Industry Directory of PI Programs (Medical)
Standard PI programs and their definitions: a shared language for comparing programs.
Payment Integrity Standards & Benchmarks
Spearheading standards for more affordable healthcare. The industry’s first savings PMPM benchmarks launched at HPRI 2026. The next edition is being built now, for HPRI 2027.
- 50+
- PI leaders in the Workgroup
- 15+
- Health plans contributing metrics
- $37B
- PMPY savings, first three benchmarks*
Industry standards didn’t exist. Now they do.
Payment integrity continues to evolve into a critical cost containment and affordability lever for health plans. Without industry standards, plans have had no way to optimize their PI performance and impact on affordability.
To address this gap, Kisaco Research, in collaboration with PI leaders, launched the PI Benchmarking Workgroup two years ago to develop the first PI standards and benchmarks.
Today, the initiative includes 50+ health plan and vendor PI thought leaders who’ve developed standard PI program definitions and the industry’s first benchmarks.
Benchmarks drive affordability
In a system under pressure to reduce costs, benchmarks reveal hidden inefficiencies and enable proactive cost containment. They give health plans:
- Objective analysis of performance and best practices by PI program
- Opportunities to identify new savings or cost avoidance/prevention solutions
- Evidence for a strong national value story for Blues plans
- Executive reporting on PI value and opportunities
- Justification for investments in PI vendors and resources
- Vendor performance targets
- Objective metrics for client RFPs
- Multi-year trend tracking of program improvement
What the Workgroup has delivered
View sheet
Savings PMPM Calculation Deck
How to define and calculate savings PMPM, including the proposed approach to pre-pay savings.
The industry’s first savings PMPM benchmarks
Benchmarks by PI program, released at HPRI in September 2026. Detailed data is available to contributing plans and vendor members.
Share anonymously. See the full picture.
Health plans
15+ health plans have already shared their savings metrics through an anonymous, secure survey. Plans that share their metrics can then access more detailed industry savings data, at no cost.
Vendors
Vendors must be Benchmarking Members to access more detailed benchmarking data, and can become thought leaders aligned with savings best practices throughout the year.
- Purpose
- Savings metrics are gathered solely to create aggregated, de-identified benchmarks. Submissions come through an anonymous survey with no way to identify the contributor or their organization.
- What’s shared
- Only the final calculation result, not the variables behind it. No health plan identifiers, member-level data, or PHI as defined under HIPAA.
- Who handles it
- Kisaco Research, an independent third party, is the sole aggregator: standardizing metrics, building de-identified reports, and sharing them back with participants in a blinded manner.
Share your metrics
Anonymous, secure, and free for health plans.
The road to HPRI 2027
HPRI 2026 marked the release of the first savings PMPM benchmarks. Between now and HPRI 2027, the Workgroup is expanding the dataset and the guidance, and every contribution sharpens the results shared on stage.
Now: grow the dataset
More plans sharing metrics through the anonymous survey means more robust, more granular benchmarks by PI program.
Through the year: refine the guidance
Monthly Workgroup calls continue to shape savings PMPM definitions and tackle critical PI challenges.
HPRI 2027: the next share-out
Exclusive benchmarking sessions, panel discussions and roundtables for attendees. See the 2026 benchmarking sessions.
Get involved
No cost for health plans or government organizations
Join the Workgroup
Join your peers on a low-commitment monthly call to inform the benchmarking strategy and discuss critical PI challenges and solutions.
Learn more
Benchmark access for health plans
Access more detailed benchmarking data, free, by sharing savings metrics through a secure, confidential, anonymous survey.
Get in touch
Benchmark membership for vendors
Access more detailed benchmarks and become an exclusive thought leader aligned with savings best practices throughout the year.
Find out more
Join the community
The PI Standards & Benchmarks LinkedIn group shares updates, discussions and networking.
Join groupWho’s at the table
How the initiative works
Industry-wide feedback loop
A Workgroup of cross-functional PI experts creates guidance and collects ongoing industry feedback. Standards represent the collaboration of all participants, collated by Kisaco Research as an objective third party.
Insights not proprietary
Standards and benchmarks are developed from non-proprietary input and metrics.
Progress over perfection
Every PI program is different. Guidance may not fully align with every plan’s approach, but a flexible framework and support drive progress.
Resources
Unlocking the vault: a guide to calculating prepayment savings in payment integrity
Establishing PI benchmarks is highly complex, so how do we get it right?
Savings PMPM: why the Workgroup chose this metric first
Payment integrity KPIs and reporting strategies
KPIs to manage a world-class payment integrity organization
Be in the room for the next benchmarks
Register your interest for HPRI 2027 for exclusive access to benchmarking metrics, panel discussions, roundtables and Workgroup meetings.
Register interest