Defining Excellence & Democratizing Access to High Performance Health Plans

What is Nautilus?

Nautilus is an ambitious initiative to transform health plan market norms in procurement, contracting, and data use by 2030. Nautilus creates and partners with others to create shared standards of excellence and enabling resources that simplify adoption of these standards, enabling broad adoption of new market norms.

Nautilus is made up of discrete projects, each led by panels of experts, organizers, and evangelists. For now, projects focus on specific health plan procurement, contracting, or data use topics. Over time, Nautilus will launch many projects in these and other topics.

Excellence in these topics catalyzes a virtuous cycle that enables health plans to provide better care at lower costs, while helping plan sponsors (employers, unions, etc.) meet fiduciary, ethical, legal, and other obligations to individual plan members.

Standards and enabling resources created by Nautilus Projects are entirely open source, meaning they are free and openly available to any individual and organization to use.

Learn more about current and coming Nautilus Projects.

Nautilus is enabled by the Nautilus Health Institute, a 501(c)(3) non-profit.

  • Success starts with selecting the right partners to help strategize, implement, and manage a high-performance plan. From advisors to plan administrators to targeted solutions, the path to success starts here.

  • Contracts memorialize best practices, set expectations, create accountability, and reduce risk for everyone. They're a weapon for separating the talkers from the walkers.

  • Accessing and intelligently using data gives plans superpowers for making effective decisions that improve care quality, cost, and access. Being able to access and navigate the immense complexity of health plan data is the first step to this.

Many employers, unions, and others are subject to fiduciary or similar obligations under various laws and organizational charters. Effective fiduciary management is a complex topic, but plans that excel at procurement, contracting, and data use are far more likely to meet these obligations.

What is Nautilus Solving and Who Benefits?

Problems Nautilus is Solving

No Common Language for Excellence

Very few areas of employer and union-based health plans have shared definitions of what good looks like. This limits ability to transform market norms or rapidly make improvements in health plans.

Limited Standardization

So much of the same work is done over and over by employers, unions, advisors, vendors, and others. Much of this work is non-differentiated and does not create any real value. A lack of standardization across organizations in key areas just increases costs and avoidable errors for everyone.

Little Repeatability

Because there is limited standardization across organizations, each new RFP, contract, data request, report, and more requires starting over each time work is done because nothing is standardized between organizations. This complicates hiring, unit economics, and more.

Low Cross-Organizational Trust

Because nothing is standardized or repeatable, little trust exists between market players. This creates duplicative work across organizations, additional costs, and more.

Who Benefits from Nautilus

Employers and Unions

Plan sponsors lack north stars for improving their plans. There are so many complex, constantly changing topics, it is nearly impossible to navigate. What should I put in my RFP, how do I measure ROI, what should a contract have in it

Benefits Advisors

Modern benefits advising is changing rapidly as transparency and other market trends require advisors to demonstrate their value. They’re increasingly expected to be experts in every strategy, knowledgeable on every vendor, and able to verify the results every activity.

Benefits Vendors

The hard work of being excellent is rarely rewarded in the current employer and union-based health plan market. This makes it hard for forward-leaning, exceptional vendors to stand out in a way that customers and prospects understand or value. A lack of shared standards of excellence also complicates prioritizing operational improvements.

Program Architects

More and more Community-owned Health Plans and other next-generation health plans are emerging each day. Each and every one of them has to start from ground zero on many topics that create little differentiated value.

Active Nautilus Projects

TPA Procurement,
Contracting & Mgmt.

Project Stage: Initial Resources Live + Building Project Panel

Data Access
& Utilization

Project Stage: Initial Resources Live + Building Project Panel

PBM Procurement,
Contracting & Mgmt.

Project Stage: Building Project Panel & Initial Resources

  • Strong procurement processes, contracts, and data use are the foundation for effective fiduciary oversight that leads to high-performing health plans. Tackling these topics equips plans to better fulfill increasingly scrutinized fiduciary duties related to health benefits, reducing organizational, regulatory, clinical, and financial risk.

    However, many market norms, best practices, benchmarks, supporting resources, and more need to be developed before wider adoption of effective fiduciary management can happen.

  • Plan documents are the key governing document for health plans and require complex implementations to effectively adjudicate claims. This project will create open standards for compliance, best practices, definitions, and more, so that plan documents can be consistently operationalized and managed.

  • Plan sponsors want to know how well their plan is performing, whether they're implementing the right strategies, how compliant they are, and more in verifiable and benchmark-able ways. This project will develop these metrics.

  • Developing appropriate methodologies for measuring overall plan and specific program performance is complex, even with good data. This project will adopt shared methodologies for performing key analyses important to measuring plan performance.

  • Primary care is the foundation for any high-performance health plan. This project will define and simplify how best to build primary care into health plans.

  • Risk management and underwriting is complex and rapidly evolving, yet few plan sponsors really know how to manage their plan's risk. This project will define key risk management standards and create educational resources to simplify adoption.

Advisor Procurement,
Contracting & Mgmt.

Project Stage: Initial Resources Live + Building Project Panel

Projects Currently Being Scoped

These projects have been identified as important and are currently being defined and scoped, but have not yet started building the project panel and have not created any criteria, resources, or adoption plans yet.

In the future, we expect to launch many other projects. The current active and scoping projects address foundational key issues that open the door for plan sponsors to build plans that advance the Quadruple Aim.

Get Involved

Get Involved with Nautilus by using, contributing to, developing, or financing Nautilus projects, standards, resources, and adoption.

Use Resources

Start using project resources in your plan, with your clients' plans, or to differentiate your organization in the market.

Develop & Support Projects

Contribute your expertise and existing resources to make current and future projects better and stronger. Proactively get involved in creating, maintaining, and distributing resources libraries.

Finance

Help fund Nautilus Projects and adoption of Nautilus Standards.