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By Scott Conard MD and Brian UhligAsking the right questions is a fundamental skill that drives success in healthcare and organizational improvement. Thought leaders across various fields emphasize that well-formed questions help in understanding value, identifying issues, fostering collaboration, driving change, and measuring success. Here’s why asking good questions matters and how it impacts different aspects of healthcare and organizational progress.<h3> Understanding Value and Needs</h3> A core function of asking questions is to determine what constitutes value from different perspectives, particularly the patient’s. Stacey Richter highlights that value is in the eye of the beholder, and true value emerges when we deeply understand others' challenges, pains, and needs. Dr. Komal Bajaj underscores the necessity of questioning and listening to discern employees' purpose and align them with organizational goals. Similarly, Dr. Beau Raymond advises that the first step in improving care is defining the destination—asking where are we trying to go? provides direction.<h3> Gathering Critical Information and Identifying Problems</h3> Asking the right questions is essential for collecting crucial data and pinpointing underlying problems. Dr. Beau Raymond notes that even if certain questions feel uncomfortable, they must be asked to gain meaningful insights—for instance, inquiring about gender identity to better tailor healthcare solutions. Karen Root also stresses that analyzing the root cause of customer-initiated calls can expose systemic issues and lead to more effective solutions.<h3> Driving Change and Innovation</h3> Innovation often starts with curiosity. Asking questions challenges the status quo and fuels progress. Dr. Komal Bajaj shares an example where healthcare workers’ enthusiasm for "planet-friendly care" was uncovered simply by asking and listening. Marty Makary argues that when patients become health literate and ask informed questions, it shifts the market towards more ethical and evidence-based care. Stacey Richter reinforces the importance of asking “why” questions to build a compelling case for transformation.<h3> Fostering Collaboration and Alignment</h3> Good questions enable communication and collaboration among diverse stakeholders. Stacey Richter points out that ensuring the right voices are included in discussions about value is crucial for making informed decisions. Jodilyn Owen highlights the importance of asking questions in the presence of peers, as it promotes shared learning, strengthens trust, and ultimately enhances patient care. Meanwhile, Brian Uhlig suggests that targeted questions during the discovery phase help assess a client’s readiness for optimization and improvement.<h3> Improving Communication and Understanding</h3> Effective communication depends on asking clarifying questions to ensure alignment. Scott Conard emphasizes the importance of identifying what others don’t understand and framing messages accordingly. This is particularly vital when communicating across different expertise levels or organizational hierarchies. Asking simple but strategic questions bridges knowledge gaps and enhances comprehension.<h3> Measuring Progress and Success</h3> Well-crafted questions help define objectives and track progress. Ashleigh Gunter advocates for soliciting feedback by asking what worked well and what could be improved. Regularly measuring and sharing successes reinforces positive change. Kate Wolin further asserts that you can’t optimize a process if you haven’t first defined the goal—a process that begins with asking the right questions.<h3>Conclusion</h3> Ultimately, asking good questions is not just about finding answers; it is a powerful tool for understanding value, diagnosing problems, driving innovation, enhancing collaboration, improving communication, and measuring success. Whether in healthcare or broader organizational contexts, mastering the art of inquiry leads to better decision-making and improved outcomes. By fostering a culture that encourages thoughtful questioning, we pave the way for meaningful progress and lasting impact.

The Power of Asking the Right Questions in Healthcare and Organizational Improvement

