Every vendor says they're accountable. So who owns plan performance?
The PBM owns pharmacy. The TPA owns claims administration. Navigation and care management vendors, the stop-loss carrier, and other point solution providers each own their piece.
That can make it difficult to answer questions like:
- Which programs are producing value?
- Where are performance gaps emerging?
- Who is accountable when expectations aren't met?
- What actions should be taken next?
Vendor reports can answer some of those questions but rarely provide a complete picture.
Typically, no single vendor is responsible for evaluating overall plan performance. That responsibility ultimately belongs to the employer.
That's where governance comes in.
Governance helps employers evaluate performance across vendors, identify issues, assign accountability, and document the actions that follow.
Without it, employers are left connecting the dots across multiple vendors, reports, and definitions of success.
We recently discussed this topic during our webinar, Fiduciary Proof in Practice: Defensible Governance in a 9% Trend Environment.