Intelligence
Reverse-chronological coverage of deals, platform launches, benefit design shifts, and the operating mechanics behind direct contracting.
This post explores the differences between group and single-parent captives, their startup costs, and how to evaluate their fit for self-insured employers.
Read the analysisExplore how level-funded health plans operate, who they are best for, and the hidden costs often overlooked by brokers.
Read the analysisUnderstand the headcount thresholds, cash flow needs, and risk profiles to determine the best health insurance model for your organization.
Read the analysisExplore six crucial leverage points that self-insured employers often overlook in their negotiations with health systems.
Read the analysisExploring how self-insured employers leverage Centers of Excellence contracts for cancer care to reduce costs and enhance patient outcomes.
Read the analysisA deep dive into the access, cost, and contract considerations for self-insured employers regarding behavioral health carve-outs in 2026.
Read the analysisLearn about the audit rights self-insured employers have and why these tools often go unused.
Read the analysisExplore why musculoskeletal conditions are the largest driver of employer health costs and how direct contracting strategies can effectively reduce these expenses.
Read the analysisA practical guide for employers on how to design narrow network plans that improve quality and reduce costs.
Read the analysisExplore the concentrated costs of diabetes management and how to effectively structure vendor contracts for better health outcomes.
Read the analysisThis guide identifies six leverage points that self-insured employers often overlook in negotiations with health systems.
Read the analysisMulti-year direct contracting agreements can lock in savings and stability—but the wrong provisions turn long-term deals into expensive traps. Here's what belongs in fixed terms, what needs escape valves, and how to structure flexibility without giving up leverage.
Read the analysisSelf-insured employers leverage Cancer Care Centers of Excellence contracts to enhance patient care and cut expenses.
Read the analysisMost value-based care arrangements fail because the incentive math is wrong or the metrics are unmeasurable. Here's how self-insured employers structure outcomes-based payments inside direct contracts that hold providers accountable and deliver real savings.
Read the analysisExplore the implications of behavioral health carve-outs for self-insured employers regarding access, cost, and contract considerations.
Read the analysisA detailed look at health plan audit rights for self-insured employers and why they often go unused.
Read the analysisSelf-insured employers pursuing direct contracts with health systems carry ERISA fiduciary obligations that most never formally address. Here's what those obligations actually require and where employers routinely fall short.
Read the analysisUnderstanding the impact of musculoskeletal issues on employer health costs and effective direct contracting strategies.
Read the analysisLearn how to design a narrow network plan that maximizes performance while minimizing employee dissatisfaction.
Read the analysisClaim disputes are inevitable in direct contracting arrangements. Here's how to resolve them fast, protect your data rights, and keep the provider relationship intact.
Read the analysisRural direct contracting is harder than urban—but the math still works if you know which constraints are real and which ones are negotiating theater. Here's what self-insured employers are doing to make it happen.
Read the analysisExplore the concentrated costs of diabetes management and discover effective interventions and vendor contract structures for self-insured employers.
Read the analysisMost direct contracting programs fail not because of bad contracts, but because members never change where they seek care. Here's how to build a communication strategy that moves utilization.
Read the analysisAnalyzing diabetes management costs, effective interventions, and structuring vendor contracts for self-insured employers.
Read the analysisNetwork leakage silently drains direct contracting savings by routing claims through full-rate carriers instead of your negotiated providers. Here's how to find it, quantify it, and stop it.
Read the analysisExplore six critical claims reports that self-insured employers should analyze to optimize healthcare spending.
Read the analysisExplore the critical factors that influence the decision between onsite and near-site clinics for self-insured employers.
Read the analysisPrimary care direct contracts are table stakes. The real savings are in specialty care — but oncology, orthopedics, and cardiac deals require a fundamentally different negotiating approach and contract structure.
Read the analysisUnderstanding broker compensation and fiduciary duty is crucial for self-insured employers.
Read the analysisSelf-insured employers often sign direct contracts without knowing whether the rates are actually good. Here's a practical methodology for benchmarking your negotiated rates against market data before you sign—and after.
Read the analysisLearn how bundled payments and shared savings can effectively reduce healthcare costs for self-insured employers.
Read the analysisDirect contracts live or die on data access. Here's what self-insured employers need to demand, what providers will push back on, and how to protect your organization when negotiations get difficult.
Read the analysisExclusivity clauses in direct contracts can lock you into arrangements that cost more than they save — or give you meaningful leverage and pricing certainty. Here's how to tell the difference before you sign.
Read the analysisLearn about critical term sheet clauses in direct hospital contracts that can expose employers, and strategies to negotiate better terms.
Read the analysisMost direct contracts fail not because of bad pricing but because no one inside the TPA is accountable for making them work. Here's what a TPA champion does and how to find one before you sign anything.
Read the analysisA structured timeline and key data points that empower self-insured employers in health plan negotiations.
Read the analysisDirect contracting isn't just for Fortune 500 companies anymore, but employers under 500 lives face real structural limits. Here's what actually works at your size and what will waste your time and budget.
Read the analysisExplore how self-insured employers are optimizing specialty care through carve-outs in high-cost procedures.
Read the analysisExplore how cost-plus pharmacy models work, the implications of NADAC pricing, and how to evaluate pharmacy benefit manager alternatives.
Read the analysisCarving out pharmacy, behavioral health, or oncology from a direct contract can cut costs and improve care—but done wrong, it fragments care and adds administrative overhead. Here's how to decide.