Shopping cart with dollars, US currency with medicine pills

<h3>By Brian Uhlig and Scott Conard, MD.</h3>Big consulting firms are increasingly running their own pharmacy coalitions, raising serious concerns about conflicts of interest, transparency, and accountability. While these coalitions claim to lower costs, they often prioritize profits over patient care, leaving employers and employees with inflated expenses and limited oversight.<h3>The Conflict of Interest Problem</h3>When consultants also own or manage pharmacy benefit managers (PBMs), they profit at multiple stages—negotiating contracts, setting drug prices, and managing claims. This creates incentives to maximize revenue rather than secure the best deals for plan sponsors. Employers may unknowingly be paying excessive fees while receiving suboptimal healthcare benefits (KFF, 2023)¹.A study by the Government Accountability Office (GAO) found that PBM-owned coalitions often use spread pricing and opaque rebate structures, making it difficult for employers to understand actual costs (GAO, 2022)². This lack of transparency contributes to rising prescription drug prices, with PBMs pocketing billions in hidden fees (Brookings, 2023)³.<h3>The Need for Transparency</h3>Many PBMs operate with complex rebate structures and hidden fees that obscure true drug costs (Health Affairs, 2023)⁴. Employers should demand:<ul><li>Full disclosure of all compensation from PBMs and coalitions. </li><li>Engagement with independent consultants who do not receive PBM commissions. </li><li>Regular RFPs to compare PBM pricing and performance. </li></ul><h3>How Employers Can Take Action</h3>To protect plan members and control costs, employers should:<ul><li>Engage legal counsel to review PBM contracts and financial incentives. </li><li>Explore cost-plus PBMs that operate transparently (Commonwealth Fund, 2023)⁵. </li><li>Separate pharmacy benefits from health plans for better cost control. </li><li>Ensure executive leadership involvement to drive informed decision-making</li></ul>Potential Benefits—If Managed ProperlyPharmacy coalitions can offer savings, but only with independent oversight and accountability. Employers should:<ul><li>Conduct regular contract reviews to ensure promised savings are realized. Use data analytics to identify waste and inefficiencies. </li><li>Demand performance guarantees to hold PBMs accountable. </li><li>Driving Change Through Accountability</li></ul>Regulators and market forces are pushing for greater scrutiny of PBM practices, particularly regarding the use of tax-exempt and 340B funds (American Journal of Managed Care, 2023)⁶. Employers can accelerate this shift by demanding transparency and prioritizing long-term health outcomes over short-term savings.<h3>The Path Forward</h3>Organizations must challenge the status quo by identifying waste, reinvesting in employee health, and collaborating with transparent partners. By prioritizing value and accountability, employers can ensure that their healthcare dollars serve their employees—not corporate profits.&nbsp; Sources:<ol><li>Kaiser Family Foundation (KFF), 2023. "The Role of PBMs in Rising Prescription Drug Costs." </li><li>Government Accountability Office (GAO), 2022. "PBM Practices and Their Impact on Drug Pricing." </li><li>Brookings Institution, 2023. "The Hidden Costs of PBMs and the Need for Reform." </li><li>Health Affairs, 2023. "PBM Transparency: A Step Toward Lowering Prescription Drug Costs." </li><li>The Commonwealth Fund, 2023. "How Cost-Plus PBMs Could Transform Pharmacy Benefits." </li><li>American Journal of Managed Care, 2023. "340B Program and the Need for PBM Oversight." </li></ol>Written by Rob Thwaites

The Hidden Risks of Big Consulting Firms Running Their Own Pharmacy Coalitions

<h2>Understanding Zero Trend in Healthcare</h2>
The concept of Zero Trend is revolutionizing how healthcare organizations manage costs and employee health. By focusing on preventing health issues before they arise, Zero Trend aims to stabilize or reduce healthcare expenses over time. This proactive approach requires a shift in how HR teams operate, incorporating innovative tools and strategies to successfully implement these initiatives.

Implementing Zero Trend strategies can lead to significant cost savings for organizations while promoting a healthier workforce. HR teams play a crucial role in this transition, as they are responsible for integrating these practices into the company's culture and operations.

<figure id="figure-vf1q3zxanwm6pk6xtk"><img id="vf1q3zxanwm6pk6xtk" src="https://media.gettyimages.com/id/81712153/photo/doctor-and-nurse-in-hospital-corridor.jpg?b=1&s=2048x2048&w=0&k=20&c=6BRnex-GsHppUjD3Dy9vsjBpv0dOIBFXGQGYXxYDtuo=" alt="healthcare teamwork" class="object-cover bg-gray-100" style="aspect-ratio: 16/9"></figure>

<h2>Essential Tools for HR Teams</h2>
<h3>Data Analytics Platforms</h3>
Data analytics is a cornerstone of successful Zero Trend implementation. By leveraging advanced analytics platforms, HR teams can identify trends and patterns in employee health data. This information helps in predicting potential health issues and implementing targeted wellness programs to mitigate them. Platforms that offer real-time data analysis and visualization tools can significantly enhance decision-making processes.

