Trend control
We manage the drivers — unit price, site of care, pharmacy spread, network leakage, and high-cost claimants — rather than negotiating the percentage those drivers produce.
All four views
For the chief financial officer
Stop negotiating the increase.
Stop negotiating the increase.
Start managing the cost.
A renewal negotiation moves a number. Plan management changes what generates the number. You get line-of-sight into every dollar, a run-rate you can forecast against, and savings documented well enough to survive an audit — none of which come out of your employees' pockets.
Paid claims run-rateRolling 12, trended against budgetLive
High-cost claimant watchMembers trending toward the specific deductibleEarly
Opportunities identifiedTied to a specific claim and a specific actionTraceable
Stop-loss positionAggregate corridor and specific reimbursementsTracked
Illustrative view of the questions active management is built to answer.
What changes
Financial control, in the places you actually lack it.
Most CFOs discover their healthcare result in month eleven. That is not a reporting problem — it is a management problem that reporting merely reveals.
Forecast integrity
Paid claims run-rate, IBNR, stop-loss position, and projected year-end in one view, refreshed monthly. You stop finding out late, which is when options disappear.
Attributable savings
Because a change is made against a known starting point, the result traces to a specific action on a specific claim rather than to a renewal percentage somebody negotiated.
Where the money moves
The drivers behind the number.
These are the things that actually generate your trend. A renewal negotiation addresses the percentage they add up to; plan management addresses the drivers themselves.
- Unit priceThe same service priced very differently across facilities in the same market, with no corresponding difference in the care.
- The vendor stackPrograms billed per employee per month whose actual use, and actual value, nobody has tested lately.
- Cash flow, not just costSelf-managing changes when money leaves the building, which is a separate question from how much of it leaves. Both are worth modelling before anything changes.
- High-cost claimantsA small number of members whose care, left unmanaged, sets the tone for the entire plan year.
| Lever | Marketed once a year | Actively managed |
|---|---|---|
| Unit price | Accepted as the network rate | Benchmarked, and bought on better terms |
| Site of care | Wherever the referral lands | Alternatives raised while care is still ahead of you |
| Specialty pharmacy | Bundled in the PBM deal | Purchased deliberately, as its own decision |
| High-cost claimants | Discovered after the fact | Visible as they emerge, addressed in-year |
| Vendor stack | Grows every year | Measured against what it actually delivers |
The part nobody puts in a proposal
Walk into the board meeting with the one slide every CFO wants: the cost line that went the other way.
You have defended this number for years using someone else's explanation. The point of plan management is that the explanation becomes yours — specific, sourced, and repeatable next quarter.