Getting Comfortable — Tell Us Who's in the Room

• How often do you run a formal renewal process for this group? Options: Annually, Every 18 months, Every 2+ years, On change in broker or service model
• Who are the decision-makers and influencers we should know about for this renewal? (Select all that apply) Options: Benefits Director, CFO/Finance, Total Rewards VP/Head, HR Director, Broker/Consultant, CEO/Owner, Legal/Compliance, Other
• Who ultimately signs the contract or approves the budget for this line of business? Options: CFO/Finance, CEO/Owner, Board/Comp Committee, Benefits Leader, Shared approval (Finance + HR), Broker-preferred signer, Other
• Roughly how many months until your final renewal effective date? Options: Less than 1 month, 1–3 months, 3–6 months, 6–12 months, More than 12 months
• How would you describe your overall feeling about the upcoming renewal? Options: Confident — already on track, Concerned about cost only, Worried about network/member disruption, Unsure where to start
• What’s one thing you wish the carrier understood about your priorities going into this renewal?

If Budget Numbers Weren’t the Only Thing That Mattered, What Would You Do Differently?

• Would you consider a different funding model (self-funded / level-funded / fully insured hybrid) if it materially improved outcomes or price certainty? Options: Yes — strongly consider, Maybe — need more analysis, No — prefer current model, Open with strong guardrails
• What are the non-negotiable budget guardrails you cannot exceed this renewal cycle? Options: % increase limit (enter in free text below), Absolute dollar cap (enter below), We do not have strict guardrails, Other
• If forced to prioritize between premium reduction, trend guarantee, and clinical outcomes, which order would you choose? Options: Premium → Trend guarantee → Clinical outcomes, Trend guarantee → Premium → Clinical outcomes, Clinical outcomes → Premium → Trend guarantee, Undecided / need guidance
• How flexible are you to redesign benefits (networks, formulary, telehealth, incentives) to meet financial targets? Options: Very flexible, Somewhat flexible with stakeholder approval, Only minor tweaks, Not flexible
• If you have a numeric target for premium or trend, please state it and whether it's absolute or a cap (e.g., '3% cap' or '$X per employee').
• Which stakeholders would need to be convinced to accept a different funding model or material plan redesign? Options: CFO/Finance, Benefits Director, Broker/Consultant, Board/Comp Committee, Union/Employee Rep, Other

Where the System Actually Leaks Money

• Which of the following cost drivers have been the primary contributors to trend over the past 12–36 months? Options: Inpatient admissions, Emergency room utilization, Specialty drug spend, Chronic condition progression (e.g., diabetes, COPD), Behavioral health escalations, High-cost claimants / catastrophic cases
• Over the last 12 months, how would you categorize your medical trend? Options: Under 3%, 3%–6%, 6%–9%, Over 9%, Unsure / need analytics
• How many claims above $100k did you experience in the last plan year? Options: 0, 1–5, 6–10, 11–20, More than 20, Unsure
• Are you tracking any hidden leakage areas (e.g., out-of-network billing, prior auth failures, coding mismatches)? If so, which and how long has this been an issue?
• Do you currently use stop-loss or other risk-transfer products, and at what attachment point(s)? Options: Yes — Specific attachment (enter below), Yes — but variable, No
• Tell us about one recent high-cost case that surprised you and why it stuck out—clinical, network, or processing reasons.

Who Gets Hurt When Networks Change?

• If your network were narrowed to save premium, which employee groups or locations would feel it most? Options: Major metro offices, Rural employees, Remote workers nationwide, Union sites, Field sales/ops teams, Executives, Other
• How many employees live or work outside of your largest 3 metropolitan areas (approximate %)? Options: 0–10%, 11–25%, 26–50%, 51–75%, Over 75%
• Have past network changes caused measurable disruption (e.g., increased complaints, claims denials, delayed care)? Tell us an example and how long it took to resolve.
• Which provider types are mission-critical for your population (select all that apply)? Options: Primary care, OB/GYN, Behavioral health/psychiatry, Oncology, Cardiology, Pediatrics, Specialists (other)
• How important is maintaining existing patient–provider relationships versus lowest-cost provider access? Options: Maintain relationships is paramount, Balance both equally, Cost-efficiency is primary
• How many documented member complaints or network access incidents did you record in the last 12 months? Options: 0, 1–10, 11–50, 51–200, Over 200, Unsure

Do You Trust the Data Enough to Make a Guarantee?