<h3>Wellness Program Software</h3>
Integrating comprehensive wellness software allows HR teams to design and manage personalized health initiatives. These platforms often include features like fitness tracking, mental health resources, and nutrition planning, enabling employees to engage in activities that support their individual health goals. Automated reminders and progress tracking can further enhance engagement and outcomes.

<figure id="figure-cp6o0yi5gim6pk6xtk"><img id="cp6o0yi5gim6pk6xtk" src="https://media.gettyimages.com/id/886500564/photo/going-to-take-a-before-and-after-training-photo.jpg?b=1&s=2048x2048&w=0&k=20&c=BHGZjjoYWOZPm5oG7WumPmlhcbxWRT9nfumINlPnHe4=" alt="wellness software" class="object-cover bg-gray-100" style="aspect-ratio: 16/9"></figure>

<h2>Strategies for Effective Implementation</h2>
<h3>Employee Engagement</h3>
One of the most critical aspects of Zero Trend is ensuring high levels of employee engagement. HR teams should focus on creating a culture of health by communicating the benefits of wellness programs and encouraging participation. This can be achieved through workshops, seminars, and incentives that motivate employees to take an active role in their health management.

<h3>Partnerships with Healthcare Providers</h3>
Forming strategic partnerships with healthcare providers can bolster the effectiveness of Zero Trend strategies. These partnerships offer access to specialized resources, expertise, and services that support preventive healthcare measures. Collaborating with providers allows HR teams to offer tailored health solutions that align with organizational goals.

<figure id="figure-7e93zikjgbm6pk6xtk"><img id="7e93zikjgbm6pk6xtk" src="https://media.gettyimages.com/id/81712153/photo/doctor-and-nurse-in-hospital-corridor.jpg?b=1&s=2048x2048&w=0&k=20&c=6BRnex-GsHppUjD3Dy9vsjBpv0dOIBFXGQGYXxYDtuo=" alt="healthcare collaboration" class="object-cover bg-gray-100" style="aspect-ratio: 16/9"></figure>

<h2>Overcoming Challenges</h2>
While the benefits of Zero Trend are substantial, HR teams may face challenges during implementation. Resistance to change is a common hurdle, often stemming from a lack of understanding or perceived inconvenience. To overcome this, HR should focus on transparent communication, emphasizing the long-term benefits for both employees and the organization.

Additionally, continuous monitoring and adaptation of strategies are necessary to address evolving needs and ensure sustained success. Regular feedback loops between employees and HR can help identify areas for improvement and foster a collaborative environment.

<h2>The Future of Zero Trend in Healthcare</h2>
As healthcare costs continue to rise, the adoption of Zero Trend strategies is likely to become more prevalent across industries. For HR teams, staying informed about emerging tools and best practices is crucial to maintaining a competitive advantage. By embracing these innovations, companies can cultivate a healthier workforce while achieving financial stability.

Empowering HR teams with the right tools and strategies not only supports organizational goals but also enhances employee well-being, creating a win-win scenario for all parties involved.

Empowering HR Teams: Tools and Strategies for Implementing Zero Trend in Healthcare

