High Performance Self Funded Ecosystem | Benefit Systems, Inc. (BSI)

Better Benefits. Better Health. Better Costs.

A High-Performance, Self Funded Ecosystem (HPSE)

Why BSI Built a
High Performance Self Funded Ecosystem
(HPSE)

Healthcare is inherently complex, and health plans are no exception. At BSI, our primary focus is the self-funded market, which covers approximately 68% of private-sector employees in the United States. The cost of health coverage has continued to rise faster than wages, creating significant strain for both employers and members. While there must always be a balance between cost and quality, cost has now become the industry’s most pressing challenge.

Over the past decade, the healthcare landscape has grown increasingly fragmented as entrepreneurs introduced specialized products designed to improve efficiency. These offerings - often referred to as “point solutions” - have proliferated rapidly, resulting in thousands of options within the self-funded market. While well-intentioned, this explosion has led to increased complexity, confusion, and widespread vendor fatigue.

Compounding these challenges is the post-pandemic surge in healthcare costs, placing the industry in one of the most difficult periods in U.S. healthcare history. Rate increases are substantial, member out-of-pocket expenses are becoming unsustainable, ACA subsidies are expiring, and prescription drug prices are at an all-time high.

In 2024, BSI chose a different path - one grounded in data and outcomes rather than marketing hype. We recognized that by identifying the highest-performing segments that drive more than 85% of self-funded plan spend, we could deliver truly best-in-class solutions. The thesis was straightforward. Validating it - and executing it - was anything but.

Areas of Focus

BSI’s High Performance Self-Funded Ecosystem (HPSE) was built to address rising healthcare costs, increasing complexity, and vendor fatigue in the self-funded market. Using extensive claims analysis and rigorous vendor performance evaluation, Benefit Systems Inc. identified the key drivers of over 85% of plan spend and integrated only the top-performing solutions. The ecosystem was actuarially validated, reviewed by stop-loss carriers, and underwritten to confirm consistent savings of 10% or more. Designed for flexibility, HPSE can be deployed as a turnkey or customized Direct-to-Employer solution or as a market-ready self-funded plan - delivering a proven, performance-based alternative to traditional healthcare models.

Learn More

Click each part of the wheel to be taken to the corresponding page.

How BSI Built a High Performance Self-Funded Ecosystem (HPSE)

Five Primary Steps Taken by BSI to Develop this High Performance Ecosystem

Self-Funded Claims Analysis

Analyzed detailed claims data from over 250,000 self funded employees across 47 states. This revealed that between 85-88% of all self-funded claims come from six key areas.

Key Vendor Performance Evaluations

BSI needed to find the best performing entities in each of these six areas. We approached over 100 vendors in these categories and asked for performance data. We evaluated over 60 vendors in these key categories, analyzing more than 6 million lines of performance data to identify the top performers.

Actuarial Validation

Our thesis was if we integrate these top performing entities in a self-funded plan will we be able to deliver at least 10% total cost savings for clients. Our thesis was confirmed by the actuaries.

Carrier Evaluation

BSI shared its data and actuarial validations with key stop-loss reinsurers and asked them to evaluate our thesis and findings. Again, the carriers validated our thesis based on the data.

Plan Rates

BSI engaged underwriters to price a vertically integrated structure and benchmark those rates against actual market data. The results consistently confirmed 10%+ savings across every market evaluated.

Plan Flexibility

Turnkey DTE Self-Funded Plan

Using the HPSE platform, BSI can launch a turnkey DTE program in approximately 90 days. With the infrastructure already in place, the health system only needs to provide its provider network at competitive discounts. BSI’s actuaries evaluate the local network and deliver a competitive market analysis. Plans may be white-labeled under the health system’s brand or offered under BSI’s national brand, Harmony Health—making this a game-changing option for systems exploring a DTE strategy.

Customized DTE Plan

For systems seeking a fully customized solution, BSI provides end-to-end guidance, including market analysis, plan design, vendor selection, actuarial review, network strategy, go-to-market planning, and risk alternatives. With more than 12 years of DTE experience, BSI can deliver highly tailored programs, though these custom solutions require more time and investment than the turnkey option.

Select Market Self-Funded Health Plan – Harmony Health

HPSE is also deployed as a competitive self-funded health plan in select markets through Harmony Health. Because research, actuarial validation, vendor selection, and plan design are already complete, implementation requires only the addition of strong local provider networks.

Current launch markets include: