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Series

A Tiered TPA Product

Series 15 is a product proposal, not market commentary. The evidence across 14 preceding series produces a design: three tiers serving three employer segments through three distribution channels, each with a defined capability stack and a defined economic logic. Core builds the foundation. Plus demonstrates that cost management can pay for itself. Black creates the capability that no competitor can replicate.

The Tiered TPA: Why One Product Serving All Employers in the 1-to-50 Range Is a Strategic Error

A landscaping company in central Texas and a remote technology company in Denver are both 1-to-50 employers. The landscaping company needs price-competitive administration it will …

Core: What Table-Stakes Level Funded Administration Includes and What It Costs

Core is where reputation is built and claims data is generated. Every employer enters here. The margin is modest by design: market entry, broker relationship development, and the …

Plus: Active Cost Management as a Standard Feature, Not an Upsell

When cost management programs are priced as add-ons, the employers who decline them are the ones who need them most. Bundling facility steering, pharmacy optimization, maternity …

Black: The Full-Stack TPA and What It Offers That Nobody Else Does

JCI-accredited facilities at 40 to 70 percent savings. International pharmacy purchasing at 50 to 90 percent off US retail. A named concierge for every member household. The …

Risk-Covered vs. Add-On: How the Tier Classification Affects Employer Economics and Behavior

The classification principle: if a service reduces claims cost, it belongs inside the tier premium. If not, it is an add-on the employer chooses separately. One steered …

Pricing the Tiers: PMPM Economics, Margin Structure, and the Math That Makes Each Tier Viable

Core competes on price. Plus competes on a value claim: savings from bundled cost management exceed the premium increase over Core. Black competes on capability without a …

The Technology Black Requires: From Claims Processor to Cost Management Platform

Core runs on existing commercial platforms. Plus requires a care routing engine, a provider cost and quality database, and pharmacy integration built on top of Core infrastructure. …

The Broker Channel: How the Tiered Model Changes the Sales Conversation

Tier recommendation adds a second decision: not only level funded versus fully insured, but which tier. Level funded specialists treat this as advisory differentiation. Generalists …

The Direct Channel and the Digital Front Door: Reaching Employers Who Do Not Have Brokers

Micro-employers below 10 lives who have never had a broker relationship have no natural path to level funded. Core can be sold through a fully digital self-service flow. Plus …

The Association and Affinity Channel: Group Purchasing as a Distribution Strategy

A single three-person group cannot get viable stop loss terms. Fifty three-person groups pooled through an association produce 150 covered lives underwritten as a block. The …

Go-to-Market Sequencing: Which Tier First, Which Geography First, Which Employer Segment First

Core first: the technology exists and claims data generated feeds Plus analytics. Plus second: operational credibility is established and stop loss carriers begin accumulating data …

The Competitive Moat: What Makes the Tiered Model Defensible Once Competitors See It Working

Cross-border care infrastructure takes three or more years to build and cannot be purchased. Claims data assets accumulate every year the competitor has not started. The feedback …

The Case Against the Tiered Model: Why Complexity Kills, Brokers Cannot Sell It, and Deepening the Core May Be the Better Strategy

Complexity kills in the small group market. Generalist brokers, who represent the majority of distribution, will present Core and skip the tier decision. One product, executed with …

What This Series Is and Is Not: Applied Product Design for the TPA Market

Series 01 through 14 are analysis. This series is design. The reader is not learning how the market looks; they are evaluating a product proposal for a specific operator. The …

The Complete Product Architecture: Core Through Black

Three tiers, three employer segments, three price points, three channels. Core for price-sensitive employers who want level funded economics without active management. Plus for …