and carrier contracts without custom software builds.
20-Year Cohort Economics
  • Compounding Renewal Asset: Insourced distribution compounded to $63M–$84M in enterprise equity value per 10,000 enrolled members over 20 years.
  • The $62M+ Opportunity Cost: Proved that outsourcing forfeited over $62M in long-term enterprise value for minimal upfront referral compensation.
  • Operational Hurdle Rate: Quantified the true cost of licensing, CMS compliance oversight, and scaling from 5 to 20 dedicated producers.
Deliverables Handed Off & Capital De-Risking
Executive Decision Presentation & 4-Month Roadmap:

Delivered a 7-slide C-suite decision deck and a 4-phase rollout plan from FMO selection to AEP launch.

Unanimous Capital Preservation Decision:

Armed with clear operational data and governance requirements, executive leadership unanimously elected to bypass market entry, protecting capital and avoiding distraction from core wealth advisory growth.

Enterprise Takeaway "In non-traditional distribution, strategic discipline is defined by knowing what not to build. High-impact executive advisory delivers immense value when it de-risks capital allocation, giving leadership the unvarnished operational truth required to walk away from distractions and protect focus on their core business model."
The Distribution Decision: Insource vs. Outsource Deck NDA Protected
De-identified executive decision presentation detailing the 20-year LTV model and trade-off mechanics.
Venture Architecture, Governance & Organizational Design

High-Growth Emerging Venture: Multi-Entity Corporate Architecture & Operating Governance

$1B+ Scope Asset Scope Governance

A capital-intensive agriculture and manufacturing startup targeting $1B+ in infrastructure assets faced organizational bottlenecks. Unstructured founder workflows, unaligned compensation models, fiduciary exposure in employee benefit selection, and disconnected legal entities risked investor credibility and post-launch execution.

$1.2B Facility Asset Scope
Parent / Sub Holding Structure
3,000+ FTE Planned Scale
Fiduciary Benefits Audit
Pre-Launch Vulnerabilities
  • Fragmented Investor Narrative: Presenting agriculture and manufacturing as separate ventures with the same leadership created institutional governance concerns.
  • Fiduciary Benefits Exposure: Initial broker quotes breached basic compliance standards, exposing the venture to fiduciary liability and poor cost containment.
  • The Growth Trap: An aggressive 60-day post-funding commercial launch risked execution collapse without an operational backbone in place.
Governance & Restructuring
  • Education-First Model: Applied a 3-tier framework (Education → Audit & Analysis → Recommendation) across compensation, benefits, and governance.
  • Holding Company Hierarchy: Designed a parent company governing two operating subsidiaries, establishing a clear structure for institutional lenders.
  • Tiered Total Rewards: Structured market-standard base salaries and performance-based bonus pools stratified by organizational level.
Core Deliverables & Strategic Guidance
Corporate Architecture & Total Rewards Decks:

Authored the parent/subsidiary governance presentation, tiered employee bonus structures, and a fiduciary health benefits RFP guide for institutional broker selection.

Launch Sequencing & Operating Spine Guidance:

Advised executive leadership against an immediate commercial launch, recommending the creation of an operational spine prior to market deployment to protect capital and Intelectual Property.

Enterprise Takeaway "Founders often believe speed to market is their greatest defense against competition. In reality, scaling before establishing an institutional operating spine simply accelerates operational failure. Rigorous corporate governance, fiduciary benefit design, and structured compensation do not slow down startups, they make rapid expansion sustainable."
Pre-Launch Venture Architecture & Governance Brief NDA Protected
Executive briefing detailing parent-subsidiary holding design, total rewards tiers, and fiduciary benefits strategy.
Capabilities

Core Advisory Practice Areas

Tailored senior advisory structured around measurable P&L outcomes, commercial alignment, and operational execution.

01

Payer Strategy & P&L Turnaround

Rigorous financial and product diagnostic engagements for Medicare Advantage, joint-venture health plans, and regional carriers facing margin compression, CMS funding adjustments, or volatile MLRs.

  • Product rationalization & county footprint exits/entries
  • Product design to achieve growth & margin objectives
  • Cross-functional C-suite and Board alignment frameworks
02

Distribution Strategy & Partner Economics

Commercial and operational advisory for organizations scaling through external sales channels, broker/agent networks, aggregators, and strategic partnership ecosystems.

  • Partner ROI & Capacity Allocation: Modeling unit economics and net margin yield to prioritize high-value partnerships and protect finite enterprise resources.
  • Commercial Alignment & Comp Design: Structuring commission models, margin-sharing tiers, and performance incentives that drive profitable conversion over raw volume.
  • Channel Operations & Scale: Streamlining partner onboarding, compliance/certification workflows, and SLAs to lower administrative overhead and friction.
03

Enterprise Feasibility & Interim Leadership

Hands-on executive leadership, commercial feasibility, and strategic diligence for organizations navigating market transitions, business line expansions, or capital deployment.

  • Interim & Fractional Leadership: Stepping in as VP/Executive Lead during turnaround, launch, or transition cycles.
  • Commercial Feasibility: New business or service line expansion and capital allocation audits.
  • Venture Architecture: Pre-launch sequencing, holding company governance, and PE transaction diligence.
About the Advisory Practice

Direct Strategic Counsel from an Experienced Operator

JR Advisory Group was established by Jake Roberts to deliver practical, unvarnished strategic guidance to leadership teams navigating complex markets including: healthcare, payer, commercial distribution, and business strategy.

Every strategic deliverable is backed by firsthand leadership operating within complex, highly matrixed enterprise environments. Having navigated regional health plan joint ventures, national carrier distribution, and high-growth commercial platforms, the practice bridges the critical divide between sales distribution, product design, enterprise IT, corporate finance, and actuarial pricing. Engagements focus on breaking down institutional silos—translating multi-departmental friction, complex regulatory dynamics, and quantitative modeling into clear, data-driven executive narratives that align C-suites and secure Board-level consensus.

By combining deep institutional domain knowledge with modern, agile analytical tooling, the practice moves with speed, delivering rigorous, board-ready work products that bridge high-level strategy with ground-level operational reality.

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Reach out directly to discuss project scope, request de-identified deliverables, or schedule an initial executive consultation.

Direct Inquiries: Jake@jradvisorygroup.com | Des Moines Metro, Iowa