Corporate Healthcare

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

Leave a Comment / Employer Healthcare Solutions /

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. 

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

The Vital Role of a Physician Executive: More than Just Healthcare Management 

Employer Healthcare Solutions /

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 executive’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 executive’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 executives 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 executive 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   

The Vital Role of a Physician Executive: More than Just Healthcare Management  Read More »

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

Employer Healthcare Solutions /

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.

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

Primary Care for All

1 Comment / Clinical Consulting /

An initiative that will transform the U.S. health system so that it is driven by Advanced Primary Care by Scott Conard, MD There is a group of us who are working together to bring a foundation of advanced primary care to every American. With this foundation we can establish a “system” of care for America that will significantly reduce the confusion, disorganization, low health literacy, inappropriate navigation, and excess costs. At this time our initiatives are:To Renew the commitment to a primary care system: Create a renewal process that will stimulate deep reflection that leads to re-discovery and embrace of the core values, goals and sense of purpose that underlies the Family Medicine movement To Revitalize those believing in the value of advanced primary care: To inspire and to articulate a vision for the next stage that engages a community of innovators and early adopters who will act on the vision. To Transform the system: To advocate and act on systems change: from models to networks to systems to institutions. All of this is based upon primary care that makes a difference. Running patients through 40/day, handing out referrals and scripts at a record rate, at 7 minutes a visit or spending an hour with every patient, ordering every possible test – regardless of evidence base and/or pre-test probability. Nor is it about ignoring what is going out outside of the office and just caring for those who call and make an appointment. Advanced primary care calls us to provide a higher level of service and care. Truly in the old “Marcus Welby” vision of caring for people as they age – having a trusted relationship – and ensuring patients get the right care, at the right time, in the right place, and at the right cost. What are your thoughts about this? Is it realistic? Is it fair to ask primary care providers to do more without providing better tools, better data and information, proactive reimbursement, or other support? 

Primary Care for All Read More »

Exposing Hidden Waste: Out-of-Network Payment Schemes

Employer Healthcare Solutions /

As 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” ProgramsConsider 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 VisitImagine 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. Where the Waste Happens—and How to Fix ItThis kind of wasteful spending arises when employers accept opaque arrangements without fully understanding the underlying payment mechanics. To address this problem, organizations must: 1.     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.     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.     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. Data-Driven ResultsEmployers 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 ControlAs 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 Read More »

Realigning Incentives for Better Health Outcomes and Lower Costs

Clinical Consulting, Employer Healthcare Solutions /

For 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. The Misaligned Incentives 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. A Smarter, More Aligned Approach 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. A Path to Sustainable Savings 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: The Payoff 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 Read More »

The Critical Role of Health Insurance in Employee Wellbeing

Employer Healthcare Solutions /

Jan 09, 2025 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. The Current Healthcare Landscape 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. Impact on Employee Health and Wellbeing 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. 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. How Employers Can Improve Employee Wellbeing Through Health Insurance Employers play a pivotal role in changing this dynamic and creating a healthcare system that benefits both the company and its employees. Here are a few steps to take: C-Suite Involvement: 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.Transparency and Audits: 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.Focus on Data and Risk Assessment: 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.Value-Based Care: 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.Employee Education: 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.Humanize the Problem: 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. 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. Let’s create a healthier, more engaged workforce together. Contact us now to start building a plan that works for everyone. Written by Rob Thwaites Pathway to Zero Trend Contact us The Critical Role of Health Insurance in Employee Wellbeing

The Critical Role of Health Insurance in Employee Wellbeing Read More »

Scroll to Top