Intelligence
Reverse-chronological coverage of deals, platform launches, benefit design shifts, and the operating mechanics behind direct contracting.
Self-insured employers now publish detailed pricing and coverage data in machine-readable formats—here's what you're required to do and how to use it.
Read the analysisThis post breaks down reference-based pricing, its repricing mechanics, and common pitfalls for 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 how cost-plus pharmacy models work, the implications of NADAC pricing, and how to evaluate pharmacy benefit manager alternatives.
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 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 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 analysisSelf-insured employers use direct contracting to cut out the carrier middleman and negotiate rates, care pathways, and accountability directly with providers. Here's how the model works, who's using it, and what a real contract looks like.
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 analysisCOE programs and direct contracts are often run as separate projects. Done well, they’re two sides of the same steerage strategy.
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 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 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 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.
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