How It Works — CommonHealth Plan

The Big Picture

A Coordinated System, Not a Collection of Vendors

CommonHealth Plan integrates a structured vendor ecosystem designed to function as a single operating model. Employers enter through a controlled onboarding mechanism and transition into true self-funding as they gain data, credibility, and operational confidence.

Every component — from primary care to pharmacy to stop-loss — is aligned toward one goal: better outcomes at lower cost, with full transparency.

"A community-owned healthcare system that uses disciplined design, transparent economics, and aligned incentives to reduce costs by 20–30%."

The CommonHealth Plan Summary

The Journey

From Entry to Full Ownership

Employers progress through a clear, structured pathway that builds control and reduces cost over time.

1

Entry: Level-Funded Structure

Employers enter through a level-funded model — providing predictable monthly costs, a lower barrier to entry compared to full self-funding, and immediate access to the COHP structure and vendor ecosystem. A controlled, low-risk onboarding mechanism.

2

Build: Data, Transparency & Familiarity

Employers gain claims credibility, data transparency, and operational familiarity with the system. They develop a clear picture of their population's health, utilization patterns, and cost drivers — knowledge the old system never gave them.

3

Transition: True Self-Funding

Employers transition into true self-funded arrangements supported by stop-loss coverage. This increases employer control, improves long-term economics, and strengthens risk management discipline — giving employers genuine ownership of their healthcare outcomes.

Core Infrastructure

The Engine Behind the Model

A coordinated vendor ecosystem — not a collection of point solutions, but a system designed to operate as one.

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Third-Party Administration

Transparent claims administration with full employer visibility and no hidden fees.

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Reference-Based Pricing

RBP or direct contracting reduces inflated provider pricing at the source.

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Direct Primary Care

Advanced primary care reduces unnecessary specialist and ER utilization.

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Transparent PBM

Pharmacy benefit management that eliminates spread pricing and rebate distortion.

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Care Navigation & Steerage

Members guided to the right care, at the right time, at the right cost.

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Stop-Loss Protection

Structured stop-loss integration manages catastrophic risk throughout the transition.

The Economics

How 20–30% Savings Are Achieved

These savings are engineered, not negotiated. Structural improvements across five dimensions — not cost shifting to employees.

20–30%

Cost reduction target

5

Structural drivers

1. Unit Cost Reduction

Reference-based pricing and direct contracting eliminate inflated provider rates. Transparent PBM removes spread pricing and rebate distortion.

2. Utilization Management

Direct Primary Care and primary care-first models reduce unnecessary specialist and ER utilization. Navigation ensures members access the right care.

3. Elimination of Waste

Hidden fees, duplicative services, and unmanaged networks are removed. Payment integrity tools prevent overbilling and financial leakage.

4. Standardized Plan Design

Disciplined, repeatable plan design reduces variability and adverse selection — improving underwriting confidence and stabilizing risk.

5. Better Risk Alignment

Structured stop-loss integration, controlled entry through level funding, and a clear glidepath to self-funding create predictable, manageable financial exposure.

How CommonHealth Plan Works