Public plans are accountable for decisions they cannot currently document

Most public plans can document what they bought. Fewer can explain how care entered the plan and what decision was made.

Build Your Plan’s Control Tower

The claim shows what was paid. It does not show what was decided

A claim records what was paid. Understanding how care entered the plan requires a clearer account of the pathway offered, the member's choice, and why the decision was made.

The Claim

What was paid

A record of the service, provider, and payment associated with a claim

Service
Provider
Date of service
Amount paid
Records the payment. Not the decision
The Decision

How care entered the plan

Understanding the decision requires a record of the rule, how it was applied, and the result.

1
Approved rule
Which written rule governs how care enters?
2
How the rule was applied
How was the rule applied to this entry?
3
Resulting pathway decision
Which pathway decision followed?
Makes the decision understandable and reviewable

What governed entry gives a public plan

A written rule, applied consistently, with a decision record and defined network fallback.

Written rule

A written rule, approved by the plan

The plan approves a written rule governing how care enters the plan.

Governed Entry Rule
1.
The rule establishes how care enters the plan.
2.
If a member does not choose a governed option, the existing network remains available.
Approved by the plan
Applied consistently

Decisions follow the rule, not the case

The approved rule provides a consistent basis for decisions.

Decision
Basis
Status
Decision
Approved plan rule
Rule applied
Decision
Approved plan rule
Rule applied
Decision
Approved plan rule
Rule applied
Reviewable record

What was presented, what was chosen, what happened.

Governance decisions are recorded. Broader closed-loop adherence and pathway evidence is being built into the platform.

Decision record
Approved rule
Governed entry rule
How the rule was applied
Applied consistently
Resulting pathway decision
Plan-approved entry rule
Defined fallback

Existing network access remains available

If a member doesn't choose a governed option, the existing network remains available.

The defined fallback
Use a governed pathway
Follow the plan's approved entry rule.
Keep my existing network
Existing network access remains available.
A documented process, not a savings promise.
Any effect on a particular plan's cost pattern must be measured by that plan.

Working inside what already exists

Public plans operate through administrators, consultants, negotiated obligations and procurement rules. HealCo sits above that structure rather than replacing it.

Confidentiality

HealCo does not publish client names, findings, datasets or dollar figures from public-sector engagements. Material derived from a plan's data stays with that plan and its authorized representatives unless the plan authorizes otherwise in writing.

HealCo
Governance layer, added on top
Existing arrangements remain in place
Existing administration
Stays
The existing TPA continues to administer and adjudicate
Existing network
Stays
The network stays.
Advisory relationship
Stays
The consultant or broker of record stays.
Negotiated obligations
Stays
The plan manages its bargaining obligations. HealCo's rules are configured to fit them.
Procurement requirements
Respected
Where procurement requires it, HealCo is engaged as a named component under an incumbent prime rather than as a separate award.

Start with the agreements

Understand your plan’s agreements, procurement requirements and existing obligations to determine the appropriate scope for analysis, monitoring or governance.

Build Your Plan’s Control Tower
i
Pathway evaluation

Any governed pathway is evaluated separately for authority, partner capacity and validated workflow.