• Which data feeds do you currently receive from your carrier(s)? (Select all that apply) Options: Eligibility roster, Medical claims (line-level), Pharmacy claims, Paid/processed claims files, Encounter data, Lab results, Care management logs
• What is your typical claims run-out period or claims lag we should expect when analyzing current-year experience? Options: Under 30 days, 30–60 days, 60–90 days, 90–180 days, Over 180 days, Unsure
• Have you encountered material data quality issues (duplicates, missing provider IDs, mis-coded DRGs) that affected decision-making? Please describe one example and its impact.
• Which analytic outputs would you find most valuable to validate an offer? (Select top three) Options: Trend by line of business, High-cost claimant file, Geo-based network impact, Rx trend and formulary sensitivity, Risk-adjusted utilization, Projected PMPM scenarios
• What file formats and delivery cadence work best for your team (e.g., SFTP monthly, daily API, CSV extract)? Options: Monthly CSV via SFTP, Weekly extracts, Daily API, Quarterly reports, Ad hoc requests only
• Are there governance, privacy, or vendor access constraints we should be aware of before requesting raw or de-identified claims? Options: Yes — strict constraints (describe below), Some constraints, No major constraints

What Does Success Actually Look Like Next Year?

• Which success metrics would make you call the renewal a win? (Select all that apply) Options: Premium at or below target, Trend guarantee met, ER visit reduction, Readmission rate improvement, Improved chronic disease metrics (A1c, BP), Pharmacy spend reduction, Higher member satisfaction
• For the KPIs you selected, what are realistic target thresholds or percentage improvements you’d expect in year one?
• Which of these outcomes would you be willing to tie into commercial guarantees versus which are informational? Options: Financial metrics only, Financial + select clinical KPIs, Clinical KPIs as guarantees, Prefer no guarantees tied to clinical measures
• How would you like success to be reported—dashboards, quarterly business reviews, raw files, or a mix? Options: Interactive dashboard, Quarterly business review (QBR), Raw files for internal analytics, Monthly scorecard + QBR
• Who on your side will be responsible for monitoring KPIs and escalating issues post-renewal? Options: Benefits Director, Finance Analyst, Vendor/Broker, Shared team, Other

What Keeps You Awake at Night About Making This Change?

• If we narrowed the network or adjusted plan design to hit your financial targets, what unintended outcome worries you most? Options: Member churn/attrition, Employee complaints and morale, Regulatory/compliance exposure, Provider access gaps, Increase in claims appeals
• Have you faced legal, compliance, or contract disputes after a past carrier change? If yes, briefly describe the nature and duration. Options: Yes — litigation/dispute, Yes — contractual disagreement resolved, No significant past disputes, Prefer not to disclose
• What level of service disruption (if any) is acceptable during a transition period? Options: Minimal to none, Short, managed disruption OK, Acceptable if offset by cost savings, Unsure — need guidance
• Which mitigation steps would make you comfortable moving forward? (Select up to 3) Options: Phased rollout, Guarantees tied to data quality, Robust member communications, Provider continuity agreements, Escalation SLAs with penalties
• How quickly do stakeholders require remediation if an agreed KPI is missed post-go-live? Options: Immediate (within days), 30 days, Quarterly review, Handled case-by-case

If We Could Show Proof, What Would Seal the Deal?

