The play I keep coming back to
At Geisinger, I created bundled offerings we sold directly to employers: a defined episode of care, a price, and a contract between the health system and the people actually paying for the care, without a carrier's network math in the middle.
We worked on the same play at DVACO (never had a bite).
Direct-to-employer is a hard sale. Employers buy benefits through brokers and consultants, the buying cycle runs on renewal calendars, and a provider walking in with a bundle is asking a benefits team to rewire how they buy. Most of these pitches just die.
What level-funded changes
A level-funded plan gives an employer self-funded economics with a predictable monthly payment. The payment covers expected claims, stop-loss insurance, and administration. If claims come in under the funding, the employer gets money back at the end of the year.
That refund is the whole psychology. When the employer keeps what they don't spend, the employer starts caring how care actually gets delivered. And the MGUs (managing general underwriters) who build and run these plans live on claims performance, so they care too.
It's a rapidly growing segment, and I think it takes over the employer insurance market soon.
What we're building
Right now I'm building a direct contracting network with providers for a level-funded plan and MGU. I can't disclose the network partners yet. The design I can describe: the member experience and the workflow are being built directly inside the payer, heavily backed by AI at every step.
Building inside the payer matters. Point solutions bolted onto a plan from the outside fight for eligibility files and member attention. Inside the payer, enrollment, claims, and outreach run in one place, and the AI works from the full picture instead of a nightly file drop.
The clinical levers are the commercial ones: site-of-care optimization, pre-operative management, infusion cost mitigation. Levers that pay off inside a 1-3 year horizon, before the contract renews.
I've been circling employer risk for years: COE networks designed for a coalition of 42 self-insured employers (7 million lives) through the Health Transformation Alliance, and Angle Health's clinical cost mitigation MSO across 110K commercial lives. The level-funded network is where all of it points.
Bundles were my first draft of this idea at Geisinger. A direct contracting network inside a level-funded plan is the version I think scales.