The plan is not a product to renew.
It is a business system to manage. The Framework focuses attention on the choices, contracts and evidence behind the renewal result.
The High Performance Health Plan Framework™
10 Components. 100 Points. One Objective.
Better healthcare at a sustainable cost.
The Framework gives employers a practical operating system for moving from passively purchasing health insurance to actively managing the economics, care and experience underneath the plan.
An executive view of health plan performance
Three layers. One management system.
The Framework organizes ten interconnected decisions into a clear sequence: control the economics, improve the healthcare and make the work sustainable.
01
Foundation
Control the economics
Build visibility, financing discipline and risk protection before pursuing isolated cost-containment ideas.
01
Plan Financing & Risk Strategy
Are we financing healthcare in the most efficient way for our organization?
Explore component02
Data, Analytics & Transparency
Do we actually know where our healthcare dollars are going?
Explore component03
Medical Network & Provider Economics
Are we paying reasonable prices for high-quality healthcare?
Explore component04
Pharmacy & Specialty Drug Management
Do we understand the economics behind every pharmacy dollar?
Explore component05
Stop-Loss & Catastrophic Risk
Are we protecting the plan against catastrophic claims without unnecessarily transferring dollars to an insurer?
Explore component02
Strategy
Improve the healthcare
Design better access and better pathways for the care moments that shape both cost and employee experience.
06
Primary Care & Early Intervention
Can employees access high-quality care before small problems become expensive ones?
Explore component07
High-Cost Care & Clinical Strategy
Do employees have a better pathway when healthcare becomes expensive or complex?
Explore component08
Navigation & Employee Experience
Can employees actually figure out how to use the health plan?
Explore component03
Governance
Make it sustainable
Create the accountability, communication and measurement practices that make progress durable.
09
Fiduciary Governance, Contracts & Accountability
Can the employer demonstrate that the plan is being managed prudently and in the interests of participants?
Explore component10
Employee Engagement, Communication & Measurement
Are employees using the plan the way it was designed—and can we prove the strategy is working?
Explore componentThe goal is performance, not simply a lower price.
No single solution is right for every employer.
Funding models, networks and vendors should follow the employer’s objectives, population and capacity—not the other way around.
The goal is performance, not simply a lower price.
The most durable strategy balances cost, quality, access, risk, employee experience and sustainability.