'Medical costs soaring' says headline. Rising graph demonstrates it

By Scott Conard MD and Brian UhligAs a senior executive, you’re constantly focused on efficiency, transparency, and maximizing the value of your company’s investments. Healthcare benefits—often one of your organization’s largest expenditures—should be no exception. Yet, many employers unknowingly bleed money due to hidden fees and opaque out-of-network payment arrangements. If you think a polished benefits package guarantees fairness and cost control, think again.Pulling Back the Curtain on Out-of-Network “Savings” Programs Consider a scenario: You have 5,000 employees. Your broker partners with a major carrier that promises a cutting-edge out-of-network cost-management program. On the surface, you’re shown impressive statistics: “We saved you X%!” “Your plan saved hundreds of thousands of dollars!” But ask a crucial question: Saved compared to what? Suddenly, the narrative isn’t so clear.One leading carrier’s program, One of the major insurance carriers offers out-of-network “payment integrity” solutions. The carrier presents data showing significant reductions in billed charges—numbers that look like heroic cost containment. Yet, behind these reported “savings,” the carrier often takes a percentage cut for themselves, effectively turning your plan’s supposed cost control measure into a revenue generator for the insurer.Real-World Example: The 13-Hour Office Visit Imagine a provider billing over 50 increments of a single 15-minute service in one day—implying a marathon 13.5-hour visit. Under standard Medicare rates, this service might only be worth about $32 each time. Yet the provider’s billed amount was thousands of dollars, with the plan paying only a fraction. On paper, this program would claim massive “savings.” But in reality, the carrier charged the plan a hefty percentage of that “avoided” cost—far exceeding what the doctor actually received. In one particularly egregious case, the provider was paid a mere $61 while the insurer pocketed $3,700 in “fees.”The question executives must ask is: If the insurer knows these questionable billing practices are happening, why don’t they stop it? Quite simply, they profit from the difference.<figure id="figure-efvhfeh8pm6f9yxdt"><img id="efvhfeh8pm6f9yxdt" src="https://media.gettyimages.com/id/1461115793/photo/businessman-shaking-hands-with-long-nose-on-shadow.jpg?b=1&amp;s=2048x2048&amp;w=0&amp;k=20&amp;c=PjwvB_rH8OVOGlL3jM1XPIwJ_EI6zfxPwJ4NW1izwgI=" alt="Businessman shaking hands with long nose on shadow" title="Businessman shaking hands with long nose on shadow" class="object-cover bg-gray-100 rounded-2xl md:rounded-3xl lg:rounded-4xl" style="aspect-ratio: 16/9; object-position: undefined undefined;" data-corners="default" data-aspect="16:9" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://media.gettyimages.com/id/1461115793/photo/businessman-shaking-hands-with-long-nose-on-shadow.jpg?b=1&amp;s=2048x2048&amp;w=0&amp;k=20&amp;c=PjwvB_rH8OVOGlL3jM1XPIwJ_EI6zfxPwJ4NW1izwgI=" data-mce-style="aspect-ratio: 16/9; object-position: undefined undefined;"></figure> Where the Waste Happens—and How to Fix It This kind of wasteful spending arises when employers accept opaque arrangements without fully understanding the underlying payment mechanics. To address this problem, organizations must:1. &nbsp; &nbsp; Renegotiate During RFPs: Start strong by establishing clear contract terms that prohibit the carrier from earning more than what is paid to the provider. Demand transparency and define “savings” in measurable, meaningful terms.2. &nbsp; &nbsp; Limit Out-of-Network Services: Consider eliminating or tightly restricting out-of-network benefits. Handle exceptions individually to ensure members get needed care without giving carriers an open invitation to pad their margins.3. &nbsp; &nbsp; Engage Expert Negotiators: Partner with advisors who understand these complex billing games. They’ll ensure plan language and fee structures minimize the potential for misaligned incentives.Implementing these strategic approaches can reduce your per-employee per-month (PEPM) costs significantly. In fact, by addressing just one out-of-network program, some employers have seen immediate reductions of up to 7.5% of total healthcare spending.&nbsp;<figure id="figure-911uuf7gzmm6fa1f41"><img id="911uuf7gzmm6fa1f41" src="https://media.gettyimages.com/id/1954841243/photo/data-analysis-chart-graph-3d-statistics-background.jpg?b=1&s=2048x2048&w=0&k=20&c=JqlWDrRuqpKotSJiWlw9XEKfqmlar9qw3g5TGMGWdVk=" alt="Data Analysis Chart Graph 3D Statistics Background" title="Data Analysis Chart Graph 3D Statistics Background" class="object-cover bg-gray-100 rounded-2xl md:rounded-3xl lg:rounded-4xl" style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionX="undefined" data-positionY="undefined" data-fullWidth="false"/></figure> Data-Driven Results Employers who actively root out these hidden fees and adopt transparent payment models have achieved substantial cost reductions. Data shows that organizations employing robust payment integrity strategies and strict out-of-network controls can drive down total health plan costs by as much as 15%.Your Next Move: Take Back Control As an executive, every dollar counts. In a landscape where healthcare spending spirals ever upward, protecting your plan from hidden charges and self-serving “savings” schemes is critical. Don’t leave your organization’s financial health to chance. Take the first step toward total transparency and meaningful savings. Contact us to learn more and schedule a consultation. Our team will review your existing arrangements, identify hidden waste, and help you negotiate a plan structure that truly prioritizes cost control. Stop letting opaque deals drain your resources—act now and put your company on the path to zero trend.Written by Rob Thwaites

