Build Your Own
Community Health Plan.
We Handle Everything.
Unified Health Plan partners with self-funded employers and local providers to design, contract, and administer fully integrated community health plans — lower costs for members, better outcomes for patients, and real value for providers who deliver results.
What’s Included — All Under One Roof
Third-Party Administration (TPA)
Full claims administration, member services, and plan management — in-house.
PPO Network
Our own provider network with direct contracting capability in your market.
Utilization Management
In-house UM means faster decisions, fewer conflicts, better care coordination.
Value-Based Payment Design
We structure and administer outcome-based provider incentives — beyond fee-for-service.
Every Piece of the Puzzle — Solved.
Most organizations need multiple vendors to stand up a health plan. We bring it all together so you have one accountable partner from concept through ongoing management.
Market & Employer Strategy
We assess your market, identify aligned employers, and size the opportunity before a single contract is signed.
Step 1Direct Provider Contracting
We negotiate and structure direct contracts with local hospital systems and provider groups — including value-based payment arrangements that reward better outcomes.
Step 2Benefit Plan Design
Plans are structured to incentivize members toward community providers — with lower out-of-pocket costs when they choose high-value, in-network care.
Step 3TPA & Claims Administration
Our in-house TPA team handles all claims processing, adjudication, member services, and employer reporting — no third-party hand-offs.
Step 4Utilization Management
In-house UM means prior authorizations, case management, and care coordination all flow through one aligned team — not an adversarial third party.
Step 5Performance Reporting & Renewal
Transparent data, outcome tracking, and value-based payment settlement — with ongoing plan refinement to drive better results year over year.
Step 6Two Partners. One Shared Goal.
Community health plans succeed when employers and providers are aligned around the same outcome. We build the structure that makes that alignment possible.
Control Your Health Spend — and Keep It in Your Community
You’re already self-funded. You’re already taking on risk. A community health plan gives you the tools to actively manage that risk — while lowering costs for your employees and investing in local care.
- Reduced total cost of care through outcome-based provider arrangements
- Lower out-of-pocket costs for employees who use community providers
- One accountable partner for TPA, network, and utilization management
- Full transparency into where your health dollars go — and what they’re producing
- A benefits story that resonates — keeping healthcare dollars local
Get Paid for the Outcomes You’re Already Delivering
Traditional fee-for-service rewards volume. Our community health plan model rewards value — and connects you directly with local employers who want to keep care close to home.
- Value-based payment arrangements tied to measurable quality improvements
- Direct employer relationships — without the friction of large commercial insurers
- Steerage of local employee populations to your facilities and care teams
- Coordinated UM reduces unnecessary prior auth conflicts and administrative burden
- A true mission-aligned partner focused on community health — not premium growth
How Value Flows Through the Plan
Every stakeholder has a reason to perform — and a financial structure that rewards it. That alignment is what makes community health plans work.
Employers Fund the Plan
Self-funded employers retain financial risk and reward. When utilization improves and outcomes get better, those savings come back to the employer — not to an insurer’s bottom line.
Members Are Guided to Value
Plan design steers employees toward high-value community providers through lower copays and out-of-pocket costs — supported by care navigation at every step.
Providers Are Rewarded for Results
Value-based payments reward providers for measurable improvements in quality, efficiency, and outcomes — not just the volume of encounters billed.
TPA, PPO network, and utilization management operate as one — no handoffs, no gaps, no conflicting incentives.
Competitive direct contracts layered with outcome incentives.
Local employers fund local care. Local providers deliver it. Value stays in the market.
The Only Partner Who Does All of This
Most TPAs administer plans. Most networks negotiate rates. Most UM firms manage utilization. We do all three — and connect them into a single model built for community health plan success.
No Misaligned Incentives
Because we own TPA, network, and UM, every part of the system pulls in the same direction — toward better outcomes at lower cost.
Proven in Real Markets
We’ve built this model with real employers and real providers — not a theoretical framework. We know what works and what doesn’t.
National Reach, Local Execution
Our model scales nationally, but every community health plan is purpose-built around the specific providers and employers in your market.
One Call. One Partner. Everything Handled.
From market assessment through annual renewal — one point of contact who owns the outcome alongside you.
Ready to Build Something Better
for Your Community?
Whether you’re a self-funded employer ready to take control of your health spend, or a provider system looking for a true community partner — let’s talk. No pressure, no pitch deck. Just an honest conversation about what’s possible in your market.
Call Us Directly
Speak with a member of our partnership development team. We’re available to answer questions and walk through your specific situation.
(800) 259-8330Submit an Inquiry
Tell us about your organization and what you’re trying to accomplish. We’ll follow up within one business day to schedule a conversation.
sales@unifiedhealthplan.net