Employer Healthcare Solutions

ICYMI: Blog series with Mike Adams and Scott Conard MD

Employer Healthcare Solutions /

In case you missed it, 7-11’s Mike Adams and Converging Health’s Scott Conard MD published a series of blogs as it relates to corporate healthcare and navigating the complex realm of employee benefits. See below for any of the posts you may have missed: Mike Adams and Scott Conard: Nursery School is Over Mike Adams and Dr. Scott Conard emphasize that individuals must take personal responsibility for their health, utilizing available resources. Employers should implement data-driven wellness programs with effective incentives. Payers are urged to act as responsible fiduciaries, and health solution providers must deliver measurable returns on investment. Collective accountability is essential for improved health outcomes. Read More Here Mike Adams on The Vital Role of a Physician Advisor Physician advisors are crucial in healthcare organizations, ensuring compliance, optimizing clinical documentation, and enhancing patient care quality. They bridge the gap between clinical staff and administrative processes, leading to improved efficiency and financial performance. Their expertise supports medical necessity reviews, appeals, and staff education, fostering better healthcare delivery.​ Read More Here The Real Enemy in Healthcare Benefits: Fighting Disease, Not Just Managing Costs Mike Adams and Dr. Scott Conard argue that the true challenge in healthcare benefits is combating disease, not merely controlling costs. They advocate for a shift from transactional to relational healthcare, emphasizing preventive care and active employee engagement. By focusing on long-term wellness, companies can reduce expenses and enhance workforce health Read More Here Mike Adams and Scott Conard Discuss: Why Chronic Diseases Matter in Designing Effective Plan Benefits  Mike Adams and Dr. Scott Conard emphasize the importance of integrating chronic disease management into employee benefit plans. They advocate for early intervention and targeted strategies focusing on prevalent conditions like musculoskeletal disorders, cancer, heart disease, diabetes, and mental health to reduce long-term healthcare costs and enhance workforce well-being. Read More Here Mike Adams & Scott Conard on The Vital Importance and Role of Your Broker Mike Adams and Dr. Scott Conard emphasize the critical role of brokers in healthcare benefits planning. They advocate for treating brokers as consulting partners, ensuring transparency in compensation to avoid conflicts of interest. By fostering proactive partnerships and prioritizing quality over cost-cutting, organizations can enhance employee care and achieve strategic goals. Read More Here

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Mike Adams & Scott Conard on The Vital Importance and Role of Your Broker

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Summary: Mike Adams and Dr. Scott Conard emphasize the critical role of brokers in healthcare benefits planning. They advocate for treating brokers as consulting partners, ensuring transparency in compensation to avoid conflicts of interest. By fostering proactive partnerships and prioritizing quality over cost-cutting, organizations can enhance employee care and achieve strategic goals. Broker Relationships in Healthcare Benefits Planning: Transparency, Innovation, and the Real Value of Partnership  In planning healthcare benefits having the right broker may be the most essential yet often overlooked relationship. Brokers are the gatekeepers, guiding organizations through the complex landscape of legal, compliance, and marketplace options. But not all broker relationships are created equal, and there’s a lot to consider when determining the true value of a broker.  Reclaiming Strategic Control: Brokers as Partners, Not Planners  For any business leader, it’s crucial to treat brokers as consulting partners rather than as strategic decision-makers. Your company’s vision, values, and goals should shape your benefits strategy—not your broker’s latest product lineup. While brokers bring industry insights and can be invaluable for vetting and implementation, they shouldn’t be your main source of innovation.  The best approach is to take ownership of the strategic direction. Tap into other resources—conferences, peer networks, and industry research—to identify trends and innovations. Then, involve your broker as an implementation partner. Share your ideas and ask them to stress-test these solutions: How would this integrate into our current benefits ecosystem? What data would we need to make this work? Where are the potential pitfalls?  This approach ensures that brokers act as allies in achieving your strategic goals rather than dictating them. When you lead the innovation, your broker’s role becomes one of enabling and refining rather than steering.  The Problem with Kickbacks and Hidden Agendas  One of the most troubling issues in broker relationships is the lack of transparency around compensation structures. In many cases, brokers earn commissions or “back-end” deals through point solutions, which can create conflicts of interest. These financial incentives often go unreported, leaving employers in the dark about whether a recommendation truly serves their needs or merely boosts the broker’s earnings.  The reality is, when 80% of corporations say they rely on their broker’s advice for benefits planning, there’s an inherent risk that these hidden incentives will skew decision-making. Employers need to understand that without full disclosure, they may be getting a recommendation driven by profit rather than by what’s best for their organization and employees.  Demanding Transparency in Broker Compensation  Transparency in broker compensation is non-negotiable. A company has the right to know exactly how a broker is compensated, whether through commissions, retainers, or equity stakes in recommended products. Clear, upfront agreements—such as a flat fee for specific services—builds trust and is the best way to avoid any perception of bias.  Some employers limit broker commissions to only a handful of services—like medical, dental, and disability insurance—while establishing strict controls around fees for point solutions. This approach minimizes conflicts of interest and helps ensure that every recommendation aligns with your organization’s needs.  Why Transparent, Value-Driven Broker Relationships Matter  At the end of the day, a transparent and well-aligned broker relationship directly impacts the quality of benefits you provide to your employees. Quality benefits aren’t just about saving money; they’re about enhancing the quality of care for employees. By reducing unnecessary costs and improving care, both the employer and employees win.  When companies hold brokers accountable, they not only save costs but also create a benefits ecosystem that genuinely supports their workforce. In healthcare benefits planning, transparency, proactive partnership, and a commitment to quality over quick fixes make all the difference. ICYMI: In Case You Missed It Check out the entire series of blog posts between Mike Adams and Scott Conard HERE

