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Renewal season does not start in December. It starts with the cases that ran in March.

By the time an advisor sits down for a stop-loss renewal, the claims that will drive the number have already happened. Most of them were not emergencies. They were planned. A spine surgery. A knee. A course of cancer treatment.

Roughly 5 percent of members drive about 56 percent of a self-funded plan's total spend. Members with claims over $100,000 are about 1 percent of lives and more than a third of the spend.

Planned care is the part of that you can actually get in front of.

Direct Care Alliance agrees on one all-in case price with a quality facility before the procedure happens. The employer commits to that price in advance. A care navigator coordinates the episode start to finish. The hospital is paid directly and fast.

If you are heading into fourth quarter renewals, the question worth asking now is which of next year's largest claims are already on someone's calendar.

So here is the question worth putting to the room.

When does your renewal conversation actually start? At the December meeting, at the last renewal, or the day a large case lands?

(Sources: Boon-Chapman Strategic Outlook 2026; Mployer Advisor 2026 Benefits State of the Union.)

Renewal season does not start in December. It starts with the cases that ran in March.

Here is what Direct Care Alliance puts in writing before a case ever runs.

One all-in case price, agreed with the facility before care.
The employer commits to that price in advance.
A care navigator coordinates the episode start to finish.
The facility is paid directly, at the agreed amount.
No prior authorization needed. The price is agreed in advance.

Five things, all of them checkable before a single patient is scheduled. That is the offer, in full.

We will publish outcome data when it is documented to a standard a broker could stake a client relationship on, and the method will be published with it.

If you are placing a plan this fall, what would you want a vendor to state in writing before you brought them to a client?

What Direct Care Alliance puts in writing before a case runs: one all-in price agreed with the facility, the employer committed in advance, a navigator on the episode, the facility paid directly at that amount. No prior authorization needed.

Most of the country is off today. A lot of hospitals are not.

Somewhere right now a scheduler is working a Monday holiday to move a surgery date that a family has been waiting on. Someone in a finance office is closing out a case from three weeks ago. A nurse is explaining, again, patiently, what happens next.

Planned care looks orderly from the outside. Inside, it is held together by people doing unglamorous work at inconvenient times.

Direct Care Alliance exists to take one specific piece of that load off: the part where the price is unknown, the authorization is pending, and nobody can tell the patient what any of it will cost.

We agree the price before care. The employer commits to it in advance. The facility is paid directly and quickly once care is delivered.

That does not make the work easy. It removes one thing that was never helping.

To everyone working today: thank you. If you know a scheduler, a navigator, a nurse, or someone in a finance office who is working today, tag them.

Most of the country is off today. A lot of hospitals are not.

"We already have a plan, an administrator, and a network in place."

Good. Keep all three.

Direct Care Alliance is not a replacement for any of them. It is a point solution that handles a narrow, expensive slice: planned, non-emergent surgery and cancer care.

The case price is agreed with the facility before the procedure. The employer contractually agrees to that price in advance. A concierge care navigator coordinates the full episode. The facility is paid directly and fast once care is delivered.

Everything else about the plan keeps running the way it runs today.

Most cost containment conversations ask an advisor to move something. This one asks them to add one pathway for the cases that concentrate the spend.

We built a walkthrough of exactly this. Six stages of one planned case, side by side with how it usually runs, and a list of the seven things that do not change.

It takes about a minute and it does not ask you for anything.

Link in the comments. If something in it does not match your experience, say so, that is more useful to us than agreement.

"We already have a plan, an administrator, and a network." Good. Keep all three. [short link]

A hospital can forecast almost everything about a planned procedure except when it gets paid.

Which room. Which team. How long. What supplies. What recovery looks like. All of that is knowable weeks out.

The payment is the variable. Not usually whether it arrives, but when, in how many pieces, and after how much correspondence.

An agreement made in advance moves that variable to the front. The price is agreed before the procedure. The employer has contractually committed to it. When the case is done, the facility is paid directly, at the agreed amount, quickly.

No prior authorization needed. The price is agreed in advance.

For a revenue cycle team, that is not a small difference in tone. It is a case that closes when the care closes.

A hospital can forecast almost everything about a planned procedure except when it gets paid.

If a hospital is evaluating a direct case-rate arrangement for the first time, here is what is actually worth asking.

How is the price set, and who sets it. Is it negotiated per case with the facility, or handed down from a schedule.

What happens to existing payer contracts. The answer should be nothing.

Who coordinates the patient. If the answer is "the hospital, same as always," that is a different model than ours.

When does payment arrive, and in what form. Directly, quickly, at the agreed amount, or through the usual cycle.

What happens if the case turns out to be more complex than expected.

Direct Care Alliance answers all five in the first conversation. We would rather a facility ask them upfront than discover the answers mid-case.

Swipe through the five. Each one stands alone, so screenshot whichever is useful.

There is also an interactive version where each question opens to what a real answer sounds like. Link in the comments.

If you have evaluated one of these arrangements before, what was the question you wish you had asked first?

Evaluating a direct case-rate arrangement? Five questions worth asking: price, payer contracts, coordination, payment timing, complexity.

Most of what a benefits advisor brings to a stop-loss renewal is explanation.

Here is why the year looked the way it did. Here is what was outside anyone's control. Here is what we are doing differently.

Explanation is not evidence.

Direct Care Alliance's agreements produce something closer to evidence. For each case, there is a price that was agreed with the facility before the procedure, an employer commitment made in advance, a coordinated episode, and a clean payment record.

Cases handled that way read differently to an underwriter than the same cases handled the usual way.

The advisors getting the most out of this are the ones who started before renewal season, not during it.

