A separate practice line for the organizations that serve self-funded plans. Fractional COO and CSO work — where the business is going, and whether the operation can actually get it there.
Most executives came up through one door or the other. Operators who run a tight shop but can't see the market moving. Strategists who read the market well but have never had to staff a claims team to a service level.
The gap shows up the same way every time: a growth plan the operation was never going to be able to deliver, or an efficient business heading nowhere in particular. At the size most TPAs, MGUs, and vendors operate at, you can't afford two executives to close it.
I came up through operations — TPA leadership, claims, account management, and a claims repricing and direct contracting business — and built strategy on top of that. So when I tell you a direction is viable, I mean your claims team, your account managers, and your systems can actually deliver it. Not that the market looks attractive.
Ongoing executive leadership for an organization that needs the judgment but can't yet justify the full-time seat. On the operating side: process architecture, service model design, staffing structure, partner management, and the operating cadence that keeps it from drifting. On the strategy side: where the business should be in three years, which markets are worth entering, what to build versus buy versus partner for, and what to stop doing.
Set days per month · Six or twelve month termsA large client relationship is on fire and the account team has exhausted what it can do. I come in, establish what actually happened, build the recovery plan, and help you have the conversation with the client. Often the difference between a save and a termination notice.
Entering a market you haven't served, launching a product line, or standing up a capability you've been buying. Market and competitive read, feasibility, operational design, build-versus-buy-versus-partner, staged rollout — and an honest answer on whether the organization can carry it before you commit the capital.
Preparing for opportunities meaningfully bigger than your current book. Where your operational story breaks under diligence, which claims won't survive a finals room, what a sophisticated consultant will ask, and how to answer without overpromising something your operations team then has to deliver. This is where the two chairs matter most — the pitch and the delivery have to be the same thing.
Self-funding fundamentals training for teams who administer plans without having been taught how the whole machine fits together. Account management tune-ups — escalation handling, renewal conversations, reading a claims file, knowing when to escalate internally. Delivered onsite or remote, built around your book rather than generic curriculum.
Fractional retainer for ongoing COO or CSO leadership — a set number of days per month, agreed in advance, on a six or twelve month term.
Project engagements for a defined outcome: an escalation resolved, a vertical designed, a sales organization ready by a date.
Training priced per session or per cohort, onsite or remote.
Fees are quoted against scope before work begins. As on the plan side, I don't work on contingency, commission, or a share of revenue — and I don't take equity in exchange for advisory work.
Patron Health's primary practice is independent advisory for self-funded plans — work that includes evaluating vendors and holding them to their commitments. This practice line serves those same kinds of organizations. That's a real tension, and it's managed by disclosure rather than by pretending it doesn't exist.
This market is small. Anyone who tells you they have no relationships with the vendors they evaluate is either new to it or not telling you everything. What protects you isn't the absence of relationships — it's knowing about them before you rely on my judgment, and holding the decision about whether they matter.
Before any plan-side engagement is scoped or priced, I run your vendor stack against my client history — active engagements and anything in the prior two years.
If there's overlap, you receive it before we talk fees: who, when, what the work involved, and — the part that determines everything else — whether it's active or finished. You don't have to ask, and you don't find out later.
If the relationship is finished, all three doors are open to you: proceed, carve that vendor out, or decline. If it's active, the carve-out already happened before you were asked. Either way, walking away costs you nothing — no invoice, and I'll point you elsewhere if I can.
Past experience with a vendor isn't automatically a conflict. Undisclosed experience always is.
Nearly twenty years of my career was spent inside these organizations. That's the reason my plan-side work has teeth — I know how a TPA is actually staffed, what a claims system can and can't do, and what "we're looking into it" means depending on who says it.
Knowledge of operations goes stale fast. Continuing to work inside these organizations is what keeps my read accurate rather than five years out of date. Plans benefit from that. The rules above are what keep the benefit from becoming a cost.
Whether it's an escalation that needs resolving, a build you're weighing, or a team that needs to get sharper — describe it and I'll tell you honestly whether I'm the right person for it.
Select “A TPA or MGU” when you reach out