Roadmap to High Performance Employee Health Plan 

The Roadmap for a High Performance Employee Health Plan is in the Shape of a Pyramid.
1. Primary Care is the Foundation of a High Performance Employee Health Plan.
There is Virtual Primary Care and Onsite Clinics that provide care management, mental health services and health system navigation support.
Primary Care is Paid Directly by the Employer and is Not run through the insurance carrier.
2. Specialty Care is the Middle Layer and is run through the a TPA or ASO carrier. The key is the plan design steers plan members to the highest quality specialists by offering them at a lower out-of-pocket cost, while the low quality specialists have a higher out-of-pocket cost.
3. Acute Hospital Care is at the Top and Direct Contracting is Used Outside of the insurance carrier for Ortho, Cancer and Cardiovascular care.
This High Performance Employee Health Plan is then Surrounded by a Transparent, Pass-Through PBM.
The Companies Serigraph and QuadMed implemented similar plans over a decade ago with tremendous success and cost savings.
Specifically, Serigraph made an upfront investment of $2 Million for their 1,000 Employees and saved $31 Million over 9 Years.
Sources:
The Company That Solved Healthcare by John Torinus
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