• Which types of proof carry the most weight for your leadership? (Select all that apply) Options: Transparent run-out claims & reconciliation, Case studies with similar employers, Live access to provider network lists, Clinical outcomes data, Third-party actuarial attestation
• Would you prefer a small pilot or phased proof-of-concept before committing to a full renewal change? Options: Yes — pilot required, Prefer phased rollout, No — full change if terms are right, Open to discussion
• If we provided model scenarios (pricing, network, clinical) how long would your team need to evaluate them before a decision meeting? Options: Under 1 week, 1–2 weeks, 2–4 weeks, More than 4 weeks
• Who else outside the benefits team would need to see this proof to move forward (Finance, Legal, Employee Rep, Board)? Options: Finance/CFO, Legal/Compliance, Broker/Consultant, Executive leadership, Board/Committee, Other
• What would be an unacceptable form of proof or assurance for your organization? Options: Anecdotal success stories only, Opaque pricing models, No access to data, Guarantees without measurement plan

Would a Small Win Make a Big Difference?

• Which low-effort, high-impact changes would you prioritize before renewal? (Select up to 3) Options: Eligibility cleanup, Rx formulary edits, Provider credentialing fixes, Member communication templates, Stop-loss optimization, Data reconciliation
• Which of those quick wins could your team implement internally versus which would require carrier assistance? Options: Mostly internal, Mostly carrier-led, Shared responsibility, Unsure
• How soon would you expect to see measurable impact from a quick win (e.g., reduced denials, Rx savings)? Options: Within 30 days, 30–90 days, 3–6 months, More than 6 months
• Who should own implementation of quick wins on your side and how many hours/week could they realistically allocate?
• Are there existing templates or communications you'd want us to use or adapt for a fast rollout? Options: Yes — share existing, No — prefer carrier templates, Open to collaboration

Next Steps — How Do You Want Us to Work With You?

• How would you like to receive our initial renewal proposal and supporting analysis? Options: Interactive dashboard + executive summary, Full actuarial model + data files, Slide deck + summary phone call, All of the above
• What meeting cadence would you prefer during the discovery-to-proposal phase? Options: Weekly working sessions, Biweekly checkpoints, Ad hoc as needed, Single milestone review
• Which individuals must be present at the commercial decision meeting to move to final terms? Options: Benefits Director, CFO/Finance, Broker/Consultant, Legal/Compliance, Other
• What documentation or approvals do you require from us before entering a binding negotiation (e.g., network roster, data attestation, sample SLA)? Options: Network roster, Data attestation, Service Level Agreement sample, Actuarial attestation, Other
• What is the best way for our team to share sensitive files with you (SFTP, secure portal, email is not acceptable)? Options: SFTP, Secure portal, Encrypted email, API integration, Other
• Is there anything we haven’t asked that would be important for us to know before modeling options for your renewal?

Start Here: Tell Us About the Plan We're Mapping

• Which plan(s) are we mapping in this conversation? Options: Fully insured - small group, Fully insured - large group, Self-funded (ASO), Level-funded, Captive, Stop-loss only, Multiple of the above
• How many covered lives are on the plan today? Options: Under 1,000, 1,000–4,999, 5,000–24,999, 25,000–99,999, 100,000+
• When is the upcoming renewal effective date or renewal window?
• Which lines of business are included under this contract? Options: Medical, Pharmacy, Behavioral health, Dental, Vision, Stop-loss, Wellness incentives
• Who are the decision-makers and influencers we should expect to engage during renewal? Options: Benefits Director, CFO/Finance, VP of Total Rewards, HR Director, Broker/Consultant, Legal/Compliance, Other
• Are there any active union or collective bargaining agreements, regulatory restrictions, or legacy vendor commitments that will constrain plan changes? Options: Yes - union/CBAs, Yes - state-specific mandates, Yes - legacy vendor contracts, No known constraints, Unsure

If Trend Is the Enemy, Where Is It Winning?