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Building a Health-Literate Culture: A Strategic Imperative for Corporate and Medical Leaders

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Health literacy is a critical factor in achieving better healthcare outcomes, yet it remains a significant challenge for both individuals and organizations. For corporate executives and medical practice owners, fostering a health-literate culture is not only an ethical responsibility but also a strategic imperative that impacts patient outcomes, workforce productivity, and overall healthcare costs. Defining Health Literacy Health literacy is the ability of individuals to understand and act on healthcare information to manage their health effectively. It encompasses numeracy skills, the ability to navigate the healthcare system, and the competence to make well-informed health decisions. In a broader sense, health literacy includes motivation, access to reliable health information, and the capacity to make sound judgments regarding one’s well-being. Challenges of Low Health Literacy A large segment of the population lacks the necessary health literacy skills, contributing to poor health outcomes and increased healthcare costs. Traditional approaches—such as using plain language and the teach-back method—help to some extent but do not always lead to meaningful behavior change. Chronic disease management, for example, requires patients to understand terms like cholesterol levels and insulin resistance. However, healthcare professionals often have limited training in educational methods and insufficient time to provide the necessary guidance, exacerbating the problem. The Health Literacy Instructional Model To address these challenges, a structured approach is necessary. The “Health Literacy Instructional Model” presents a three-step strategy: A key takeaway is that social and emotional support systems play a crucial role in health literacy. Patients with strong support networks are more likely to acquire and retain health knowledge, ultimately leading to improved self-management. Modern Educational Approaches to Health Literacy Traditional educational theories can enhance health literacy programs: The Role of Healthcare Professionals and Digital Tools Healthcare providers must become more effective educators. Integrating health literacy into clinical workflows, decision-support tools, and patient engagement strategies can bridge the knowledge gap. Digital health solutions—such as mobile apps, wearable devices, and AI-driven platforms—can further enhance personalized learning and engagement. However, disparities in digital access, often termed the “digital divide,” must be addressed to ensure equitable access to these resources. Patient Engagement and Shared Decision-Making Engaging patients in their healthcare journey is a critical predictor of outcomes. The FLAIR score (which evaluates patient engagement levels) is an innovative approach to measuring and improving patient participation. Shared decision-making, where patients and providers collaborate on treatment choices, further strengthens health literacy. Creating a Health-Literate Culture For healthcare organizations and corporations, cultivating a health-literate culture requires a system-wide effort. This includes: Assessing and Enhancing Health Literacy Measuring health literacy can be challenging, but tailored assessments—especially for chronic conditions like cardiovascular disease and diabetes—can help personalize patient education strategies. Understanding a patient’s literacy level allows for more effective interventions that drive better long-term outcomes. Converging Health’s Approach At Converging Health, we prioritize actionable intelligence for clinicians by answering three key questions: By leveraging data analytics and physician-driven insights, Converging Health takes the burden off clinicians, providing them with real-time, meaningful information. Our approach facilitates Advanced Primary Care, integrating population health strategies with proactive patient engagement and trust-building to drive better outcomes at lower costs. Conclusion Enhancing health literacy is a shared responsibility that requires leadership from both corporate executives and medical professionals. By implementing structured educational strategies, leveraging digital tools, and fostering patient engagement, organizations can contribute to a health-literate culture that improves lives, enhances productivity, and reduces healthcare costs. At Converging Health, we are committed to advancing this mission through innovation, data-driven insights, and physician-led strategies that empower patients and providers alike. For more information on how Converging Health can help your organization build a more health-literate workforce and patient population, visit our website or contact us today.

