Skip to main content
The High Performance Health Plan
← Designing the Strategy

Chapter 9

Building Better Care Pathways

Care pathways create a practical route from a member’s question to appropriate, timely care and a more predictable plan outcome.

Core idea

From concept to management action.

Care pathways create a practical route from a member’s question to appropriate, timely care and a more predictable plan outcome. The practical work is to make care pathways visible, assign ownership and review the result throughout the year.

This companion page translates the chapter theme into an original employer-management discussion. It is not a substitute for the book; it is a working aid for leadership teams deciding what to examine, who should be accountable and what progress should look like.

Start with the current state, identify the decision that has been left to default, and set a short review cycle. Better performance follows when leaders replace assumptions with evidence and turn the next renewal into one checkpoint within a year-round operating rhythm.

What employers commonly misunderstand

Building Better Care Pathways is a one-time project.

The strongest improvements require a regular management cadence, documented decisions and follow-through beyond a single meeting or renewal season.

A vendor report is the same as oversight.

Reports matter when leaders agree on the questions, test the evidence and use the answers to make or adjust a decision.

More activity means more progress.

Focus on the few actions that materially improve care pathways, not a long list of disconnected initiatives.

The answer is identical for every employer.

The right next step depends on workforce needs, risk tolerance, data availability and the organization’s ability to execute.

Questions for leadership

  1. 01What evidence do we have about care pathways today?
  2. 02Which leader has clear decision rights and accountability for this work?
  3. 03What assumption should we test before the next significant plan decision?
  4. 04How will employees experience a better result if we get this right?
  5. 05What would credible progress look like in the next 90 days?

Key terminology

Decision rights
Documented clarity about who recommends, approves and owns a material health-plan decision.
Management cadence
A recurring schedule for reviewing evidence, making decisions and tracking commitments.
Leading indicator
A measure that signals whether the work is moving in the intended direction before final outcomes are known.
Active stewardship
Year-round employer oversight of plan strategy, partners, evidence and member experience.

Related Score questions

  • Can leaders explain the current approach to care pathways and its intended outcome?
  • Do we have timely information to evaluate performance and adjust course?
  • Are responsibilities and next decisions clear across the employer and its partners?

Download the Executive Reading and Action Guide

Use this companion guide to turn Chapter 9's leadership questions into a focused discussion and practical next steps.

Download the guide

Take the next step

Find the work that matters most now.

Use the Health Plan Score to identify where your organization has the clearest opportunity to move from renewal management to active stewardship.

Take the Health Plan Score