• If cost trend were a single pattern draining your budget, what would it be? Options: Rising inpatient admissions, Specialty drug spend, Increasing ER utilization, Chronic condition progression (eg, diabetes, CHF), Network pricing creep, Other
• Which of the following have been the top measurable drivers of your medical trend over the last 12–36 months? Options: Inpatient admissions / readmissions, Outpatient procedure volume, Specialty pharmacy spend, ER utilization, High-cost claimants (> $100k), Behavioral health escalation, Other
• How large has your aggregate trend been in each of the past three renewals (provide ranges if exact numbers are sensitive)? Options: Year 1: <3% / 3–6% / 6–9% / 9–12% / 12%+, Year 2: <3% / 3–6% / 6–9% / 9–12% / 12%+, Year 3: <3% / 3–6% / 6–9% / 9–12% / 12%+
• Can you name a recent high-cost claim or claimant type that changed your forecast materially? Tell us what happened and the financial impact.
• How long have you been seeing this trend pattern? Options: Under 1 year, 1–2 years, 3–5 years, 5+ years, Unsure
• Which operational metrics do you currently track to explain trend (select all that apply)? Options: PMPM / PMPY, ER visits per 1,000, Readmission rate, High-cost claimant count, Specialty drug PMPM, Chronic condition control metrics (A1C/BP), Utilization by age band

Where Care Is Hardest to Access

• Which places or populations do your employees most often tell you have inadequate access to care? Options: Rural counties, Suburban pockets, Small towns, Urban behavioral health deserts, Out-of-state remote workers, International assignees
• Which specialties or provider types are hardest to find in your core geographies? Options: Primary care / PCPs, Behavioral health (therapists/psychiatrists), OB/GYN, Pediatrics, Oncology, Cardiology, Endocrinology, Orthopedics
• How often do you hear complaints or escalations related to provider availability or long wait times? Options: Daily, Weekly, Monthly, Occasionally, Rarely, Never
• Do you currently measure network adequacy quantitatively (eg, provider-to-member ratios, drive-time access)? If yes, which metrics do you use? Options: Provider-to-member ratio, Percent of members within 30 minutes, Appointment wait-time averages, Specialist density per 10k lives, We do not measure quantitatively, Other
• If network gaps exist, where have you seen the most downstream impact (select all that apply)? Options: Increased ER use, Delayed care leading to higher acuity, Member dissatisfaction/escalations, Higher out-of-network costs, Unable to staff clinics or onsite care, Other
• Please describe a recent example where limited provider access affected an employee or cohort and what you did about it.

What Keeps You Up at Night About Provider Disruption?

• If key providers were removed or changed in-network, how much disruption would you consider tolerable before escalation? Options: Virtually none (even a few members affected is unacceptable), Limited for short-term transitions with strong communication, Acceptable if tied to meaningful cost or quality improvement, We have no tolerance for disruption
• Which types of provider disruption have you experienced during past transitions? Options: Primary care terminations, Specialist network shifts, Hospital re-contracting or exclusions, Pharmacy network formulary changes, Credentialing delays for key clinicians, Other
• When disruption occurred previously, how did it show up operationally (member calls, denied claims, appeals, quality issues)? Share a specific consequence if possible.
• What transitional protections matter most to you to avoid member harm? Options: Provider grandfathering, Transition-of-care periods, Active provider outreach and re-credentialing support, Dedicated member transition communications, Rapid appeals and exception handling
• How effective were your prior communications and broker/plan support during past provider disruptions? Options: Very effective, Somewhat effective, Not effective, No communications were provided, Not applicable
• What would you need from a carrier to feel confident a provider transition wouldn't harm continuity of care?

How Confident Are You in the Data You Use to Decide?

• If you had to make renewal decisions based on a single data feed, which would you prefer and why? Options: Paid claims (carrier adjudicated), Encounter data (in network), Pharmacy claims / PBM extract, Eligibility and enrollment rosters, Clinical registry or HEDIS-style data, Other
• Which of the following data sets do you currently receive from carriers or vendors? Options: 12+ months paid medical claims, Pharmacy claim detail, Encounter data for out-of-network, Provider network geo-coverage, Enrollment and eligibility files, Stop-loss claims detail, None of the above / limited data
• What is the typical lag on the claims data you can access today? Options: Real-time / near real-time, 7–14 days, 30 days, 60+ days, Varies by feed, Unsure
• Which file formats and transfer methods are standard for your team (select all that apply)? Options: EDI 837, Flat CSV/Excel, SFTP with zipped files, Secure API, HL7 / FHIR, Other
• How would you rate your in-house analytics capability to analyze raw claims (eg, propensity to model cost drivers, run cohorts)? Options: Advanced (in-house modeling + data scientists), Moderate (BI + analyst support), Basic (pivot tables / vendor reports), None (rely on carrier/vendor analyses)
• If data access has been a blocker, what specifically gets in the way (eg, missing pharmacy detail, COB challenges, poor file structure)?

