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<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

Written by Scott Conard, MDWhen it comes to population health risk reduction, the conversation is evolving. Historically, in the U.S., managing health costs has often been approached from an actuarial perspective—calculating insurance premiums based on past expenses and statistical projections. While this method has served its purpose, it focuses on trailing indicators like price per procedure and frequency of use, leaving the underlying drivers of healthcare costs largely unaddressed. But now, a shift is happening. We’re moving beyond simply accounting for costs to asking critical questions: What’s causing these costs to rise? What are the leading indicators that drive health risks and, ultimately, healthcare utilization?<h3>Moving Beyond Actuarial Science</h3>Traditional actuarial science calculates costs by factoring in variables like age, geographic location, medical diagnoses, and prescription usage. Insurers then project future costs based on past patterns, layering in adjustments for population demographics. While precise in its methodology, this approach is inherently backward-looking, focusing on how much was spent last year rather than proactively addressing what might reduce future spending.At its core, healthcare costs boil down to two key factors: price and use. But focusing solely on these metrics ignores a fundamental truth: the largest driver of healthcare cost is the risk of illness within a population. A high-risk population will inevitably lead to higher utilization and costs, while a low-risk population is significantly less expensive over time.<h3>Identifying and Addressing Health Risks</h3>To reduce health risks, we must first identify them. The answer lies in analyzing the population’s disease burden and the lifestyle factors driving it. Experience has shown that approximately 30% of a company’s population will eventually account for the majority of high-cost claims. More importantly, about 70% of those costly claims stem from conditions that could have been mitigated through early intervention and risk reduction.Lifestyle and Emotional Health: The First Line of Defense Many of the conditions driving healthcare costs are preventable. Addressing lifestyle factors and emotional well-being plays a pivotal role in risk reduction. Strategies include:<ul><li>Stress management: Teaching individuals healthier ways to cope with stress without resorting to harmful behaviors like smoking, excessive alcohol use, or substance dependency.</li><li>Health habits: Encouraging basics like adequate hydration, regular exercise, sufficient sleep, and nurturing positive relationships.</li><li>Emotional resilience: Helping people process emotions and conflicts in healthier ways, avoiding destructive coping mechanisms. Addressing these areas not only improves quality of life but significantly reduces the risk of chronic diseases like diabetes, heart disease, and mental health conditions. Navigating Healthcare Smarter</li></ul>The second pillar of health risk reduction involves empowering individuals to make smarter healthcare choices. This includes:<ul><li>Selecting high-quality providers: Ensuring access to experienced physicians and top-tier facilities.</li><li>Cost-effective services: Choosing high-quality, low-cost imaging or surgical centers to avoid the pitfalls of poor outcomes and inflated charges.</li><li>Preventive measures: Identifying individuals at risk for advanced diseases—such as stage 3 or 4 cancer or the need for kidney dialysis—and intervening early to improve outcomes and reduce costs.</li></ul><h3>High-Quality Care = Lower Costs</h3>A critical insight emerges when we focus on proactive health management: the highest-quality care is often the least expensive care. By identifying and addressing risks early, we not only improve health outcomes but also manage costs more effectively. Predictive analytics allow us to foresee who may require expensive treatments like surgery or dialysis, enabling timely interventions that are both effective and cost-efficient.<h3>The Future of Population Health</h3>This shift in focus—from trailing indicators like price and use to leading indicators like disease risk—represents a fundamental transformation in how we approach population health. By addressing the root causes of illness, promoting healthier lifestyles, and ensuring access to high-quality care, we can achieve significant reductions in healthcare costs while enhancing overall well-being.The path forward is clear: organizations must prioritize proactive health management strategies that address the underlying drivers of risk. By doing so, they can create healthier populations, reduce costs, and foster a more sustainable healthcare system. This isn’t just good for business—it’s essential for the future of healthcare. Dr. Scott Conard is a physician and healthcare strategist dedicated to improving organizational health outcomes through innovative approaches to employee wellness and healthcare management.

Revolutionizing Population Health Risk Reduction: A Shift from Historical Costs to Root Causes

Doctor hold smartphone, conduct financial transactions with calculate expenses - income and data documents, put on the desk in the morning.

Written by Brian Uhlig and Scott Conard, MDFor executives responsible for managing their organization’s health plan, there’s a crucial question worth asking: Is our current system really designed to treat each individual and improve their health?On the surface, the answer might appear to be “yes.” After all, the system has data, information, resources, and influence at its disposal. But take a step back and ask yourself: How is it working for you?If the system truly prioritized individual health, the numbers would tell a different story. Healthcare costs in the U.S. would be at least half of what they are today. Instead, costs continue to rise at a staggering rate of 5% to 10% annually, leaving organizations and their employees struggling under the weight of increasing premiums, higher deductibles, and diminished outcomes.<h3>The Misaligned Incentives</h3>Here’s the hard truth: The current system is not designed to treat the individual effectively. Why? Because misaligned incentives drive it. Many players in the healthcare ecosystem profit more when costs go up. In fact, rising costs are often baked into their business models.This misalignment has created a scenario where nearly one-third of healthcare spending is wasted on fraud, waste, and abuse. These inefficiencies enrich middlemen and other unnecessary stakeholders while leaving employers and employees to foot the bill. Worse yet, 70% of high healthcare costs could have been prevented if root causes were addressed earlier.<h3>A Smarter, More Aligned Approach</h3>What if we could use the same intelligence—data, information, and systems—but act on it differently? What if we focused on making people healthier and tackling waste at its core?This approach is not only possible but also financially and operationally realistic. By investing in high-quality care that addresses the root causes of health issues, organizations can achieve better outcomes and lower costs. High-quality care is the least expensive care because it prevents the need for costly interventions and reduces the churn of treating symptoms without resolving the underlying problems.<h3>A Path to Sustainable Savings</h3>Consider this: if we worked to eliminate a portion of fraud, waste, and abuse each year for the next five years while improving the health of employees, could we stabilize our costs? The answer is a resounding “yes.”Here’s what that path looks like:<ol><li>Identify and Eliminate Waste: Leverage data analytics to pinpoint areas of unnecessary spending, inefficiencies, and fraudulent practices.</li><li>Promote Preventive Health: Invest in initiatives that keep employees healthier, reducing their need for expensive treatments and hospitalizations.</li><li>Align Incentives with Outcomes: Partner with providers, vendors, and consultants who prioritize value over volume, tying compensation to measurable health improvements and cost reductions.</li><li>Educate and Empower Employees: Equip employees with tools, resources, and incentives to take control of their health and make informed decisions.</li></ol><h3>The Payoff</h3> By realigning incentives and focusing on root causes, companies can break the cycle of escalating costs. Over time, this shift leads to a healthier workforce, more predictable expenses, and a competitive edge in attracting and retaining talent.As leaders, it’s up to us to ask the tough questions and take bold action. The fly in the sauce isn’t going to fix itself—but we can. Together, we can create a system that works for individuals, organizations, and the bottom line.Are you ready to take the first step toward a healthier future for your team and your company?

Realigning Incentives for Better Health Outcomes and Lower Costs

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

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 ...

Revolutionizing Population Health Risk Reduction: A Shift...

Realigning Incentives for Better Health Outcomes and Lowe...