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Corporate Determinants of Health: The Untapped Driver of Workforce Well-Being

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Introduction For years, companies have recognized the importance of offering competitive health benefits to attract and retain talent. However, health benefits alone don’t determine employee well-being. A growing body of evidence shows that corporate determinants of health (CDoH)—factors embedded in workplace policies, culture, and environment—play a pivotal role in shaping employee health outcomes. As HR professionals and corporate leaders, you have the power to influence these determinants, improving both employee well-being and company performance. But how? Let’s break it down. What Are Corporate Determinants of Health? CDoH are the factors within a company’s control that impact employee health and well-being. These include: When companies prioritize these factors, they shift from a reactive to a proactive healthcare mindset—one that fosters healthier, more engaged employees while reducing long-term healthcare costs. Why Should Companies Care? Neglecting corporate determinants of health comes with a price. The cost of chronic diseases driven by stress, poor nutrition, and sedentary lifestyles is skyrocketing. Delayed care due to financial barriers leads to higher claims and lower productivity. A disengaged workforce is more likely to experience absenteeism, presenteeism, and burnout—all of which impact a company’s bottom line. On the flip side, organizations that optimize their CDoH create an engaged, healthier workforce that drives innovation and operational success. Companies that integrate health-focused workplace policies see: ✅ Lower healthcare costs✅ Higher employee satisfaction and retention✅ Increased productivity and engagement✅ A stronger employer brand How Companies Can Take Action HR professionals and corporate executives don’t need to overhaul their benefits strategy overnight. Small, strategic interventions can make a profound difference. ✅ 1. Rethink Health Benefits Unsupported Approach: High-deductible health plans (HDHP) with high out-of-pocket costs discourage employees from seeking preventive care.Supportive Approach: Companies can offer high-value primary care at no cost, cover preventive screenings (e.g., colonoscopies), and eliminate barriers to chronic disease management (e.g., covering essential medications). ✅ 2. Build a Culture of Well-Being Unsupported Approach: Stressful, transactional work environments with little support for mental and emotional well-being.Supportive Approach: Companies can create psychologically safe workplaces, offer mental health resources, and cultivate leadership styles that emphasize empathy and support. ✅ 3. Improve Work Environments Unsupported Approach: Offices with poor air quality, lack of natural light, sedentary work routines, and limited access to nutritious food.Supportive Approach: Organizations can redesign workspaces to promote movement, healthy eating, and ergonomic safety, all of which contribute to physical health. ✅ 4. Invest in Employee Development Unsupported Approach: Employees feel stagnant, disengaged, and unchallenged in their roles.Supportive Approach: Providing ongoing training, career growth opportunities, and leadership coaching fosters a sense of purpose and resilience. Final Thoughts The shift toward a corporate determinants of health strategy isn’t just about ethics—it’s about business performance. Companies that take proactive steps to improve workplace health reduce costs, enhance productivity, and retain top talent. The question is no longer whether companies should invest in employee well-being, but how quickly they can adapt to this new model. Are you ready to lead the charge? For organizations looking to optimize their corporate determinants of health strategy, reach out to Converging Health for tailored solutions that drive measurable results. Written by Rob Thwaites in consultation with the Converging Health Consulting Team

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

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Originally posted on Choose Which Door By Scott Conard MD and Brian Uhlig Asking 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. Understanding Value and Needs 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. Gathering Critical Information and Identifying Problems 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. Driving Change and Innovation 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. Fostering Collaboration and Alignment 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. Improving Communication and Understanding 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. Measuring Progress and Success 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. Conclusion 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. Written by Rob Thwaites in consultation with the Converging Health Consulting Team

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Mike Adams and Scott Conard Discuss: Why Chronic Diseases Matter in Designing Effective Plan Benefits 