What Would Make You Say This Renewal Delivered Value?

• What is the single most convincing proof you would need to feel a renewal was successful? Options: Premium reduction vs market, Meeting an agreed trend guarantee, Measurable improvement in clinical KPIs, Maintained or improved network access, High member satisfaction scores
• Which KPIs should we prioritize and report against for the next plan year? Options: Premium / trend vs forecast, ER visits per 1,000, 30-day readmission rate, High-cost claimant count and spend, Specialty drug PMPM, Chronic disease control metrics (A1C, BP), Provider access metrics (drive time/appointments)
• For the KPIs you selected, what target or improvement would feel meaningful (quantify if possible)?
• How often do you want KPI reporting and in what format? Options: Weekly dashboard + monthly narrative, Monthly dashboard + quarterly deep dive, Quarterly reports only, Ad hoc on request
• Who is the ultimate sign-off authority for KPI acceptance and guarantees? Options: Benefits Director, CFO/Finance, VP Total Rewards, Broker/Consultant, Legal
• Have you held vendors/carriers accountable to guarantees before? If yes, what worked or didn't work in measurement and enforcement?

Practical Constraints That Shape What’s Possible

• What's a non-negotiable boundary you will not cross in the renewal (examples: max premium change, mandatory network features, data rights)? Options: Max premium increase threshold, Mandatory in-network continuity, Specific benefit design must remain, Data access and file cadence requirements, No non-negotiables
• Do you have a budget ceiling or guardrail for the upcoming year you can share? Options: Yes - percent increase cap (specify below), Yes - absolute dollar cap (specify below), No fixed budget ceiling, Undecided
• If you selected a budget cap above, please provide the percent or dollar figure (or describe the constraint).
• Are there contractual modules, legal terms, or SLA elements that must appear in any renewal (select all that apply)? Options: Claims accuracy SLA, Data access cadence & format, Trend guarantee / true-up mechanism, Provider credentialing SLA, PHI handling and security terms, State-specific compliance language, Other
• Are there procurement or broker-driven requirements (eg, RFP terms, benchmarks, incumbent transition rules) that will shape this process? Options: Yes - formal RFP required, Yes - broker dictates timeline/format, No - direct negotiation, Unsure
• What are realistic constraints on change management (communication budget, HR support, enrollment windows)?

If We Started Today: What Would You Share First?

• If we could get immediate access to one dataset or artifact that would unlock the most insight, what would it be? Options: 12+ months paid medical claims, Pharmacy claims + formulary, Eligibility/enrollment roster, Provider network reach report, Broker RFP/comparison materials, Stop-loss detail
• Which of the following documents can you share via secure transfer for analysis? Options: Claims extract (paid), Eligibility file, Plan documents / SPD, PBM utilization report, Provider directory / access maps, None immediately available
• What is your preferred cadence and forum for working through findings and trade-offs during renewal? Options: Weekly working session + dashboard, Biweekly executive check-in, Monthly deep-dive with broker, Ad hoc as issues arise
• Who will own data access and approvals on your side (name, role, and best contact)?
• What timelines and decision checkpoints should we align to for pricing, network options, and legal review? Options: 30 days to initial pricing, 60 days to final commercial terms, 90+ days for full legal review, Other (specify)
• Do you authorize us to engage directly with your broker and/or incumbent carrier operations to accelerate data collection? Options: Yes - broker, Yes - incumbent carrier ops, Yes - both, No - please coordinate through me

Getting Oriented: Who's in the Driver's Seat?

