Most employers shop for health insurance the same way every year.
They compare premiums.
They negotiate renewals.
They argue over deductibles.
And somehow, costs still go up.
That’s not because you’re doing it wrong.
It’s because you’re focused on the wrong thing.
Cost of coverage vs. cost of care
Premiums are what you pay to have insurance.
Cost of care is what actually gets spent when people use it.
If you focus on premiums, you’re arguing over the sticker price.
If you focus on care, you’re controlling the bill.
Once you make that mental shift, entirely different strategies become possible.
Below are five very different health plan designs we’ve implemented for real employers. Different sizes. Different industries. Different risks.
None of them are “standard.”
All of them work.
1. Construction Company (350 employees) – Florida
ICHRA + Direct Primary Care
The problem:
A large, spread-out workforce. High admin burden. Leadership spending way too much time managing benefits issues.
The solution:
We separated access to doctors from insurance paperwork.
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ICHRA gives employees a fixed monthly allowance to buy their own major medical plan.
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Direct Primary Care (DPC) gives employees unlimited access to a primary care doctor for a flat monthly fee.
Think of it like this:
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Insurance = seatbelt (important for big accidents)
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DPC = daily driving (checkups, sick visits, prescriptions)
Why it worked:
Employees used their doctors more. Leadership dealt with insurance less.
DPC participation was 6× higher than when the company offered a traditional group plan.
Less noise. More care.
2. White-Collar Employer (400 employees) – Illinois
Cost-Sharing + Self-Funded MEC + HSAs
The problem:
Rising costs and unpredictable claims exposure, especially from big medical events.
The solution:
We split the plan into clear “buckets,” each with a job.
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Major medical events (hospital stays, serious diagnoses) → handled through cost-sharing
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Compliance + prescription drugs → handled through a self-funded MEC
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Everyday expenses (office visits, small prescriptions) → paid through HSAs
Think of it like household budgeting:
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Mortgage = big, rare expense
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Utilities = recurring expenses
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Pocket money = day-to-day spending
Why it worked:
Risk was cleaner. Costs were more predictable.
The employer stopped over-insuring small stuff and focused protection where it mattered.
3. Manufacturer (30 employees) – Georgia
Cash-Pay + Direct Primary Care + Nurse Navigators
The problem:
A small team priced out of traditional insurance but still needing real access to care.
The solution:
We built a cash-pay system around DPC and added nurse navigators for support.
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No networks.
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No surprise bills.
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Prices shown upfront.
When care needs escalate, a nurse helps the employee find the right provider at a fair price.
Why it worked:
Employees understood the system.
The employer avoided inflated “insurance pricing.”
Care became simpler, not scarier.
4. Manufacturer (100 employees) – Missouri
Captive Self-Funding + Direct Hospital Contract
The problem:
Strong workforce. High healthcare utilization. Paying too much to the biggest hospital system in the state.
The solution:
We used a captive to self-fund risk and negotiated directly with the dominant provider system.
No middlemen setting prices.
No guessing what things cost.
Why it worked:
Employee out-of-pocket costs dropped by about 50%.
The employer gained leverage instead of hoping for discounts.
5. Hospitality Group (70 employees) – Texas
Reference-Based Pricing + Direct Contracts
The problem:
High utilization services (labs, imaging, equipment) driving costs and employee frustration.
The solution:
We combined:
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Reference-Based Pricing for major services
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Direct contracts for labs, imaging, DME, and other high-frequency needs
Think of it like shopping with price tags instead of mystery receipts.
Why it worked:
Costs were controlled without constant employee disruption.
No endless billing fights. No revolt.
The takeaway
There is no single “right” health insurance plan.
But there is a right approach.
The right approach:
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Starts with how care is delivered
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Separates risk instead of bundling everything together
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Matches the plan to the workforce, not the carrier’s default
If you’re willing to move beyond off-the-shelf options, there’s more flexibility than most employers realize.
And once you stop shopping for cheaper coverage and start designing smarter care, the math finally starts to work in your favor.
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