Exposing Hidden Waste: Out-of-Network Payment Schemes

<h3>By Scott Conard M.D. and Brian Uhlig</h3> &nbsp;Introduction As corporate executives, you are keenly aware of the significant impact healthcare costs can have on your bottom line. In today’s complex and often opaque healthcare system, many employers struggle to provide high-quality care for their employees while also managing expenses. In this blog, we’ll explore a comprehensive roadmap for optimizing medical programs, controlling costs, and improving employee health outcomes—drawing on insights from industry experts and strategies you can implement immediately.<h3>The Current Healthcare Landscape: A Call for Change</h3>The U.S. healthcare system is often characterized by misaligned incentives, a lack of transparency, and soaring costs. Employers sometimes delegate benefits management to HR teams or external consultants without fully understanding the financial layers that drive costs. As a result, many organizations overspend and miss key opportunities for improvement.Misaligned Incentives The system frequently rewards volume over value, leading to unnecessary treatments and procedures. Pharmacy Benefit Managers (PBMs), Third Party Administrators (TPAs), and brokers may profit more as healthcare costs rise, creating a perverse incentive to keep costs high. Lack of Transparency Employers often lack visibility into the true costs of their health plans. Complex contracts with TPAs, PBMs, and brokers make it difficult to track real expenses—especially around pharmacy benefits, where rebates and discounts are not always passed on to employers. Financialization of Healthcare A highly financialized environment has emerged between companies and their healthcare benefits, allowing certain entities to extract undue profits. This can inflate costs without necessarily improving patient outcomes. Over-treatment and Inappropriate Care Rewarding quantity over quality leads to overtreatment and unnecessarily high utilization of services. This not only increases costs but often fails to improve health <h3>Taking Control: Actionable Strategies for Employers</h3>A more engaged, strategic approach can help employers optimize medical programs. Below are several key strategies for you to consider:1. Embrace Fiduciary Responsibility As a self-insured employer, you have a legal and ethical duty to act in the best interests of your employees when managing their benefits. Put together a team with the expertise and tools—like the Health Rosetta Plan Grader—to analyze your plan’s performance. Consistent auditing and monitoring ensure you’re staying aligned with these responsibilities.2. Demand Transparency in Contracts Insist on full transparency in contracts with TPAs, PBMs, and brokers. Request a thorough breakdown of all fees and compensation in actual dollars (rather than percentages). Don’t hesitate to ask hard questions—even if your HR team or benefits consultant says the contract appears sound. The Consolidated Appropriations Act (CAA) requires transparency, and failing to secure it may not only cost you financially but also create legal risks, including class action lawsuits.3. Prioritize Health Literacy An informed healthcare consumer is more likely to demand better care and value for money. Equip your employees with the tools and resources to understand their health conditions and make educated decisions. Investing in health literacy can pay dividends in both cost savings and employee satisfaction.4. Focus on Prevention and Chronic Disease Management Chronic conditions like diabetes, hypertension, and mental health issues contribute disproportionately to rising healthcare costs. Implement robust prevention and chronic disease management programs—including mental health resources and medication management—so your employees can stay healthier and avoid expensive treatments down the road.5. Optimize Pharmacy Benefits Integrate pharmacy benefits with medical benefits to encourage appropriate, cost-effective medication use. Be wary of “maximizer” programs that can benefit PBMs and drug manufacturers at your expense. Consider value-based components when designing or selecting pharmacy benefit plans and keep an eye on how high deductibles affect your employees’ out-of-pocket costs.6. Utilize Data and Technology Data analytics can be a powerful tool in identifying areas of waste and steering members toward high-value providers. Use technology solutions to track practice patterns and measure the appropriateness of care. Data can highlight hidden cost drivers, helping you make more informed, evidence-based decisions.7. Standardize Contracts Explore opportunities to standardize contracts between payers and providers. Simplifying your contracts lowers administrative costs and streamlines operations. Direct contracting with Centers of Excellence or other innovative arrangements can be especially beneficial if you have a large population with specific healthcare needs.8. Humanize the Problem Invite employees to share personal stories about the challenges of high deductibles and out-of-pocket expenses. Real-life narratives can help rally internal support for change and bring a sense of urgency to your organization’s healthcare initiatives.9. Create an Environment of Open Communication Support your HR team by offering “air cover” for new and potentially challenging initiatives. HR professionals can’t enact significant reforms if they lack the backing of the C-suite. Open dialogue ensures alignment across the organization on healthcare strategy.10. Emphasize Transparency and Simplify the Process Overly complex systems frustrate both employees and providers. Whenever possible, partner with organizations dedicated to transparent pricing and straightforward processes. Simplifying the healthcare experience is a win-win for everyone involved.<h3>&nbsp; Moving Towards a Culture of Value and Accountability</h3>As a corporate executive, you have the power to shape a healthcare ecosystem that offers high-quality, cost-effective care for employees. By applying the strategies outlined here—prevention, pharmacy benefit optimization, data-driven decisions, and transparent partnerships—you can foster a healthcare model that genuinely serves your employees.The journey starts by engaging with experts and vendors who prioritize transparency. A sustainable, fair approach to healthcare benefits is not just possible; it’s profitable for everyone involved when done correctly. By cultivating a culture of value and accountability, you’ll enhance both the health of your workforce and the health of your bottom line.<h3>&nbsp; Ready to Optimize Your Medical Programs?</h3>If you’re looking to take the next step, connect with seasoned professionals who have a proven track record of helping employers restructure and improve their healthcare programs. Together, you can create a system that truly prioritizes employee well-being while maintaining fiscal responsibility.&nbsp; Interested in learning more or continuing the conversation? Connect with us today. Written by Rob Thwaites