• To make sure we involve the right people, who typically leads benefits renewals at your company? Options: Benefits Director/Manager, CFO/Finance Lead, VP Total Rewards, HR Head/CHRO, Broker/Consultant, Procurement, Other
• Which stakeholders must sign off on the final renewal terms? Options: CFO, Benefits Director, VP Total Rewards, Legal/Compliance, Broker/Consultant, CEO/Executive Committee, Other
• What's your typical renewal timeline from kickoff to effective date? Options: 9–12 months, 6–9 months, 3–6 months, Less than 3 months, Rolling/On-demand
• How fixed are the budget guardrails—do you operate with absolute caps, target ranges, or flexible outcome levers? Options: Absolute budget cap, Target range with flexibility, Outcome-based/flexible depending on guarantees, Not clearly defined
• Describe any recent changes in decision-making authority or corporate events (new CFO, M&A, headcount shifts) that could affect this renewal.

Where the Pressure Really Lives

• If you had to name the single biggest problem this renewal must solve to avoid reputational or financial pain, what would it be—and why has it persisted?
• Which of these concerns is driving the most urgency for this renewal? Options: Premium cost, Trend unpredictability, Network adequacy/disruption, Clinical outcomes (ER/readmissions), Claims/data transparency, Pharmacy spend
• How much of your last-year increase do you attribute to trend versus utilization versus plan changes (select the closest split)? Options: Mostly trend (≥6%), Mostly utilization (higher use of services), Mix: trend + utilization + design changes, Unclear/unknown
• What recurring employee complaints or access stories do you hear that influence benefits decisions?
• When these issues surface publicly or internally, who on your team bears the reputational risk? Options: Benefits Director, CFO, HR Leadership, Broker/Consultant, Executive Committee, Other

The Hidden Costs No One Mentions

• Beyond headline premium increases, what hidden cost silently inflates your total healthcare spend year after year?
• Which of the following hidden drivers most concerns you today? Options: High-cost claimants, Out-of-network leakage, Pharmacy rebates and overlap, Administrative adjustments/errors, Avoidable ER and admissions, Duplicate testing/coordination failures
• Can you estimate the ballpark impact of that hidden cost on your annual spend? Options: <1% of payroll, 1–2% of payroll, 2–4% of payroll, 4–6% of payroll, Unknown / not measured
• How long has this cost been present, and what have you already tried to address it?
• Which data sources do you currently rely on to quantify these hidden costs? Options: Claims detail files (line level), Pharmacy claims, HRIS/roster, Absence/productivity data, Broker/vendor reports, Member surveys, Other
• How confident are you in those sources' completeness and accuracy? Options: Very confident, Somewhat confident, Not confident, Don't know

What Your Data Is (and Isn't) Telling You

• If you received perfect, timely claims and pharmacy data tomorrow, what would be the first strategic decision you'd make differently?
• What claims feed cadence and formats do you receive today? Options: Daily EDI/837, Weekly extracts, Monthly feeds, Quarterly summaries, Ad hoc reports only, No electronic feed
• Which specific provider or claim fields are missing, unreliable, or require manual work to use? Options: NPI/provider taxonomy, Credentialing/contract status, Provider location/geo, Allowed/paid rate visibility, Claim line-level modifiers, Pharmacy NDC and rebate data, Other
• Tell us about a time poor data led to a missed saving opportunity or an operational failure—what happened and what did it cost?
• Which analytics outputs would actually change how you negotiate or design the plan (pick top three)? Options: Per-employee trend forecast, High-cost claimant alerts, Geographic network gap maps, Pharmacy utilization + rebate transparency, Clinical program ROI by cohort, Claims accuracy audit reports

If We Could Guarantee One Thing...

• Imagine we offered one measurable guarantee that would make you seriously consider switching—what guarantee would change the game for you? Options: Fixed trend guarantee, Network stability/no surprise closures, Claims accuracy SLA, Pharmacy spend guarantee, Clinical outcome improvements (ER/readmission), Full data access SLA
• How would you define the success metric for that guarantee (specific KPI, threshold, or time period)?
• Who internally would need to be convinced that this guarantee meaningfully de-risks the decision? Options: CFO/Finance, Benefits Director, HR Leadership, Legal/Compliance, Broker/Consultant, Board/Executive Committee
• If the guarantee isn't met, what remediation or penalties would you expect? Options: Financial credits/true-ups, Service improvement plan with milestones, Right to exit/no-penalty termination, Escalation to executive sponsor, Unsure

What Would a Smooth Renewal Actually Look Like?

