Four layers.
One system.
Plan construction, live intelligence, active intervention, and access to terms the mid-market has never been offered. Any one of them alone produces a nice-sounding capability. Together they produce a plan that performs.
Remove any one layer and the other three stop compounding.
Construction without intelligence is a guess. Intelligence without intervention is a report. Intervention without access is a phone call nobody returns. And all three without a plan document that permits them is a legal dead end.
The chassis
Before a plan can be managed, it has to be built so that management is possible. Most are not. They are inherited bundles — a carrier’s network, that carrier’s pharmacy arrangement, a stop-loss policy sold alongside both, and a plan document written for the vendor’s convenience. Construction means making each of those a deliberate decision instead.
What that includes
- How the plan is fundedSelf-funded, level-funded, or a captive arrangement — and what risk that actually puts on the balance sheet.
- Who administers itAdministration considered on its own merits rather than accepted as whatever came bundled with the network.
- How care is accessedBroad network, narrower network, or direct arrangements — a choice that should follow your geography and your claims, not habit.
- How pharmacy is purchasedPharmacy is a large and fast-growing share of spend. It deserves to be a deliberate decision rather than a line in someone else’s contract.
- How catastrophic risk is coveredStop-loss structured against a plausible bad year, with the terms understood before they are needed.
- What the plan document allowsThe document is the legal foundation for everything else. If it does not permit a better care pathway, nothing downstream can deliver one.
The instrument panel
Data that arrives quarterly, aggregated, and three months stale cannot drive a decision. We integrate claims, eligibility, pharmacy, and financial feeds into one continuously refreshed model, and we watch it.
What that includes
- Where the waste isPrice outliers, site-of-care differentials, and pharmacy purchasing gaps, identified by dollar rather than by anecdote.
- What the trend is doing nowClaims read against budget as the year develops, so month seven tells you something month eleven can no longer fix.
- Which situations are emergingHigh-cost care surfaced while it is developing, rather than discovered when the reimbursement notice arrives.
- What the vendors are deliveringPrograms billed per employee per month, measured against the use they actually get.
- What next year looks likeA forecast, and what each change under consideration would do to it.
The part that moves money
This is the difference. Analytics nobody acts on are a report. Intervention means an expensive situation gets addressed while the care is still ahead of the member: the opportunity identified, the clinical question put to the treating physician, the choice put to the member, and the change coordinated with the plan’s administrator and vendors before the money is spent.
What that includes
- Site-of-care alternativesInfusions, imaging, and procedures delivered in a clinically appropriate, far less expensive setting — where the treating physician agrees it is appropriate.
- Better care pathwaysWhere a different route to the same or better clinical outcome exists, putting it in front of the physician and the member rather than leaving it undiscovered.
- Purchasing alternativesThe same therapy obtained through a different channel or on different terms, without changing what the member receives.
- Vendor coordinationThe practical work of making a change actually happen across the administrator, the providers, and the vendors involved.
- Member supportSupport constructed into the plan, so a member facing something expensive and confusing has somewhere to turn.
Fortune 100 terms, mid-market plan
Very large employers have always had better healthcare economics — not because they negotiate harder, but because they are offered vendors, terms, and structures that never reach a plan with a few hundred employees. That gap is structural rather than mathematical, which is what makes it closeable.
What that includes
- Vendor relationshipsTerms and pricing that are ordinarily extended only to employers many times your size.
- Large-employer strategiesApproaches that work perfectly well at a few hundred employees but are almost never brought to a plan that size.
- Better purchasingThe savings come from buying care and services better, which is a different exercise from negotiating a renewal.
- IndependenceThe right vendor for your plan is a question that should be answered on the merits.
How the work is sequenced.
A construction phase, which has an end, and a management phase, which does not.
Understand it
What the plan spends, where that money goes, and what a differently constructed version of the same plan would look like.
Build it
Funding, administration, network access, pharmacy, stop-loss, and plan document — decided deliberately and sequenced around your renewal date.
Turn it on
The plan goes live with the analytics reading it and member support built in from the first day rather than added later.
Manage it
Continuous attention to what the plan is doing, and action on expensive situations while they are still in motion. This is the part that does not stop.
Cut the waste.
Not the benefits.
Every strategy in this method removes cost from the purchase of care. None of them removes care from your people.