ExplainerJune 15, 20268 min
Understanding Level-Funded Health Plans: Benefits, Suitability, and Hidden Costs
Explore how level-funded health plans operate, who they are best for, and the hidden costs often overlooked by brokers.
Read the analysisIntelligence
Analysis for employers cutting out the middleman.
Reverse-chronological coverage of deals, platform launches, benefit design shifts, and the operating mechanics behind direct contracting.
ExplainerJune 13, 20268 min
Self-Insured vs Fully-Insured: Key Factors in Making the Switch
Understand the headcount thresholds, cash flow needs, and risk profiles to determine the best health insurance model for your organization.
Read the analysisExplainerMay 18, 20268 min
Understanding Cost-Plus Pharmacy: A Guide for Employers
Explore how cost-plus pharmacy models work, the implications of NADAC pricing, and how to evaluate pharmacy benefit manager alternatives.
Read the analysisExplainerMay 13, 20268 min
TPA vs ASO: Key Considerations for Self-Insured Employers
A detailed comparison of TPA and ASO for self-insured employers, focusing on administration, cost controls, and contracts.
Read the analysisExplainerMay 12, 20268 min
Understanding Reference-Based Pricing for Self-Insured Employers
A detailed look at reference-based pricing and its impact on self-insured employers.
Read the analysisExplainerMay 4, 20268 min
Negotiating Quality Metrics Into a Direct Contract
Pricing 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 analysisExplainerApril 30, 20268 min
Picking Your First Direct Contracting Market
The 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 analysisExplainerApril 29, 20267 min
Stop-Loss and Direct Contracts: What Underwriters Actually Care About
Direct 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 analysisExplainerApril 28, 20267 min
Where Your TPA Fits in a Direct Contracting Program
Most 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 analysisExplainerApril 27, 20267 min
How to Brief Your Board on Direct Contracting in 10 Slides
Most 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 analysisExplainerApril 26, 20268 min
Year One Metrics for Direct Contracts: What to Track and When to Worry
If you cannot see steerage, unit cost, leakage, and experience in year one, you are flying a direct contract without instruments.
Read the analysisExplainerApril 26, 20269 min
Steerage That Actually Works: How to Move Members Into Direct Contracts
Direct 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 analysisExplainerApril 26, 20267 min
Is Your Market Ready for Direct Contracting? Five Signals to Check
Direct contracting is easier in some markets than others. These are the signals that your employer population and provider landscape are ready.
Read the analysisExplainerApril 26, 20267 min
Building the Direct Contracting Business Case for Your CFO
CFOs don’t buy innovation decks. They buy clear baselines, contract deltas, and reversible tests of capital discipline.
Read the analysisExplainerApril 26, 20268 min
How to Run a 90-Day Direct Contracting Pilot Without Betting the Plan
A 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 analysisExplainerApril 25, 20269 min
How to Read a Direct Contract: 7 Clauses That Actually Move Cost
Most 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 analysisExplainerApril 24, 202610 min
What Is Direct Contracting? The Complete Guide for Employers
Direct 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 analysisExplainerApril 24, 20265 min
5 Questions Every CFO Should Ask Before Signing a Direct Contract
A 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 analysisExplainerApril 21, 20267 min
Integrating Centers of Excellence Into a Direct Contracting Strategy
COE programs and direct contracts are often run as separate projects. Done well, they’re two sides of the same steerage strategy.
Read the analysisExplainerApril 18, 20267 min
Communicating Direct Contract Changes to Employees Without Spooking Them
Done badly, direct contracting sounds like a network cut. Done well, it feels like a new benefit path that happens to save money.
Read the analysisExplainerApril 17, 20266 min
How to Write a Joint Operating Committee Charter for a Direct Contract
The joint operating committee is where direct contracts either get managed or slowly drift. A clear charter keeps both sides honest.
Read the analysisExplainerApril 15, 20267 min
Bundled Payments vs. Case Rates in Direct Contracting
‘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 analysisExplainerApril 13, 20267 min
Staffing a Direct Contracting Program With a Small Team
You 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 analysisExplainerApril 11, 20268 min
Running a Claims Deep Dive Before You Negotiate a Direct Contract
Walking 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 analysisExplainerApril 10, 20267 min
Designing Member Incentives That Actually Move Steerage
Most 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 analysisExplainerApril 9, 20266 min
Using Reference Pricing Inside a Direct Contract
Reference pricing and direct contracting aren’t competing ideas. A tight reference price can be the backbone of a simple, durable direct contract.
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