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Newspaper headlines warn of rising health costs

<h3>By Brian Uhlig and Scott Conard MD&nbsp;</h3><p><br>The state of healthcare in America today is far from ideal, with many employees struggling to access affordable, high-quality care. Health insurance plays a crucial role in employee wellbeing, impacting not only their physical health but also their financial stability and overall job satisfaction. Employers who recognize and prioritize the importance of a well-structured health plan can significantly improve employee wellbeing and their company's bottom line.</p><h3>The Current Healthcare Landscape</h3><p><br>Many employers are self-insured, meaning they assume the risk of healthcare costs for their employees. This puts them in a position of essentially running a small health insurance company within their business. Unfortunately, many companies lack the expertise needed to manage these plans effectively. This often leads to overspending, wasted resources, and employee dissatisfaction. Additionally, the current system is often plagued with misaligned incentives where brokers and consultants may prioritize their own commissions over the best interests of the employer and employees.</p><h3><br></h3><figure id="figure-zac3envh5m5var6e4"><img id="zac3envh5m5var6e4" src="https://media.gettyimages.com/id/1874191615/photo/autumn-park-scenery-north-china.jpg?b=1&amp;s=2048x2048&amp;w=0&amp;k=20&amp;c=4EGtDbnDmQhz7RLMsfl1ctMmPc-0EbmxHazGQoUJrcM=" alt="Autumn park scenery, North China" title="Autumn park scenery, North China" 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" data-mce-src="https://media.gettyimages.com/id/1874191615/photo/autumn-park-scenery-north-china.jpg?b=1&amp;s=2048x2048&amp;w=0&amp;k=20&amp;c=4EGtDbnDmQhz7RLMsfl1ctMmPc-0EbmxHazGQoUJrcM=" data-mce-style="aspect-ratio: 16/9; object-position: center center;"></figure><h3><br>Impact on Employee Health and Wellbeing</h3><p><br>When health insurance plans are not managed effectively, the negative consequences are felt by the employees. High deductibles and out-of-pocket costs can deter employees from seeking necessary care, leading to delays in treatment or avoidance of preventative services. This is particularly true for employees with chronic conditions or those who require regular medication.</p><p>The stress of financial burden from healthcare costs can lead to decreased productivity, absenteeism, and lower overall job satisfaction. Employees who feel that their health plan is inadequate may also experience lower morale and increased stress levels, which could impact their performance. In contrast, a well-designed health plan can support employees in maintaining their health, offering resources and support for chronic conditions, mental health, and access to quality care.</p><h3>How Employers Can Improve Employee Wellbeing Through Health Insurance</h3><p><br>Employers play a pivotal role in changing this dynamic and creating a healthcare system that <strong>benefits both the company and its employees</strong>. Here are a few steps to take:</p><p><strong>C-Suite Involvement</strong>: CEOs and CFOs need to get actively involved in the management of healthcare benefits. They must view it as a crucial part of their business, applying the same financial scrutiny as they would to any other significant expenditure.<br><strong>Transparency and Audits</strong>: Employers should demand transparency in all contracts with TPAs, PBMs, and brokers. Regular audits should be conducted to ensure that the plan is operating efficiently and in the best interests of the employees.<br><strong>Focus on Data and Risk Assessment</strong>: By understanding the health risks of their employees, employers can create targeted interventions and support programs. This approach enables more personalized and effective healthcare strategies.<br><strong>Value-Based Care</strong>: Move away from traditional fee-for-service models to value-based care, which incentivizes providers to focus on health outcomes. This includes partnering with providers who are committed to improving patient health and reducing costs through prevention and early intervention.<br><strong>Employee Education</strong>: Employers should prioritize health literacy and provide resources to help employees make informed decisions about their care. This also includes educating employees about their own health risks and encouraging proactive engagement in their care.<br><strong>Humanize the Problem</strong>: It is important to listen to employees, understand their challenges with the healthcare system, and use these stories to drive change. Personal experiences can help leadership recognize the real-world impacts of their health plan decisions.</p><p>&nbsp;</p><figure id="figure-xb0fn9f7plm5varjtg"><img id="xb0fn9f7plm5varjtg" src="https://media.gettyimages.com/id/1359134874/photo/doctor-putting-and-stacking-wooden-block-cube-which-print-screen-health-care-and-medical.jpg?b=1&s=2048x2048&w=0&k=20&c=cPOHLbq4S3VSyHypU0O4tUGkJSvVYiHpd-m1xSyYF5c=" alt="Doctor putting and stacking wooden block cube which print screen health care and medical icons for healthy and wellness concept." title="Doctor putting and stacking wooden block cube which print screen health care and medical icons for healthy and wellness concept." 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><p><br>Ready to transform your health insurance plan into a powerful tool for employee wellbeing and organizational success? Take the first step toward a smarter, more impactful healthcare strategy today. Empower your team with a plan that reduces costs, enhances productivity, and prioritizes their health.</p><p>Let’s create a healthier, more engaged workforce together. Contact us now to start building a plan that works for everyone.</p><p>Written by Rob Thwaites&nbsp;</p><p><br></p>

The Critical Role of Health Insurance in Employee Wellbeing

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.