Guides to direct-pay healthcare

12 plain-English guides to how healthcare is priced and paid for, written for the people who have to decide: employers choosing a plan, brokers advising them, practices deciding whether to publish a price, and patients paying out of pocket.

For employers and HR

Direct contract health plans: how they actually work — What a direct contract health plan is, how it differs from renting a network, and what changes for an employer who moves to one.
Can you run a self-funded plan without a traditional TPA? — What a TPA actually does for a self-funded employer, which of those jobs a direct-pay marketplace removes, and which ones still have to be done by somebody.
An alternative to reference-based pricing — Why reference-based pricing produces balance bills and member friction, and what agreeing the price in advance changes about that.
Transparent healthcare pricing, and what it is worth to an employer — Published prices only reduce cost when somebody can act on them. What an employer needs alongside transparency for it to change the bill.
Lowering health plan costs at a small company — The levers a small employer actually controls on health benefits, and which ones change cost rather than shifting it onto employees.

For brokers and consultants

What a broker should know before recommending direct contracting — Where direct contracting genuinely helps a client, where it does not, and the questions worth asking a vendor before you put it in a renewal.
Switching to a direct-pay health plan: what actually changes — A practical account of what changes for members, for finance and for administration when an employer moves care to contracted prices.

For providers and practices

What a direct-pay provider network is, from the practice side — How a direct-pay network differs from a payer contract, what a practice gives up, and what it gets in return.
Getting paid upfront: what it changes in a practice — The real cost of the claims cycle to a practice, and what changes operationally when payment arrives at booking instead.
Bundled pricing for surgery: one price for the whole episode — What a surgical bundle includes, why unbundled billing produces surprise bills, and how a single episode price removes them.

For patients paying cash

Paying cash for healthcare, and when it beats using insurance — How cash-pay healthcare works, when it costs less than using your insurance, and what to check before you book.
How to compare medical prices without getting caught out — A practical method for comparing what a procedure costs, and the three traps that make two quoted prices not comparable.

Deploy this for your team

Mishe assembles published payer and Medicare data into the pricing, claim-editing and care-pathway intelligence that runs underneath the plans it operates. You can see the underlying numbers yourself, without an account and without talking to anyone.

Take back healthcare.