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In today’s workplace, the impact of chronic diseases cannot be overstated. With an estimated six in ten adults living with at least one chronic condition, and four in ten affected by two or more, the implications for employers are significant. Nationally, it is projected that 90% of the $4.1 trillion spent on healthcare annually is directed towards individuals with chronic and mental health conditions. This staggering figure emphasizes the urgent need for HR departments and corporate executives to integrate chronic disease management into their benefit design.  The Cost of Chronic Conditions  Chronic diseases, defined as health conditions lasting one year or more that require ongoing medical attention or limit daily activities, often develop over many years. This progression typically moves from pre-disease to disease without complications, then to complications, and finally to end-stage disease— a journey that can take anywhere from 5 to 20 years. The costs associated with each stage escalate dramatically, making early identification and intervention crucial. By understanding this continuum, employers can implement strategies that address issues early, thereby significantly reducing long-term healthcare costs.  Understanding the Landscape  To design effective benefit plans, HR professionals must first comprehend where employees stand on the continuum of chronic disease. Gathering data on employee health status allows organizations to tailor resources and programs to meet their specific needs. Given the sheer volume of chronic conditions and the limited resources available, focusing on the top five conditions that affect either the highest number of employees or incur the greatest costs provides a pragmatic approach.   Key Conditions to Address  1. **Musculoskeletal Disorders**: Consistently one of the most prevalent and costly chronic conditions, musculoskeletal disorders affect a significant portion of the workforce. Addressing these conditions through ergonomic programs and physical therapy can lead to improved employee health and productivity.  2. **Cancer**: With rising incidence rates, cancer poses a considerable challenge. Offering comprehensive support, including screenings and mental health resources, can improve outcomes and reduce associated costs.  3. **Heart Disease**: As a leading cause of death, heart disease requires robust management strategies. Providing access to preventive care, nutrition counseling, and fitness programs can help mitigate risks.  4. **Diabetes**: With its growing prevalence, diabetes management programs that focus on education, nutrition, and regular monitoring can lead to significant cost savings and better health outcomes.  5. **Mental Health**: The COVID-19 pandemic has amplified mental health issues in the workplace. Addressing mental health proactively—through employee assistance programs (EAPs) and mental wellness initiatives—can create a supportive environment that fosters overall well-being.  A Holistic Approach  It is important to note that chronic conditions often co-occur, meaning that addressing one condition can positively impact others. For instance, a comprehensive program designed for diabetes management can also benefit employees with heart disease and mental health issues. By implementing an integrated benefits strategy, employers can create a more cohesive system that supports overall employee health.  Conclusion  Chronic diseases significantly impact healthcare costs and employee productivity. By understanding the prevalence and progression of these conditions, HR departments and corporate executives can design benefits that not only address immediate health needs but also foster long-term well-being. Focusing on key chronic conditions—musculoskeletal disorders, cancer, heart disease, diabetes, and mental health—will allow employers to create targeted programs that ultimately lead to healthier employees and reduced healthcare expenditures. In this era of rising costs and increasing health challenges, a proactive approach to chronic disease management is not just beneficial; it’s essential for sustaining a healthy workforce. 

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Mike Adams on The Vital Role of a Physician Advisor

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By Mike Adams and Scott Conard M.D. When we think about a physician, the classic image is someone in a white coat, caring for patients. But in today’s healthcare landscape, there’s a new kind of physician stepping into a very different role—one that’s shaping the way companies approach employee health benefits, healthcare costs, and workplace well-being. This is the physician executive, and they’re here to break traditional molds, offering insights that align medical expertise with business strategy. And the impact? It’s profound.  A physician executive isn’t just a consultant ticking off metrics; they’re catalysts driving companies to ask the tough questions about healthcare. They’re the ones who help employers understand not only what health benefits to offer but why these decisions matter to both their people and their bottom line.  Breaking the Benchmark Trap and Leading the Pack  Let’s talk benchmarks—a favorite topic in the world of employee benefits. Many companies measure themselves against industry standards, but is being “average” really good enough? Physician executives challenge this mindset. They encourage companies to stop aiming to be in the middle of the pack and instead set new standards that prioritize quality care and employee well-being.  One popular saying captures their philosophy perfectly: “Lead, follow, or get out of the way.” That’s the attitude physician executives bring to the table. They aren’t there to rubber-stamp the same-old solutions. Instead, they push companies to take an innovative approach, whether it’s in healthcare plan design, employee engagement strategies, or even how they measure success. The goal is to create a benefits package that’s not just comparable, but truly better—one that resonates with employees and delivers real results in terms of health outcomes and cost savings.  Aligning Employee Experience with Quality Care  Here’s a crucial insight from the physician advisor’s perspective: employee experience doesn’t just mean giving employees everything they ask for. Rather, it’s about designing healthcare benefits that balance experience with top-notch clinical care. The focus should be on creating an environment where employees are engaged, healthy, and supported, not just momentarily satisfied.  This is where a physician advisor’s clinical insight comes in. They’ve spent time in the trenches, navigating the patient care process, so they understand firsthand what high-quality care looks like and how to deliver it efficiently. They know how to blend the “wants” with the “needs” to create benefits that improve employees’ overall health and productivity.  The Converging Health Solution: Data-Driven Savings and Better Outcomes  If you’re a company leader looking to improve your healthcare strategy without breaking the bank, consider partnering with Converging Health. Physician advisors from Converging Health specialize in using data to guide smarter healthcare choices, helping businesses focus on what really matters. With a deep understanding of behavioral economics and healthcare systems, they know where to trim costs without sacrificing quality.  Converging Health’s services, grounded in analytics and a comprehensive understanding of the healthcare ecosystem, help companies manage complex healthcare dynamics, from insurance to point solutions. They offer a blend of clinical expertise and financial insight that lets you see tangible savings—reducing unnecessary spending while boosting employee health and engagement.  In short, with a physician advisor from Converging Health, you’re not just navigating the system; you’re setting a new standard for healthcare benefits. Ready to save money and elevate care? Reach out to Converging Health and see how an innovative approach to healthcare can benefit your company’s bottom line and keep your employees healthier, happier, and more productive. https://converginghealth.com/contact-us    In collaboration with Mike Adams and also posted on Scott Conard’s Blog

