Blog Posts

According to the KFF 2025 Employer Health Benefits Survey, 67% of covered workers are now enrolled in self-funded plans. Every TPA says they offer customized health plans. It’s one of those words that gets used so often in this industry it’s started to lose meaning.

So let’s be direct about what customization actually looks like in practice, and what it doesn’t.

What real customization actually requires

A truly customized self-funded plan starts with a real look at your workforce: who they are, where they live, what conditions they’re managing, and where your claims dollars are actually going. Not a template with your company name on it.

That means your TPA needs to be asking questions before they’re recommending solutions. Which networks are performing in your geography? Are your members using care appropriately, or are they going to the ER for things a primary care visit would handle? What’s driving your cost trend, and is it the same this year as it was three years ago?

A generic plan can’t answer those questions, because it was never designed to.

Why plan design alone doesn’t move the needle

Plan design matters. Benefit tiers, stop-loss parameters, and network strategy are all levers that can be dialed in to fit your group. But the structure is only valuable if there’s active management behind it.

This is where most self-funded plans stall out. They get built thoughtfully and then handed to a team focused on administration rather than active management. Claims roll in. Costs creep up. Nobody flags the pattern until renewal.

Customization done right means your TPA is actively watching what’s happening inside the plan and intervening before a manageable issue becomes an avoidable high-cost claim. That’s what Precision Care Navigation does. Boon-Chapman’s model goes beyond a provider search or simple redirection. Each qualifying member is paired with a nurse who evaluates clinical need, provider quality, access, and total cost of care, then personally guides the member through the next best step. We don’t give members homework. We walk alongside them through the process.

Boon-Chapman’s Precision Care Navigation utilization rate of 60% doesn’t happen by accident. It happens because the infrastructure exists to identify those moments and act on them.

Member experience drives plan performance

One of the most overlooked aspects of plan customization is the member experience. A plan can be technically well-designed and still fail because members don’t know how to use it, can’t reach anyone when they have a question, or end up navigating the system on their own.

Boon Champions exists because we believe member engagement is inseparable from plan performance. When 40,000+ members a year are getting real, human support rather than an automated phone system and a callback, they make better decisions. Better decisions mean better outcomes and lower spend. That’s not a soft metric. It shows up in your claims data.

Customization has to include how your members experience the plan day to day, not just how it’s built on paper.

How the best plans connect DPC, Precision Care Navigation, and the network

Self-funded plans that perform best aren’t layering isolated point solutions with DPC over here, care management over there, and a wellness program nobody uses. They’re built around a connected pathway where each piece hands off to the next.

Direct primary care as the first line of contact. Precision Care Navigation as the bridge to high-quality, cost-effective downstream care. The network as the final layer for what can’t be handled earlier in the pathway. Every step designed to get members the right care, in the right setting, with the right provider, at the right price, before the claim ever hits.

That’s what “smarter” means in practice. It’s the kind of integration that only works when your TPA has the independence to build around your group.

Questions worth asking before your next renewal

If you’re evaluating whether your current plan is truly customized or just positioned that way, start here:

• When did someone last pull your claims data and walk you through what’s actually driving your cost trend?
• Do your members have a dedicated point of contact, or a phone tree?
• If they have care navigation, what does that encompass?, Is the utilization rate over 50%?
• How does your plan handle high-cost cases before they hit stop-loss?
• Can your plan design change if your workforce changes, without a year-long implementation process?

The answers tell you a lot.

Customization takes ongoing commitment, not a one-time configuration. We’ve been building health plans that actually reflect the groups they serve for over 60 years. If yours isn’t delivering, let’s talk about what’s possible.

Learn more about what smarter healthcare administration looks like.