01
Foundation
Control the economics
Build visibility, financing discipline and risk protection before pursuing isolated cost-containment ideas.
← The Framework
The High Performance Health Plan Framework™
The 10 Components
A high-performing health plan is not the result of a single vendor, discount or annual negotiation. It is the result of ten connected management disciplines that make cost, quality, access and accountability visible.
02
Strategy
Improve the healthcare
Design better access and better pathways for the care moments that shape both cost and employee experience.
03
Governance
Make it sustainable
Create the accountability, communication and measurement practices that make progress durable.
Explore each discipline
Component 01
Plan Financing & Risk Strategy
Plan financing and risk strategy is the deliberate choice of how an employer funds claims, retains risk and protects against volatility based on its goals, cash flow and risk tolerance.
Are we financing healthcare in the most efficient way for our organization?
Explore this componentComponent 02
Data, Analytics & Transparency
Data, analytics and transparency create the visibility employers need to understand claims, prices, utilization, vendor performance and the drivers behind a plan’s financial results.
Do we actually know where our healthcare dollars are going?
Explore this componentComponent 03
Medical Network & Provider Economics
Medical network and provider economics is the ongoing work of evaluating actual allowed prices, quality, access and care settings rather than equating a network discount with value.
Are we paying reasonable prices for high-quality healthcare?
Explore this componentComponent 04
Pharmacy & Specialty Drug Management
Pharmacy and specialty drug management gives employers visibility into PBM pricing, rebates, specialty sourcing and clinical programs so pharmacy is managed as a strategic spend category.
Do we understand the economics behind every pharmacy dollar?
Explore this componentComponent 05
Stop-Loss & Catastrophic Risk
Stop-loss and catastrophic risk strategy treats coverage as a financial instrument within the employer’s broader risk-management approach, with attention to contract terms and maximum liability.
Are we protecting the plan against catastrophic claims without unnecessarily transferring dollars to an insurer?
Explore this componentComponent 06
Primary Care & Early Intervention
Primary care and early intervention make high-quality, accessible care the front door to the health system, helping employees address needs before they become more complex and costly.
Can employees access high-quality care before small problems become expensive ones?
Explore this componentComponent 07
High-Cost Care & Clinical Strategy
High-cost care and clinical strategy creates intentional pathways for the relatively small number of episodes and members that can drive a disproportionate share of plan spending.
Do employees have a better pathway when healthcare becomes expensive or complex?
Explore this componentComponent 08
Navigation & Employee Experience
Navigation and employee experience give members practical support to find high-quality care, understand benefits and resolve administrative friction during stressful healthcare decisions.
Can employees actually figure out how to use the health plan?
Explore this componentComponent 09
Fiduciary Governance, Contracts & Accountability
Fiduciary governance, contracts and accountability establish a repeatable process for oversight, documentation, procurement and vendor management throughout the year.
Can the employer demonstrate that the plan is being managed prudently and in the interests of participants?
Explore this componentComponent 10
Employee Engagement, Communication & Measurement
Employee engagement, communication and measurement make benefits understandable and connect plan initiatives to defined financial, clinical and experience outcomes.
Are employees using the plan the way it was designed—and can we prove the strategy is working?
Explore this componentStart with a clearer view