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Relentless Health Value: Episode 462 with Converging Health’s…

Clinical Consulting, Employer Healthcare Solutions /

Today, Dr. Scott Conard discusses the evolution of his life’s work, focusing on his current collaboration with Mike Adams from 7-Eleven to support their plan members. Their efforts revolve around a few striking yet common insights that many plan sponsors will recognize in their own data. One key finding: roughly 70% of individuals who exceed a plan’s high-cost threshold in any given year were previously high-risk but low-cost. These individuals don’t appear out of nowhere—they were identifiable in prior years. The challenge is to identify them early and provide the right interventions to prevent them from transitioning into the high-risk, high-cost category. Effectively managing a population requires proactive identification of high-risk, low-cost members before they escalate into high-cost care. To achieve this, Dr. Conard follows a best-practice, stepwise approach, which we’ll outline below. While we cover each step in the discussion, some are explored in greater depth than others. Best-Practice Approach to Managing Population Health 1. Get the Data – The Whole-Person Risk Score Rather than categorizing members into isolated disease groups, the goal is to assess risk at a whole-person level. Patients aren’t just a collection of separate conditions—they’re complex human beings whose health factors interact. Dr. Conard often uses a car analogy: If a car’s tires wear out, you simply replace them. But humans don’t work that way. A patient may need surgery but be unable to proceed because their cardiovascular markers are too high. Yet, they can’t take the necessary medication due to contraindications with existing kidney or liver conditions. This fragmentation in care often leads to patients being bounced between specialists who don’t communicate effectively. A real-world example comes from Miriam Paramore, who shares a harrowing story about her father’s end-of-life care—an illustration of why whole-person risk scoring is critical. 2. Provide Access to Advanced Primary Care Teams Members need access to high-functioning primary care teams that are empowered to make informed referrals to top-tier specialists. These teams should ensure care is high-quality, appropriate, and optimized for each patient. 3. Align Benefit Design with Optimal Care Pathways Plan sponsors must structure benefits to support the care members need. If benefit design creates barriers—like high co-pays for essential services—members may forgo necessary care, leading to worse outcomes and higher costs in the long run. Dr. Mark Fendrick once compared benefit design and optimized medical care to peanut butter and jelly—they must go together. For example, if a doctor tells a diabetic patient to get regular foot exams to prevent amputations, but the patient can’t afford the co-pay, the system fails. The patient suffers, the doctor’s quality scores take a hit, and the plan sponsor ultimately pays for costly, avoidable complications. Step 3 ensures benefit design supports, rather than hinders, effective care. 4. Engage Members with Navigation Tools Members need guidance to navigate the healthcare system effectively. Tools like My Personal Health Assistant play a crucial role in engaging unengaged patients and ensuring they follow optimal care pathways. These tools complement advanced primary care efforts, helping members stay on track and receive the right care at the right time. By following this structured approach, plan sponsors can proactively manage population health, reduce costs, and improve outcomes—transforming their approach from reactive to strategic.

