Are You Confident Your Health Plan Is Being Properly Governed?

Most employers spend millions on their health plan without clear governance. We install financial oversight, vendor accountability, and true pharmacy transparency — so your plan operates like a well-run business unit: predictable, measurable, and aligned with your organization’s financial goals.

  • Your health plan lacks a formal governance framework.
    There is no written structure defining oversight, accountability, or decision-rights.

  • Key vendors operate without measurable performance expectations.
    No defined KPIs, no documented SLAs, and no consequences for poor results.

  • Pharmacy spend is not proactively managed.
    Opaque contracts, limited transparency, no ingredient-level auditing, and no comparative-effectiveness safeguards.

  • High-cost claimants are unmanaged or reactively addressed.
    No predictive risk identification, case-management escalation path, or periodic reviews.

  • No unified financial dashboard exists.
    Leadership cannot see trend, variances, exposure, or 12–36 month projected budgets at a glance.

  • Contracts and plan documents are not tightly aligned.
    TPA, PBM, stop-loss, and plan-document language often conflict — exposing the employer to unnecessary liability.

  • No annual governance calendar.
    Tasks like renewal preparation, vendor audits, fiduciary reviews, and legal compliance are handled reactively instead of on a structured cycle.

Spending too Much on Health Care

Our Solutions

Governance & Oversight

We install a clear decision-making structure, define roles, and create a governance calendar that brings predictability and accountability to your health plan.
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Vendor Performance Management

We establish KPIs, SLAs, and vendor scorecards — holding TPAs, PBMs, networks, and care management firms accountable for measurable results.

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Funding Strategy & Risk Modeling

We evaluate your plan’s financial structure—self-funded, level-funded, captive, consortium, or hybrid—and model expected, best-case, and worst-case scenarios over 12–36 months so leadership can plan with confidence.

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High-Cost Claimant Strategy

We identify emerging high-cost claimants early and implement a structured escalation path—case management, centers of excellence, and coordinated care—to reduce avoidable spend and protect your plan.
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Financial Stewardship & Forecasting

We provide CFO-ready reporting, 12–36 month forecasts, trend analysis, and stop-loss oversight so leadership always knows risk, exposure, and budget impact.

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Pharmacy Oversight & Transparency

We create clarity around ingredient-level pricing, eliminate spread and hidden fees, enforce audit rights, and align your pharmacy program with comparative-effectiveness and clinical value.
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Start With a Governance & Risk Diagnostic

A focused 20-minute conversation will quickly show whether your health plan has the governance,
financial controls, and vendor accountability your organization needs — or where the gaps are.

What you’ll receive:

  • A brief review of your current governance structure, pharmacy oversight, and financial monitoring
  • A preliminary assessment of risk, waste, or misalignment in your plan design, vendors, and contracts
  • Clear next steps to strengthen performance, reduce volatility, and protect your organization

No pressure. No obligations. Just clear visibility into how your plan is being run.

→ Schedule a 20-minute Governance Diagnostic call

Prefer email? Contact us at info@allypartners.net