By Jason Coon
For many Catholic employers, there is a sincere and thoughtful commitment to ensuring that their health plans reflect the mission and teaching of the Church. Decisions are made carefully. Plan documents are reviewed. Trusted advisors are engaged. There is, in most cases, a genuine desire to do what is right—for employees, for families, and for the integrity of the organization itself.
And yet, CBA is finding with its review process that the question is increasingly worth asking: Is alignment something we can assume… or something we must verify?
At a high level, most health plans we review appear aligned with the Faith. They are compliant with applicable requirements. They include thoughtful exclusions. They reflect decisions that were made with good intent. From the perspective of leadership, the plan often appears stable, well-structured, and consistent with expectations.
But health plans do not operate at a high level.
They operate through definitions, clinical policies, administrative processes, and vendor interpretation. These are the places where decisions are made every day—quietly, consistently, and often without direct visibility. What is approved, what is denied, what is encouraged, and what is normalized are not determined by intent alone, but by how the plan is written and how it is administered in practice.
Photo by Drazen Zigic.
Across Catholic employers, we consistently see a pattern emerge. There is strong intent to follow Church teachings at the leadership level, but a gap exists between that intent and how the plan functions day to day. This is not because anything was done incorrectly, or because organizations lack commitment. It is because health plans are complex, evolving systems. They rely on third parties. They depend on language that is often assumed rather than fully defined. And over time, health plans are shaped by policies and interpretations that can extend beyond the original design.
This is where alignment begins to break down—not in principle, but in execution.
Ambiguity Transfers Authority
Misalignment rarely presents itself in obvious ways. It is not typically found in mission statements or high-level summaries. Instead, it lives in the details: in areas where the plan is silent, where definitions are not fully specified, where ambiguous clinical policies are adopted, or where vendor partners are left to interpret intent on behalf of the employer. In those moments, something subtle but important occurs: Where the plan is unclear, someone else decides.
Those decisions are often made in good faith and according to industry standards. But they are not always made according to the specific mission or values of the Catholic employer. And because these decisions are embedded within the system, they can persist over time without being easily detected.
In the past, it may have been reasonable to assume that a well-designed plan would remain aligned once established. Today, that assumption is more difficult to sustain because healthcare systems continue to evolve, clinical guidelines change, vendor practices shift, and administrative interpretation evolves. Even plans that were reviewed and updated at one point in time can gradually drift as these changes occur.
Shifting Your Oversight Approach
For Catholic employers, this represents a quiet but important shift in responsibility.
Alignment is no longer something that can be established once and left alone. It is something that must be revisited, understood, and maintained over time, not out of concern or suspicion, but out of a desire for clarity and faithfulness in execution.
This does not require organizations to become experts in every technical aspect of their health plans. But it does require a way to see what is otherwise difficult to see—to understand how the plan is actually functioning beneath the surface, and to identify where gaps may exist between what is intended and what is taking place.
This is the space where many employers have found it helpful to adopt a more structured approach to plan review. Rather than relying on assumptions or periodic updates, they are beginning to ask a different set of questions: How is the plan being interpreted? Where are decisions being made? What is being left undefined? And how do we know that what is happening in practice reflects what we believe?
Tools like the CBA’s CARLO review have emerged in response to this need—not to replace existing advisors or structures, but to bring greater clarity and visibility into the system. By examining how a plan is actually operating and identifying areas where alignment may be incomplete, employers are able to move from general confidence to informed understanding. Just as importantly, plan sponsors are able to establish a baseline and revisit it over time, recognizing that alignment is something that must be sustained, not simply achieved.
Perhaps the most helpful place to begin is with a simple question: How would we know if our plan was not aligned?
For many organizations, the answer is not immediately clear. But that uncertainty is not a failure, it is an invitation. An invitation to look more closely at your plan, to ask more precise questions, and to ensure that the systems supporting employees and their families truly reflect the mission they are meant to serve.
Catholic identity is not expressed only in what is stated. It is expressed in what is done—consistently, over time, through the systems we operate. Health plans are one of those systems.
And in today’s environment, alignment cannot be assumed. It is something we are called to see, to understand, and to maintain.