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HR Director’s Dilemma: How Corporate Financial Incentives Impact Employee Healthcare Costs and Access

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As an HR director, managing employee benefits is one of the most impactful ways to support your workforce. Yet, navigating the complexities of healthcare costs and access has never been more challenging. Corporate financial incentives—the unseen forces behind many decisions in the healthcare system—play a critical role in shaping the quality and affordability of care for your employees. These incentives, while often intended to improve efficiency, can unintentionally lead to higher costs, reduced access, and a focus on profit over patient outcomes. Understanding how these financial incentives affect your employees’ healthcare experience is essential. Here’s a breakdown of key factors and potential solutions: Employer-Sponsored Health Plans: Navigating the Balancing Act Provider Incentives: A Double-Edged Sword Pharmacy Benefit Managers (PBMs): Misaligned Incentives Insurance Companies: Limited Competition, Rising Costs Lack of Transparency: A Barrier to Better Decisions The Ripple Effect on Employees and the Economy Charting a Path Forward: Solutions for HR Leaders A Call to Action As HR leaders, we have a unique opportunity to influence not just the lives of our employees but the broader healthcare system. By understanding the unintended consequences of corporate financial incentives and advocating for innovative, patient-centered solutions, we can create a system that prioritizes care over costs. It’s time to step up, ask the tough questions, and champion changes that benefit our employees, organizations, and communities. Together, we can transform healthcare from a source of stress into a cornerstone of employee well-being and organizational success.

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The Hidden Cost of Overutilization and Lack of Primary Care: A Call to Action for CFOs and HR Directors

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As leaders responsible for balancing the financial health of your organizations with the well-being of your employees, you face a complex challenge: managing escalating health insurance costs without compromising the quality of care. Two often-overlooked factors significantly driving these costs are the overutilization of medical services and a lack of primary care engagement among employees. Overutilization of Medical Services: Paying More for Less Overutilization occurs when medical services are provided with a higher volume or cost than is appropriate. This includes unnecessary tests, redundant procedures, and avoidable emergency room visits. While these services may seem beneficial on the surface, they often do not contribute to better health outcomes and can, in fact, expose patients to unnecessary risks. For example, an employee with a minor headache might receive an expensive MRI scan when rest and over-the-counter medication would suffice. Such instances not only inflate individual claims but also contribute to higher premiums for the entire organization. Overutilization can account for up to 30% of healthcare spending, a staggering figure that directly impacts your bottom line. The Role of Primary Care: The First Line of Defense Primary care physicians (PCPs) serve as the gatekeepers of health, providing preventive services, managing chronic conditions, and coordinating specialist care. However, a significant number of employees lack a strong relationship with a PCP. This absence leads to fragmented care, delayed diagnoses, and increased reliance on specialist and emergency services—all of which are more costly and less efficient. Without primary care guidance, employees are more likely to self-refer to specialists for issues that could be managed by a PCP at a lower cost. They may also overlook preventive measures, resulting in advanced-stage diagnoses that require expensive interventions. The lack of primary care exacerbates overutilization by funneling employees into high-cost healthcare settings unnecessarily. Connecting the Dots: How These Issues Compound Costs The interplay between overutilization and lack of primary care creates a feedback loop that drives up healthcare expenses. Employees without primary care guidance are more susceptible to overutilization, and overutilization further discourages the establishment of primary care relationships due to the complexity and frustration it can cause. This cycle leads to: A Strategic Approach: Investing in Primary Care to Reduce Overutilization To address these challenges, consider implementing strategies that encourage primary care engagement and reduce unnecessary medical services: 1. Promote Primary Care Relationships: 2. Educate Employees: 3. Implement Value-Based Insurance Design: 4. Partner with Providers: Conclusion: A Call to Action As CFOs and HR directors, you have the opportunity to transform these challenges into strategic advantages. By fostering a culture that values primary care and actively combats overutilization, you can reduce healthcare spending while enhancing the well-being of your employees. Investing in primary care is not just a cost-saving measure; it’s a commitment to the long-term health of your workforce. It leads to better health outcomes, increased productivity, and a more sustainable financial model for your organization. It’s time to take a proactive stance. Let’s work together to build a healthcare ecosystem that delivers value, promotes health, and ensures that every dollar spent contributes meaningfully to the well-being of our employees and the vitality of our organizations.  Dr. Scott Conard is a physician and healthcare strategist dedicated to improving organizational health outcomes through innovative approaches to employee wellness and healthcare management.

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