Optimizing Medical Programs: A Comprehensive Guide for Employers

Stethoscope on calculator, Finance, Account, Statistics, Analytic research data and Business company medical health concept.

<h3>By Scott Conard MD and Brian Uhlig</h3>For executives managing health plans, one of the biggest challenges is engaging individuals who are in the early stages of disease risk progression but feel perfectly fine. These individuals, often unaware of the looming consequences, present a significant opportunity—and a unique challenge—to healthcare strategies. Once someone becomes symptomatic, behavior change is much easier; they’re desperate to feel better. However, by then, it’s often too late to reverse the damage. Instead of cheaply and effectively addressing the issue, we’re left managing a chronic condition for the foreseeable future.The key question: How do we engage people early, before symptoms appear, and inspire them to take meaningful action?This is where cutting-edge health risk engagement strategies, driven by predictive data and real-time activation technology, become a game-changer. Our algorithms utilized by the MyPHA team is your solution to this problem.&nbsp; Shifting the Paradigm: From Retrospective Cost Analysis to Proactive Risk EngagementThe status quo in healthcare analytics relies on retrospective cost-based reporting. Most organizations are equipped with tools that answer questions like:<ul><li>How much did diabetes cost us last year?</li><li>What are our highest-cost conditions?</li></ul>These data points are useful for understanding the past but do little to impact the future. They focus on individuals who are already in the high-cost, high-risk category—individuals whose health trajectory has already caused irreparable harm.What’s missing from this equation is predictive engagement—the ability to identify the individuals who are trending toward risk before they become symptomatic and to intervene effectively in real time.Consider this: 70% of today’s high-cost individuals won’t be the same people next year. If you’re only looking at historical data, you’re blind to the emerging risks within your population.<h3>&nbsp; Why Predictive Engagement Matters</h3> Let’s look at the CFO perspective: "I’ve already got reports. I know I have 384 diabetics and 264 people with hypertension. I have programs in place for them. Why do I need anything more?”Here’s why: Traditional reports don’t tell you who your next high-cost individuals will be, nor do they provide actionable insights about how to prevent them from becoming costly. They miss the nuances of health risk drivers—factors like comorbidities, social determinants of health, geographic influences, and behavioral patterns—that determine whether an individual can avoid a serious medical event.Predictive engagement goes beyond labels and costs. It examines the whole person—integrating data about:<ul><li>Chronic and acute conditions.</li><li>Economic and social resources.</li><li>Workplace tools and wellness programs available to them.</li><li>Behavioral trends and opportunities for timely interventions.</li></ul>This holistic approach enables organizations to answer the most critical question: How can we prevent costly and emotionally taxing events before they occur?<h3>&nbsp; Engagement, Activation, and Support: The Pillars of Early Intervention</h3> Effective early intervention requires a three-pronged approach:Engagement: Identify individuals who are silently at risk and help them understand the stakes. This requires leveraging predictive data to highlight their unique vulnerabilities—before symptoms appear.Activation: Inspire behavior change by connecting the risk to personal outcomes they care about. It’s not enough to say, “You’re at risk for diabetes.” Instead, communicate, “If we take action now, we can help you avoid painful complications and maintain your quality of life.”Support: Provide the tools, resources, and follow-up necessary for sustained behavior change. This includes personalized care pathways, access to health coaches, digital tools, and community support systems.<h3> &nbsp;The Financial Case for Early Engagement</h3> For employers, early intervention is not just a health imperative; it’s a financial one.<ul><li>Avoiding a single preventable medical event can save tens of thousands of dollars.</li><li>Employees who avoid disease progression are more productive, have lower absenteeism, and cost less in disability claims.</li></ul>But this requires a shift from reacting to past costs to proactively managing future risks. By investing in predictive analytics and engagement technology, organizations can reduce costs while improving outcomes for individuals.<h3>&nbsp; Conclusion: The Future of Health Risk Management</h3> The old approach—focusing on retrospective cost and disease management—is no longer enough. Health risk engagement strategies must evolve to focus on real-time insights, whole-person care, and proactive prevention.The stakes are high, both for individual lives and corporate budgets. But with the right strategies, tools, and commitment, we can make a measurable difference—shifting the focus from managing disease to building health and resilience.As executives, the question isn’t, “Why should I care about your data?” It’s, “How can I afford not to?”By embracing proactive engagement, activation, and support, you can ensure your organization is leading the way in creating healthier, more productive populations. That’s a future worth investing in.

