What to measure
Evidence before assumptions.
- Funding-model fit
- Claims credibility
- Reserve adequacy
- Long-term cost trajectory
← The Framework
Component 01
Plan Financing & Risk Strategy
Are we financing healthcare in the most efficient way for our organization?
Clear definition
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.
Common mistakes
What weakens performance.
- Treating self-funding as a strategy instead of a financing vehicle
- Choosing an arrangement only because it is presented at renewal
- Ignoring cash-flow and reserve requirements
High-performance practices
Build a deliberate approach.
01
Compare fully insured, level-funded, self-funded and captive structures against defined objectives
02
Model best-case, expected and adverse claim scenarios
03
Review administrative cost, taxes, margins and contractual flexibility together
Book connection
Chapter 10: Financing with intent
Chapters 10–16
Use the financing chapters to frame funding as a risk and capital decision—not a renewal selection.
Explore the bookHealth Plan Score connection
Plan Financing & Risk
How deliberately is the organization matching its funding model, reserves and stop-loss protection to its risk tolerance?
A lower score signals that the next step is to establish financial baselines and compare funding structures before the next renewal.
Take the Health Plan ScoreEmployer Benefits IQ resource
Self-Funded Readiness Assessment
A printable Employer Benefits IQ worksheet for defining the decision, evidence, accountable owner and review cadence.
Author perspective
By Corry Hull, REBC, CSFS — Author, The High Performance Health Plan and Founder, Employer Benefits IQ.
Explore the Health Plan Score