Read the analysisSelf-insured employers can utilize hospital price transparency data to negotiate better direct contracts and significantly reduce healthcare costs.
Read the analysisA comprehensive overview of stop-loss insurance types, key terms, and negotiation strategies for self-insured employers.
Read the analysisCost Plus Wellness posts provider contracts publicly, bans insurer participation, and requires 30-day payment — and ambulatory surgery centers are signing up first.
Read the analysisExplore the real return on investment for employers integrating Direct Primary Care with their health plans.
Read the analysisA detailed comparison of TPA and ASO for self-insured employers, focusing on administration, cost controls, and contracts.
Read the analysisA detailed look at reference-based pricing and its impact on self-insured employers.
Read the analysisPricing alone doesn't make a direct contract work. Here's how to build quality accountability into the deal without turning it into a compliance audit.
Read the analysisThe first direct contract you sign matters more than the fifth. Here’s a simple way to pick a market and service line where the politics, economics, and operations are most likely to work.
Read the analysisDirect contracting changes the claim pattern, not the fact that you’re self-funded. Here’s how to keep your stop-loss underwriter comfortable while you experiment with new contract structures.
Read the analysisMost self-funded employers underestimate how much their TPA can help—or hurt—a direct contracting strategy. This is how to align roles, incentives, and operations before the first claim hits.
Read the analysisMost boards have never heard a clean, CFO-grade explanation of direct contracting. This is the slide order that gets you through the conversation without hand-waving or vendor jargon.
Read the analysisIf you cannot see steerage, unit cost, leakage, and experience in year one, you are flying a direct contract without instruments.
Read the analysisDirect contracting does not replace TPAs; it changes what 'good' looks like for administration, data, and member experience.
Read the analysisDirect contracts save nothing if members do not use them. This is how employers build steerage that feels like an upgrade instead of a restriction.
Read the analysisDirect contracting is easier in some markets than others. These are the signals that your employer population and provider landscape are ready.
Read the analysisFor many providers, predictable cash flow is as valuable as a higher rate. Employers who understand that can trade timing for price.
Read the analysisMost failed direct contracts do not blow up on pricing; they erode quietly through weak steerage, vague data rights, and misaligned partners.
Read the analysisCFOs don’t buy innovation decks. They buy clear baselines, contract deltas, and reversible tests of capital discipline.
Read the analysisA 90-day pilot is the only credible way for most self-insured employers to test direct contracting economics, steerage, and operations without gambling the whole benefit design.
Read the analysisMost employer teams scan direct contracts for the legal boilerplate and skip the few clauses that actually drive cost. This is how to read the document like a CFO instead of a benefits brochure.
Read the analysisThe ingredients have finally lined up: rising employer costs, more self-funded exposure, public contract infrastructure, and a market that is increasingly tired of paying carriers to sit between the buyer and the provider.
Read the analysisDirect contracting gives self-insured employers a way to negotiate rates, care pathways, and accountability directly with providers instead of outsourcing every pricing decision to an insurer.
Read the analysisA direct contract can lower cost and improve control, but only if the economics, steerage, and operating model are real. These are the five questions finance leaders should ask first.
Read the analysisThe direct contracting market still runs on scattered announcements and case studies. Here are the public deals and platforms that actually matter right now.
Read the analysisCost Plus Wellness is doing something the employer market rarely sees: publishing contract structure openly enough for buyers to compare how direct arrangements are actually being built.
Read the analysisNot every direct contract works. The difference between a useful failure and a political disaster is how you handle the post-mortem.
Read the analysisYear-one results make or break the internal story for direct contracting. Here’s how to calculate ROI in a way your CFO will trust.
Read the analysisCOE programs and direct contracts are often run as separate projects. Done well, they’re two sides of the same steerage strategy.
Read the analysisDirect contracting often ignores pharmacy until a specialty claim blows up the math. PBM strategy and medical direct contracts have to talk to each other.
Read the analysisYou don’t have to ‘go all in’ on direct contracting to get value. Targeting high-cost outliers can be a quieter, more practical first move.
Read the analysisDone badly, direct contracting sounds like a network cut. Done well, it feels like a new benefit path that happens to save money.
Read the analysisThe joint operating committee is where direct contracts either get managed or slowly drift. A clear charter keeps both sides honest.
Read the analysisMost providers say they want value-based contracts until the downside clauses show up. Here’s how to structure risk so both sides can live with it.
Read the analysis‘Bundle’ and ‘case rate’ get used interchangeably in direct contracting conversations. They’re not the same, and the differences matter for risk, reporting, and provider behavior.
Read the analysisIf every direct contracting platform pitch sounds the same, it’s because the questions are too generic. Here’s an RFP checklist that separates infrastructure from marketing.
Read the analysisYou don’t need a 20-person center of excellence to run a serious direct contracting program. You do need clear roles and a realistic view of the work.
Read the analysisMost direct contracting dashboards are noise. Here are the few metrics that actually tell you whether a program is working and what to do next.
Read the analysisWalking into a direct contract negotiation without your own claims view is like buying a building without looking at the rent roll. Here’s the minimum analysis to do first.
Read the analysisMost direct contracting programs underpay the incentive side of steerage. Here’s what it takes to make the preferred pathway feel like a genuine upgrade to members.
Read the analysisReference pricing and direct contracting aren’t competing ideas. A tight reference price can be the backbone of a simple, durable direct contract.
Read the analysisA direct contract in a one-system town behaves very differently from one in a fragmented metro. The same playbook doesn’t work for both.
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