Services Overview

Healthcare Strategy, Designed and Governed

We help employers redesign funding structure, align incentives, and implement performance governance across their health plans.

For organizations with 25–250 employees, healthcare is often a major expense category without a formal governance model. Our services focus on building that structure — from architecture to oversight.

Our Advisory Scope

Four Areas of Structured Advisory

Layer 1

Funding Strategy

Evaluation of fully insured, level-funded, and self-funded structures based on claims profile, risk tolerance, and financial objectives.

Layer 2

Plan Architecture

Design of benefit structures that align incentives, improve employee access, and reduce unnecessary spend.

Layer 3

Vendor Transparency

Objective assessment of PBMs, networks, administrators, and service vendors for cost alignment and performance clarity.

Layer 4

Performance Governance

Ongoing benchmarking, reporting cadence, and structured accountability to ensure continuous improvement.

Deep Dive — Funding

Funding Model Evaluation

Most mid-sized employers default to fully insured models without evaluating whether the structure aligns with their risk profile and cash flow strategy. We conduct disciplined analysis of:

Claims volatility and risk exposure
Stop-loss thresholds and structure
Cash flow implications
Administrative capacity
Long-term sustainability

Funding decisions should be data-driven and aligned with leadership objectives — not dictated by renewal convenience.

Funding Model Comparison

Fully Insured

Current Progress

Step 1

Step 2

Step 3

High Cost

Level-Funded

Current Progress

Step 1

Step 2

Step 3

High Cost

Mid cost

Self-Funded

Current Progress

Step 1

Step 2

Step 3

High Cost

Optimized

Indicative model. Actual results depend on claims profile and structure.

Deep Dive — Plan Design

Incentive-Aligned Plan Design

Cost outcomes are driven by behavior. Behavior is influenced by incentives. We redesign plan architecture to:

Encourage use of high-value providers
Improve transparency around cost and quality
Reduce unnecessary utilization
Lower employee friction points
Align plan features with organizational priorities

Well-designed incentives reduce volatility without shifting unnecessary burden to employees.

How incentives change behavior

Incentive Design

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Employee Behavior

Utilization Quality

Cost Reduction

Deep Dive — Vendor Alignment

Objective Vendor Evaluation

Vendor selection and PBM arrangements significantly impact cost and transparency. We review:

Compensation structures and rebate flows
Network performance and access
Administrative fees and service levels
Alignment between carrier incentives and employer outcomes

Our evaluation prioritizes clarity and alignment — not carrier relationships.

Traditional vs. Objective Review

Traditional

Carrier-led selection

Rebate opacity

Relationship-driven

Objective Review

Performance-led selection

Fee transparency

Data-driven accountability

Deep Dive — Oversight

Year-Round Performance Oversight

Healthcare should not be evaluated once a year. We implement:

Regular performance reviews
Benchmarking against peer groups
Claims trend analysis
Vendor accountability discussions
Strategic adjustments before renewal pressure

Governance transforms healthcare from a renewal event into an ongoing managed asset.

Governance Cadence

Monthly

Claims trend review

Quarterly

Performance benchmarking

Semi-Annual

Vendor accountability

Annual

Strategic planning

Execution

Implementation and Transition Guidance

When structural changes are recommended, we guide the process carefully to minimize disruption. Support includes:

Communication strategy for leadership and employees
Coordination with carriers and administrators
Transition timelines aligned with renewal cycles
Education resources to support adoption

Strategic change requires careful execution. Our role is to ensure the transition supports both financial and employee outcomes.

Execution

What This Is Not

We do not operate as a transactional quoting service.
We do not recommend structural change without modeling risk and cash flow.
We do not rely solely on carrier marketing materials.
We do not limit engagement to annual renewal negotiation.

Our role is strategic advisory, not product placement.

How to Engage

How Engagement Begins

Plan Architecture Review

Objective assessment of funding structure, design, vendor alignment, and governance.

Strategic Roadmap

Clear recommendations with financial modeling and implementation considerations.

Implementation & Oversight

If aligned, structured execution and ongoing governance.

No obligation. Clarity precedes commitment.

Request a Plan Architecture Review

Understand how your current funding model, plan design, and vendor structure are performing — and whether strategic redesign could improve cost stability and outcomes.

Request a Plan Architecture Review

Schedule a Strategy Call