• Close your eyes—describe what a renewal that reduces anxiety instead of creating it actually feels like for your team.
• Which operational items are non-negotiable for a seamless go‑live? Options: Provider credentialing confirmed, Daily claims feeds established, Enrollment windows integrated with HRIS, ID cards and member communications on time, Pharmacy formulary aligned, Compliance/ERISA documentation complete
• Which employee transition risks worry you most during deployment? Options: Lost provider relationships, Enrollment errors, Delayed ID cards/access issues, System downtime/integration failures, Confusion from poor communications
• What SLA thresholds (claims accuracy, adjudication speed, data cadence) would make you comfortable signing a mutual commit? Options: Claims accuracy >99%, Claims adjudication 95% within 5 business days, Claim/data delivery weekly, Provider credentialing confirmed 30 days before go-live, Other
• How would you prefer ongoing issue handling after go-live—real-time dashboard alerts, weekly performance reviews, or an escalation hotline? Options: Real-time dashboard + alerts, Weekly executive review, Dedicated escalation hotline, Combination of the above, Other

Next Moves That Don't Break the Budget

• If you had to pick one low-effort, high-impact change for this renewal, what would it be—and what might stop you from implementing it?
• Which levers are you open to exploring to control trend while protecting access? Options: Plan design changes (copays/deductibles), Narrower or tiered networks, Enhanced care management for high-risk members, Pharmacy formulary/value-based contracting, Onsite/virtual clinics, Value-based arrangements with providers
• Which of those levers are politically realistic in your organization within the next renewal cycle? Options: Can implement this cycle, Possible with executive buy-in, Only next year or later, Not realistic
• What timeline and milestone cadence would you need before you could sign a mutual commitment? Options: Immediate (sign within 30 days), 30–60 days, 60–90 days, 90+ days, Depends on SLA/guarantee terms
• Who on your side would own execution if we moved forward (name and role)?
• Is there anything else we should know about procurement rules, vendor preferences, union or regulatory constraints, or past experiences that could block progress?

Start Here: A Quick Reality Check

• In one sentence, how would you summarize this renewal’s most important objective for your team?
• Which describes the size and structure of the population we’d be covering? Options: < 1,000 employees, 1,000–5,000, 5,001–20,000, 20,001–100,000, >100,000, Mix of multiple lines
• Who will drive the final decision on the renewal? Options: Benefits Director/Manager, CFO/Finance lead, Head of Total Rewards/HRVP, Broker/Consultant (advisor to employer), CEO/COO, Procurement
• What is your target renewal date or window? Options: Within 3 months, 3–6 months, 6–9 months, 9–12 months, More than 12 months
• If you had to name one outcome above all others for this renewal — cost, network continuity, clinical results, or data transparency — which would it be and why?

Is the Data Really Telling the Whole Story?

• If you had to place a bet, how much do you trust your current claims + pharmacy data to accurately identify this plan’s top cost drivers? Options: Completely trust it, Mostly trust it with caveats, Somewhat trustworthy — I suspect gaps, Poorly trustworthy
• Which data feeds do you currently receive from your vendor or TPAs (select all that apply)? Options: Raw adjudicated claims (EDI/837), Claim line-level detail, Pharmacy claim history (PBM data), Enrollment/eligibility files, Provider directory exports, HEDIS/quality or clinical registries, None of the above
• Where do you see the biggest gaps or delays in the data we’d need to model and monitor performance?
• Can you share a recent example where the data surprised you or changed your thinking about cost drivers? Tell us what changed and why it mattered.
• How quickly could you provide a 12–24 month claims extract and pharmacy file for a modeling exercise? Options: Within 1 week, 1–2 weeks, 2–4 weeks, More than 4 weeks, Not available

Where Your People Feel the Friction

• How often do employees raise issues about provider access, billing surprises, or claims processing errors? Options: Daily, Weekly, Monthly, Quarterly, Rarely, Hard to say
• And how long has that frequency been true—weeks, months, or years? Options: Under 3 months, 3–6 months, 6–12 months, More than a year, Not sure
• Which geographies or ZIP-code clusters consistently show the most access or network adequacy challenges for your population?
• Have there been recent provider disruptions (hospital/clinic closures, credentialing denials, contract terminations)? Describe one example and the impact on employees.
• How do these access or disruption issues show up in measurable outcomes (ER visits, out-of-network claims, appeals)? Options: Higher ER utilization, Increased out-of-network spend, More claims appeals/overturns, Reduced preventive care uptake, Not measured / unclear

What Are You Willing to Trade to Hit the Number?

