Resource library
Guides for self-funded employers and their advisors
Plain-English explainers on healthcare cost containment, self-funding, stop-loss, emergency room economics, and what a modern telehealth benefit should deliver.
Cost containment
Cost containmentHow to Reduce Employee Healthcare Costs Without Cutting BenefitsRising healthcare costs aren't inevitable. Seven employer strategies that reduce claims spend without shifting costs to employees — ranked by effort and evidence.Cost containmentTelemedicine for Employers: What a Telehealth Benefit Should Include in 2026A buyer's guide to telemedicine for employers: what 24/7 telehealth benefits deliver, why utilization decides ROI, and how in-home diagnostics separate modern programs from video-only visits.Cost containmentWhat Is a Pharmacy Benefit Manager (PBM)? Follow the RebatePharmacy benefit managers sit between your health plan and every prescription. What PBMs do, how spread pricing and rebates work, and the questions self-funded employers should ask.Cost containmentHealthcare Claims Data Analysis: The Six Numbers Every Plan Sponsor Should PullYour claims data already knows where the money goes. The six metrics to pull — ER per 1,000, high-cost claimant concentration, site-of-care spread — and how to turn them into action.Cost containmentWhat Is Care Navigation? And Where It Stops WorkingCare navigation guides members to high-quality, fairly priced care and routinely pays for itself on big-ticket episodes. What navigation does well, where it stalls, and what to pair it with.
ER & urgent care economics
ER & urgent care economicsUrgent Care vs. Emergency Room: Which One, When — and What Each CostsUrgent care vs. emergency room: when each is the right call, what visits typically cost, and the third option — telehealth with in-home diagnostics — that resolves many episodes at home.ER & urgent care economicsHow Much Does an ER Visit Cost? What's Behind the BillER visit costs commonly run $1,200–$2,900+ once facility fees, imaging, and labs land. Here's what drives emergency room bills — and how employers and families avoid the avoidable ones.ER & urgent care economicsEmergency Room Alternatives: Where to Get Care When It's Not a True EmergencyNot every 9pm health scare needs the ER. Compare emergency room alternatives — urgent care, telehealth, retail clinics, and in-home diagnostics — by speed, capability, and cost.ER & urgent care economicsAvoidable ER Visits: The Math Every Self-Funded Employer Should RunRoughly two-thirds of ER visits are potentially avoidable. Here's how to quantify what they cost your self-funded health plan — and the benefit design that actually redirects them.
Self-funded fundamentals
Self-funded fundamentalsSelf-Funded vs. Fully Insured Health Plans: What Actually ChangesSelf-funded vs. fully insured: who carries the risk, what ERISA changes, where the savings come from, and why cost containment only pays off when the employer owns the claims.Self-funded fundamentalsWhat Is Stop-Loss Insurance? How Self-Funded Plans Cap Their RiskStop-loss insurance caps a self-funded employer's claims exposure. Specific vs. aggregate coverage, how deductibles and lasering work, and how claims experience shapes renewals.Self-funded fundamentalsWhat Is a Third-Party Administrator (TPA)? The Engine Room of Self-Funded PlansA third-party administrator (TPA) runs the machinery of a self-funded health plan — claims, networks, compliance, reporting. What TPAs do, how they're paid, and how to choose one.Self-funded fundamentalsLevel-Funded Health Insurance: Self-Funding With Training WheelsLevel-funded health insurance gives smaller employers self-funding economics — claims transparency and surplus refunds — with fixed monthly payments and built-in stop-loss protection.Self-funded fundamentalsWhat Is Captive Insurance? Group Captives for Self-Funded Health PlansCaptive insurance lets employers own a piece of their risk. How group medical stop-loss captives work, who they fit, and how claims performance turns into dividends.Self-funded fundamentalsReference-Based Pricing: Paying Hospitals From the Bottom UpReference-based pricing anchors what a health plan pays to a benchmark like Medicare rates instead of discounted hospital charges. How RBP works, the savings, and the member-experience risks.Self-funded fundamentalsERISA Compliance for Self-Funded Health Plans: What Plan Sponsors Actually OweA plain-English tour of ERISA compliance for self-funded employers: preemption, plan documents, fiduciary duty, Form 5500, and why the fiduciary era rewards benefits with provable value.
Benefits strategy
Benefits strategyPresenteeism and Absenteeism: The Productivity Bill Behind Your Healthcare BillAbsenteeism is the empty chair; presenteeism is the occupied one doing half the work. What each costs employers, why health access drives both, and the benefit designs that shrink them.Benefits strategyDo Employee Wellness Programs Work? What the Evidence Says — and What to Fund InsteadRigorous studies of classic employee wellness programs find weak short-term ROI. Where wellness spending disappoints, what the evidence supports, and how access-based benefits differ.Benefits strategyWhat Is Direct Primary Care? Flat-Fee Medicine, Explained for EmployersDirect primary care trades insurance billing for a flat monthly fee and real physician access. How DPC works, what it costs, its limits, and how it pairs with in-home diagnostics.