Sometimes, small decisions set big things in motion.
When Allison De Paoli took a position in Florida, partially influenced by a pursuit of warmer weather, it became the start of an impactful career helping employers bring clarity, control and measurable results to their health benefits. It also set the stage for the evolution of a boutique advisory firm that focuses on delivering smarter, more transparent and more humane health plans to the organizations she works with.
"Nobody grows up saying, 'I want to sell insurance for a living,'" De Paoli says with a laugh, but she is no stranger to the industry. After studying international relations in Washington, D.C., she moved to Florida to join her family's multigenerational benefits practice. It was there, working hands-on with mid-sized employers, that she began to understand the intricacies of self-funded plans and develop creative solutions to complex challenges. She also spent those early years constantly asking herself why certain problems existed and how to fix them, eventually learning to tackle them one employer at a time.
Her early years in the industry also gave her room to experiment and develop a deeper understanding of what works for employees and employers alike. From managing midsize employer groups to navigating emerging health care trends, De Paoli worked to hone a practical, solutions-oriented approach that became the foundation for the firm she created and runs today.
Boutique vision
In 2012, De Paoli took the leap into entrepreneurship, founding Altiqe Consulting, a San Antonio-based boutique advisory firm focused on fiduciary health plan design, pharmacy reform and care-delivery strategy. While her early career included voluntary benefits and a brief stint running a small enrollment firm, De Paoli quickly realized her passion lay in designing core health plans, rather than managing supplemental coverage.
"I was looking around thinking, 'Why? Why is this problem here? I know how to fix this." And so then I realized, 'Well, then maybe just go fix it.'"
Her approach was shaped by years of experimentation and problem-solving that taught her how misaligned incentives, opaque contracts and complicated plan designs often fail employers and employees and lead to serious problems. At Altiqe, she focuses on a systems-level mindset — treating benefits as an operating system rather than a yearly renewal exercise — and a hands-on, practical focus on results.
"We do that one employer at a time," she says. "We get to do all the fun and innovative things with some employers, while others are more traditional."
De Paoli notes that independent firms can offer a level of independence and flexibility that larger competitors can't match.
"The larger firms have to play by some rules that I don't have to play by," she says." I am not responsible to anybody except my clients, and my profit margin does not depend on a bonus. I don't have to have a certain amount of business with any particular vendor. We have maneuverability, so if something isn't working, we can change it."
From the start, De Paoli has emphasized long-term relationships and measurable outcomes. As a result, some of her earliest clients have stayed with for decades, as she has built a small, highly skilled team that can deliver both strategic insight and day-to-day support. Her persistence and commitment has also helped build deep loyalty.
"My very first client from 2002 is still my client," De Paoli said. "I love them to death."
Fixing what others don't
De Paoli doesn't shy away from hard truths about the benefits industry. The system works for some industry players, but often not for the employers and employees, she says. From her perspective, the system is rife with obfuscation and misaligned incentives, making it difficult to know who is truly acting in the employer's interest.
She recalls a recent contract review that left her baffled: A generic drug benefit was moved to a lower-cost pharmacy benefit manager for better pricing, while high-cost specialty drugs remained under a provider where the employer had no control.
"They left the high-cost drugs in the high-cost environment and created a manual process for people to get cheaper generics. It doesn't make any sense and it's not acting in the interest of the employer," she says.
De Paoli has helped reduce pharmacy spend by as much as 50% for multiple clients, without changing the formulary or increasing member cost sharing. She has also sustained 25% pharmacy savings for three consecutive years through specialty drug and contract redesign, maintained full coverage while lowering total plan costs by 3%, and implemented access-first plans using direct primary care that achieved 20% year-over-year cost reductions. Over the same period, employee contributions have remained flat for seven years, with reductions in dependent tiers, demonstrating that cost control and employee experience can improve at the same time.
Colleagues say De Paoli's persistence often makes the difference in urgent situations. David Balat, CEO of the Direct Care Alliance, a network of independent physician practices focused on patient-centered direct-care models, says that several traits set her apart.
"She's extremely intelligent, and what makes that dangerous is that she's incredibly persistent," Balat says."If she sees an opportunity to help someone or to right a wrong, there isn't much that's going to stand in her way."
He recalls a case where an employee of one of De Paoli's clients received a denial from a carrier late in the week. Rather than waiting for the issue to resolve itself, De Paoli began making calls across her professional network on Friday afternoon. By Monday, Balat says, she had secured an alternative option that was both more affordable for the employer and higher quality for the patient, allowing the procedure to move forward on time.
Impact that extends beyond clients
De Paoli sees education as a core part of her work. Many employers and decision-makers are unaware of alternatives like self-funding or direct-pay models, so she helps them understand what's possible and how to move forward. By providing actionable insights, she empowers clients to make informed decisions about costs, care access and employee experience.
And her thought leadership extends beyond her own clients. De Paoli recently helped produce the documentary" It's Not Personal, It's Just Healthcare" and contributed a chapter to a book titled "Breaking Through the Status Quo," both projects aimed at educating employers on pharmacy benefit management and care delivery challenges. She also hosts vendor-free annual advisory retreats, providing a space for independent advisors to share best practices and elevate standards across the profession.
Outside of her career, De Paoli maintains an active volunteer life focused largely on health care access and community wellbeing. She previously served as chair of the South Texas Blood & Tissue Foundation, raising $800,000 during her term, and remains on its board, supporting initiatives that bring complex therapies closer to patients. Her leadership has also helped bring mobile leukapheresis services to patients who otherwise would have had to travel long distances for care, making advanced treatments more accessible.
Most recently, De Paoli was appointed to the University Health System Foundation Board, where she continues to advocate for more accessible care.
"It's given me an opportunity to help get patients into that facility and connect them with extremely high-quality care at a cost that is not predatory," she says. "I'm pretty proud of that."
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