• If we asked you to accept a narrower network in exchange for a stronger premium/trend guarantee, how would you react? Options: Open immediately, Would consider with proof of outcomes, Reluctant but negotiable, Not acceptable
• What percentage of your covered members could you tolerate being asked to change primary providers to achieve a meaningful premium improvement? Options: 0–1%, 1–5%, 5–10%, 10–20%, 20%+
• Which commercial guarantees or protections matter most to you? (select up to 3) Options: Premium trend cap, Trend guarantee with reconciliation, Risk corridor / stop-loss structure, Pharmacy rebate guarantees, Member continuity commitments, Provider hold-harmless clauses, Data access SLAs
• Which clinical KPIs would you require to be embedded in any commercial guarantee? Options: ER visit reduction, 30-day readmission rate, Total cost of care per member, High-cost claim management outcomes, Medication adherence for chronic conditions, Behavioral health engagement
• Tell us about one past renewal where a trade-off worked well—or backfired. What did you learn?

Let’s Define Success—Not Just Targets

• Imagine it’s 12 months post-implementation and you’re thrilled — what three concrete things would need to be true?
• Which of these metrics should we include in a shared success dashboard (select up to 5)? Options: Medical PMPM trend, Pharmacy PMPM trend, ER utilization rate, Inpatient readmission rate, Out-of-network spend %, Claims accuracy/error rate, Member satisfaction/Net Promoter Score
• Beyond numbers, what qualitative signals would make you feel this partnership is succeeding (examples: fewer escalations, smoother broker conversations, easier audits)?
• Who on your side should be directly invited to the monthly/quarterly performance reviews? Options: Benefits Director, CFO/Finance, HRBP/Total Rewards, Broker/Consultant, Clinical Leader/Medical Director, IT/Data Owner
• What cadence and format for reporting would you find most useful? Options: Monthly dashboard + quarterly deep dive, Bi-weekly check-ins early then monthly, Quarterly only, Ad-hoc as issues arise

Barriers We’ll Need to Remove

• What internal process or stakeholder is most likely to delay or block a smooth implementation?
• How long does typical legal and procurement review take for your benefits contracts? Options: Under 2 weeks, 2–4 weeks, 1–2 months, Over 2 months, Varies widely
• Who owns system integrations and data transfers (HRIS/PAYROLL, enrollment feeds, EDI), and how readily can they allocate time? Options: Internal HRIS/IT team, Third-party administrator, Broker/consultant manages, Shared responsibility, Unclear/not assigned
• Are there regulatory, union, or state-specific rules we must design around? List any known constraints.
• What would cause the employer to pause a go-live even after contracts are signed? Options: Data quality issues, Provider network contingencies, Enrollment/communication failures, Compliance concerns, Budgetary approval changes, Other

Commitments & Next Steps—What Would Make This Easy?

• If we could commit to one small, guaranteed action before renewal that would materially change your comfort level, what should it be?
• Which onboarding milestones must be completed before go-live for you to feel comfortable (select all that apply)? Options: Claims feed validation, Provider directory reconciliation, Pharmacy formulary mapping, Benefit configuration testing, Member communications plan, Credentialing confirmation
• How do you prefer to receive scenarios and pricing models? Options: Interactive web model / dashboard, PDF model with notes, Live walkthrough workshop, Spreadsheet exports
• When can our team schedule a data-handoff and technical discovery workshop (pick the earliest realistic window)? Options: Within 1 week, 1–2 weeks, 2–4 weeks, More than 4 weeks
• Are there any final concerns, stories, or constraints you want us to know before we build the initial model?