So, honestly, when you walk into a stop-loss renewal this fall, are you bringing an explanation or a record?

Most of us have done both. The difference usually shows up in the room.

Most of what an advisor brings to a stop-loss renewal is explanation. Explanation is not evidence. So heading into this fall, are you bringing an explanation or a record?

The part of this model that is hardest to put in a slide is the phone call.

Somebody is told they need surgery, or that they have cancer. In the days after that, they are handed a process. Find a surgeon. Get the authorization. Understand the estimate. Call this number, then that one.

They are asked to become a project manager at the worst moment of their year.

A concierge care navigator is the person who takes that over. Finding the right facility. Getting the date set. Making sure the price is agreed before anything happens. Answering the phone when the patient has a question at seven in the evening.

It is not a card in a wallet. It is a team that stays with the case until it is done.

That role is the reason the rest of the model works, and it is the part nobody can quite see from the outside.

Here is what I would like to know from anyone who has been near one of these cases, on any side of it.

What is the part that never makes it into the cost analysis?

I have my answer. I suspect there are better ones.

The hardest part of this model to put in a slide is the phone call. For anyone who has been near one of these cases: what is the part that never makes it into the cost analysis?

Ask an operations leader what a bad case looks like and very little of the answer is clinical.

It is the case that gets moved twice. The patient who arrives without the workup done. The family asking finance questions that nobody in the room is positioned to answer. The authorization that is still pending the morning of.

Those are coordination failures, and they cost real capacity.

An agreement made in advance, with a navigator attached, is designed to prevent them. Price agreed before the procedure. Employer committed in advance. One person owning the episode from selection through follow up.

The clinical work stays exactly where it belongs. The scaffolding around it stops falling over.

Operations people, settle something.

What actually makes a case go bad? The date moving twice, the workup arriving incomplete, finance questions landing at the bedside, or the authorization still pending the morning of?

Pick the one that costs you the most.

Ask an operations leader what a bad case looks like and very little of the answer is clinical. So which one costs you most? Date moved twice, workup incomplete, finance questions at the bedside, or auth still pending.

A benefits advisor sees a lot of savings claims in the fall. Here is a way to sort them quickly.

Ask what the baseline is. Savings against billed charges is not savings. Billed charges are a starting position, not a price anyone pays.

Ask over what period, and whether the same population was measured on both ends.

Ask who calculated it. A vendor scoring its own performance is a starting point, not evidence.

Ask what happens to the number when a single large case lands in the wrong month.

Apply that to us too. Direct Care Alliance does not publish a savings percentage, because we have not documented one to a standard that survives those four questions.

What we will tell you is exactly what we do, and every piece of it is verifiable.

Swipe through the four. Screenshot them, use them on us.

There is an interactive version with what a real answer sounds like under each one. Link in the comments.

And if you have a fifth question you always ask, add it below. I will happily steal it.

Four questions for any savings claim, ours included. What is the baseline. Over what period. Who calculated it. What happens when one large case lands in the wrong month. Got a fifth? I will steal it.

There is a difference between being someone's payer and handling someone's case.

Direct Care Alliance does the second one on purpose.

We work case by case, nationally, on planned surgery and cancer care. We source the right facility for the patient, or coordinate travel to a center of excellence when that is the better option. We agree the price with that facility before the procedure. The employer commits to it in advance. The facility is paid directly and fast.

Then the case closes and nothing lingering has been created.

For a hospital, that means evaluating one pathway rather than one relationship. For an advisor, it means adding one capability rather than restructuring a plan.

Narrow is the feature.

Genuine question, and I do not think the answer is obvious.

Heading into fourth quarter, would you rather evaluate one broad relationship or one case?

One is a bigger conversation. One is a smaller commitment. I know which I would pick, but I am not the one carrying it into a client meeting.

There is a difference between being someone's payer and handling someone's case. Heading into Q4, would you rather evaluate one broad relationship or one case?

Direct Care Alliance is not a fit for every hospital, and it is worth being clear about where it is.

It fits facilities with steady planned volume in spine and orthopedic care, general surgery, and oncology, including cancer care delivered as ongoing treatment rather than a single procedure.

It fits where the finance and contracting teams have room to evaluate one additional pathway that does not disturb existing payer contracts.

It fits where a coordinated, pre-priced case arriving on schedule is worth something operationally.

It is not a fit for emergent care, and it is not a broad payer relationship.

If the first three describe your service lines, the first conversation is short and specific. If they do not, we would rather say so early.

Swipe through the fit and the not-fit. It is a short read and it is deliberately honest about the second half.

There is a self-check version if you would rather work through it yourself. Link in the comments.

If your service line is on the edge of this, tell me where and I will tell you straight whether it is worth a conversation.

DCA is not a fit for every hospital and it is worth being clear where it is. Swipe through the fit and the not-fit. If your service line sits on the edge, tell me where and I will tell you straight.

The hardest thing to do in fourth quarter is add anything.

So we are not going to ask you to.

One case. That is the entire proposal. Pick a planned surgery or a cancer course you already know is coming for one client, and let us price and coordinate that one case.

Nothing about the plan changes. No carve-out. No network move. No new card for the employee. The hospital keeps its existing payer contracts.

If it works, you have a documented case and a real answer for the renewal conversation. If it does not, you have spent one case finding out.

Most vendors ask for a decision in the fall. We are asking for a case.

So here is September's actual ask, and it is the smallest one we have.

Name the case. Comment it, or send it to me directly if it is client sensitive. One planned surgery or one cancer course you already know is coming.

That is the whole thing. No program, no plan change, one case.

The hardest thing to do in Q4 is add anything. So we are not asking you to. Name the case. One planned surgery or one cancer course you already know is coming.