Health Risk Engagement Strategies: Driving Change Before It's Too Late

Which Door?

The "Which Door?" is a concept that involves a strategic approach to healthcare, aiming to achieve a zero trend in healthcare costs for employers. This approach combines clinical expertise, care pathways, and contract consulting to manage health risks and encourage people to engage with their own health. The pathway to zero trend is not just about cutting costs; it is also about improving health outcomes and creating a system of care that leads to sustainable long-term reductions in healthcare spending.
Key components of the "pathway to zero trend" include:
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Data-driven decision-making: The first step is to distinguish between rumors and facts by obtaining objective data analysis from a third party. This helps employers understand the difference between best and worst performers on a risk-adjusted basis.
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Strategic Contracting: After understanding the data, employers should negotiate contracts that hold intermediaries and providers accountable for outcomes, with performance guarantees.
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Care Pathways: Implementing evidence-based care pathways is essential to manage current and future large claims. These pathways are not static but should be continuously improved based on new data and learnings.
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Integration of Clinical and Contractual Expertise: The approach combines clinical management of health risks and care pathways with expertise in contracting and plan design. This holistic approach creates a system of care that encourages engagement with individual health and reduces long-term costs.
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Transparency and Education: Transparency with consumers and employers about relative quality is important, and rewarding members who seek high-quality care can also be effective.
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Empowerment of HR teams: Providing support to HR teams by helping them feel confident, having the right tools, asking the right questions, and getting the right answers. This also means having the C-suite provide air cover for the changes that need to happen.
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Focus on trends: Rather than aiming for "zero" the focus is on achieving a "zero trend" which is more specific and clarifies the goal. This indicates that the focus is not on eliminating all costs, but rather stabilizing the rate of increase, or achieving a flat cost trajectory.
The "pathway to zero trend" also involves a commitment to continuous improvement and a willingness to challenge established norms. It recognizes that change is not easy and that it may require overcoming resistance and established behavior patterns. It requires a value-based mindset that focuses on the why behind the change, making a case for it. This approach focuses on aligning the incentives of all stakeholders and creating a system where everyone is working towards the same goal. The idea is that this approach can be a journey of transformation, not just a strategy for cost savings.
In short, the pathway to zero trend is about creating a sustainable, value-driven healthcare system where the focus is on both controlling costs and achieving better health outcomes.

Which Door?

Blog

The Power of Asking the Right Questions in Healthcare and...

The Hidden Risks of Big Consulting Firms Running Their Ow...

Empowering HR Teams: Tools and Strategies for Implementin...

Exposing Hidden Waste: Out-of-Network Payment Schemes

Optimizing Medical Programs: A Comprehensive Guide for Em...

Health Risk Engagement Strategies: Driving Change Before ...