Independent Fiduciary Governance for Tribal Health Plans
We assume delegated fiduciary responsibility for Tribal self-funded health plans—replacing fragmented vendors with enforceable governance, transparent oversight, and disciplined stewardship
A fiduciary structure entrusted to govern, not merely administer
TRIBAL NATIONS HEALTH provides independent fiduciary health plan governance, serving Tribal governments and Tribal enterprises with self-funded health plans.
We are not a traditional broker or third-party administrator. We sit on the Tribe’s side of the table — accountable only to the Tribe — with a fiduciary duty to protect Tribal assets, health plan data, and decision-making authority.
Under this fiduciary role, we govern the entire health plan system. This includes health insurance and stop-loss placement, third-party administration, claims operations, brokerage services, and specialty vendors — all managed within a single fiduciary structure aligned solely to the Tribe’s interests.
Rather than coordinating disconnected vendors or navigating conflicting incentives, TRIBAL NATIONS HEALTH establishes clear authority, transparency, and accountability across the plan. Every partner operates under defined governance, performance standards, and fiduciary oversight.
The result is a health plan managed as a long-term institutional responsibility — not a transactional insurance product.
TrustFirst™ Governance and Data Stewardship
Effective governance requires more than good intentions. It requires structure.
TRIBAL NATIONS HEALTH operates all self-funded health plans within TrustFirst™, a fiduciary governance architecture designed specifically to support Tribal oversight, transparency, and long-term continuity.
Through TrustFirst:
• Health plan funds are governed within a formal trust arrangement
• Fiduciary roles and responsibilities are clearly defined
• Decision-making authority remains with the Tribe
• Oversight processes are documented, repeatable, and auditable
This structure ensures that governance does not depend on personalities, vendor relationships, or informal knowledge. It is designed to endure leadership transitions and vendor changes without disruption.
Compensation Transparency and Financial Governance
TrustFirst™ is designed so that compensation cannot hide.
All plan-related compensation and financial flows are documented and governed through the Administrative Services Agreement and the Trust Agreement, including the schedules and exhibits that define what can be paid, to whom, and under what conditions.
Under this structure:
• All compensation is agreed to in advance and cannot be altered informally
• The Tribe approves the compensation structure as part of plan governance
• The Trustee administers payments only as authorized by the governing agreements
• Compensation and fees are fully disclosed and traceable, supporting complete transparency
• No vendor or partner is permitted to receive payment outside the agreed framework
This approach is intended to ensure that the Tribe can govern with clarity, prevent conflicts from accumulating quietly, and maintain durable control over plan economics over time.
Data Sovereignty by Design
Health plan data is one of the Tribe’s most valuable assets.
Under TrustFirst, TRIBAL NATIONS HEALTH ensures that
• The Tribe retains control over its health plan data
• Reporting is transparent and accessible to Tribal leadership
• No vendor quietly accumulates data control or informational advantage
• Historical data continuity is preserved over time
While third-party administrators operate the claims systems and day-to-day platforms, TRIBAL NATIONS HEALTH serves as the fiduciary system-of-record steward, overseeing data integrity, compliance, and transparency across all plan vendors. This approach allows Tribal leaders to govern with clarity — without being forced into the mechanics of administration.
Care and Case Management Aligned With Tribal Priorities
Effective health plans do more than pay claims. They guide care.
TRIBAL NATIONS HEALTH supports care and case management strategies that are aligned with each Tribe’s priorities, workforce realities, and long-term financial stewardship — without shifting responsibility or cost burden onto members.
Our approach emphasizes:
• Early identification of high-risk and high-cost conditions
• Coordinated case management across medical, pharmacy, and specialty vendors
• Critical illness and catastrophic risk mitigation
• Proactive support for members navigating complex care
These efforts are governed within the same fiduciary framework as the rest of the plan — ensuring that care programs are accountable, measured, and aligned with overall plan sustainability.
The goal is not to manage people.
The goal is to manage systems so people receive the right care at the right time — while protecting the Tribe’s health plan for the long term.
TrustFirst™
TrustFirst™ Architecture is the fiduciary governance framework through which Tribal Nations Health formally assumes responsibility for health plan oversight and decision-making. By transferring plan governance to an independent professional fiduciary with contractual authority, insurance coverage, and enforceable accountability, TrustFirst™ materially reduces legal, personal, political, reputational, and enterprise risk for Tribal leadership and administration, while restoring transparency, discipline, and trust to healthcare decision-making.