As employers look for more control over health plan costs and the member experience, high-performance networks are getting more attention. That is especially true for organizations considering or already using an unbundled self-funded plan. In a recent Q&A with Centrus Health Direct (CHD), CBIZ explored five key considerations to help employers evaluate how these networks can support a smarter benefits strategy.
High-Performance Networks Can Lower Costs Without Cutting Quality
These networks are curated to include high-performing providers and competitive contracts, with the goal of reducing costs without sacrificing outcomes. CHD said its model is rooted in value-based arrangements and ongoing quality oversight, including the Healthcare Effectiveness Data and Information Set (HEDIS), alongside health systems and independent providers. The model intentionally includes high-value providers and excludes consistently high-cost settings, with flexibility to help guide employees to those providers. That structure can help employers achieve meaningful savings while maintaining the quality of care employees expect. It also gives employers a clearer path to help employees understand and use the network effectively.
“Our network is going to drive 20% plus savings on medical claims…compared to national BUCA broad networks,” said Justin Fallein, vice president of business development at CHD.
Jonathan Krass, senior account executive at CBIZ, said the transition to a high-performance network (HPN) can feel more manageable when employers give employees the awareness and information they need.
Quite often, employees and their families are already using the providers in the HPNs, but they are enrolled in the broad network plan, which means the employees are paying more for their coverage, and the plan is paying more for their claims. Through communication and education, employees can literally be shown the value of their plan selection, and how that selection can benefit both them and the plan without any change in how they receive care.”
Unbundled Self-Funding Puts Employers in Control of Four Building Blocks
Moving from a bundled carrier model to an unbundled approach lets employers and their consultants select the right partners for each component. In the session, CHD emphasized flexibility across more than 30 third-party administrators (TPAs), the ability to pair with transparent pharmacy benefit managers (PBMs) and stop-loss carriers that support cost-control strategies. Operationally, CHD said its partner, Healthcare Highways (HH), reprices claims at network contract rates before the TPA pays them, creating more consistent pricing and clearer data. The benefit is more opportunities to lower total cost. The challenge is making sure each partner works together with clear roles and tight coordination.
“Unbundled, self‑funded, that’s a model where you actually own your plan… The carrier doesn’t own your plan, you own your plan as the employer,” noted Fallein.
“Each one of those four pieces is a value opportunity to save money,” said Jeff Andersen, president of CHD.
Kevin Clipp, senior benefits consultant at CBIZ, said a trusted consultant can help take the guesswork out of the transition to self-funding.
“Self-funding can feel like an intimidating endeavor. With the right partner who can apply innovative approaches like Centrus, you can turn a traditionally confusing cost center like your employer health plan into a clear, strategic advantage that drives real savings.”
Use Data and Repricing to Help Employers Identify Measurable Savings
Before making a change, employers should ask for a repricing analysis of recent claims to estimate potential savings versus current contracts. In the operating model outlined, HH reprices every claim before payment, which centralizes pricing and preserves claim-level detail for analytics and fiduciary oversight. This enables a credible pro forma and helps employers design steerage (e.g., tiers, site-of-care strategies) to amplify savings beyond base discounts. Early results discussed in the session aligned with repricing expectations, while acknowledging outcomes vary by provider mix and member behavior.
“Before the TPA pays the claim, Healthcare Highways reprices every single claim… You own all the data,” said Andersen.
“Taking it a step further,” Krass said, “once you have access to all of your [organization’s] data in a self-funded plan, you can start addressing the underlying issues within your population, not just what the fully-insured carrier options include. This in turn points to solutions and other strategies that can be implemented to help mitigate your specific cost drivers while improving employee satisfaction and choice.”
Preserve Broad Access With Wraps, Tiers, and Navigation
Most employers have out-of-area members or travelers, so many pair a high-performance network as Tier 1 with a national wrap (e.g., Aetna, Cigna, First Health) as Tier 2 or offer a dual-option choice. Lower cost-share in Tier 1 encourages use of preferred providers while keeping Tier 2 available at higher cost-share to preserve flexibility. For travel, virtual care is a first line; emergencies are treated as in-network, and centers of excellence are typically handled with single-case agreements. CHD emphasized proactive provider outreach ahead of go-live to reduce intake and billing friction.
“The employee experience really should not be a whole lot different… than what they experience with any traditional insurance model,” noted Fallein.
Fit Depends on Your Footprint and Priorities
Start with a clear view of where your people live and seek care, then test network adequacy and repriced savings against your actual claims. Both Fallein and Andersen described a strong Kansas City metro footprint and discussed ongoing expansion, while noting that wraps, direct contracts, or reference-based pricing can address outliers.
For groups not ready for full unbundling, level-funded products through select partners can provide access to the network, with quoting available for groups with around 15 enrolled members. Larger groups may pursue captives with aligned TPAs.
As with any change, align stop-loss, define prior authorization and denial-management expectations with the TPA, and plan provider education and member communications.
“It doesn’t mean we’re going to be a fit for everybody,” Fallein acknowledged, underscoring the importance of a data‑driven evaluation before you move.
CBIZ Can Help You Move Forward With Confidence
Heading into the next renewal, now is the time for employers to ask deeper questions, pressure-test assumptions, and refine the approach. Connect with a CBIZ advisor to evaluate whether a high-performance network fits organizational goals, workforce needs, and budget.
DISCLAIMER:
Please note: CBIZ is not endorsing any exclusive partner. As healthcare costs are escalating, our responsibility is to help clients identify and evaluate every avenue to manage spend, including HPNs such as Centrus Health Direct.
Frequently Asked Questions
High-performance networks are typically built by selecting providers based on a combination of cost, quality, and patient experience rather than simply offering the broadest possible access. For self-funded employers, that means the network can help reduce unnecessary price variation and steer care toward providers that deliver strong outcomes at a more competitive cost. The key is to validate the opportunity with a repricing analysis, understand how providers are selected, and confirm what quality measures and ongoing oversight support the network’s performance.
Not necessarily. In many cases, employees are already using providers that participate in a high-performance network, even if they are currently enrolled in a broader plan. Employers can also preserve flexibility by pairing the network with a national wrap, offering tiered benefits, or giving employees a dual-option choice. The employee experience depends heavily on communication, provider outreach, and clear navigation support, so the transition works best when employers explain how the network functions and where employees can still access care when they are out of area or traveling.
No. The right fit depends on factors such as where employees live, where they receive care, current claims patterns, workforce travel needs, and the organization’s readiness to manage an unbundled strategy. Before making a change, employers should review a claims repricing analysis, test network adequacy across their footprint, and make sure the TPA, stop-loss carrier, PBM, and other partners can coordinate effectively. For some organizations, a full transition may make sense; for others, a wrapped, level-funded, or phased approach may be more appropriate.
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