Case Studies May 29, 2026

A Tech Company Validates its Direct Contracting and RFP Strategies

Company Profile:

~15,000 U.S. employees
Self-funded, major metro area
4-month engagement (Jan-April, aligned with RFP process)

The Challenge:

The company sought to fulfill its fiduciary responsibilities, validate its benefits consultant’s RFP recommendations, and confirm the competitiveness of its direct-contracting arrangement with a local health system.

The Findings:

The data revealed significant pricing inconsistencies on common and high-cost medical procedures, and significant inaccuracies in its carrier’s data. The data also showed that the quality of care delivered by some of the employer’s key healthcare providers was lower than expected.

How the Company Leveraged the Findings:

Improved fiduciary accountability. The employer reviewed Transparency in Coverage (“TiC”) files so it could help meet its legal responsibilities as a plan sponsor, thereby enabling it to question carriers and hold them accountable for data-related gaps.
Validation of direct-contracting strategies. The employer confirmed that its existing health system direct contract was competitive, and it built a methodology for identifying future direct-contracting opportunities.
Stronger RFP processes. The employer used the aggregated data as an independent check on its benefits consultant’s analysis, and created carrier-specific questions regarding medical procedures that had shown major price variations across markets.
A blueprint for the future. The employer plans to integrate price transparency data into its medical-claims audit process.

Bottom Line:

This employer enhanced its ability to meet its fiduciary obligations, while also securing stronger carrier performance commitments and building new capabilities to pressure-test its consultant’s recommendations.

The Employer’s Advice:

“Use it as a tool for strategic decision-making and push toward better quality and affordability.”