Blog

Tablet, doctors and business woman planning, healthcare service and management, schedule and teamwork. Nurse, medical professional and people on digital technology for feedback or hospital data

<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:<ol><li>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. </li><li>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.” </li><li>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. &nbsp;<h3>The Financial Case for Early Engagement</h3></li></ol>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

Closeup lawyer or insurance agent pointing at contract showing male client where to signature sign

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.</li></ul><h3>Navigating Healthcare Smarter</h3> 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.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;&nbsp; &nbsp; &nbsp; &nbsp;

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

Mature couple, sofa and laptop for planning finance, retirement funding and investment or asset management at home. Elderly people or man and woman reading information on computer for pension savings

<h3>Written with Scott Conard MD &amp; Brian Uhlig&nbsp;</h3>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.<h3>Overutilization of Medical Services: Paying More for Less</h3>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.<h3>The Role of Primary Care: The First Line of Defense</h3>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.<h3>Connecting the Dots: How These Issues Compound Costs</h3>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:Increased Insurance Premiums: As claims rise, so do the costs passed on to employers and employees. Lost Productivity: Health issues that could be managed or prevented escalate, leading to absenteeism and reduced performance. Employee Dissatisfaction: Navigating a complex, overutilized healthcare system without primary care support can lead to frustration and decreased morale.<h3> A Strategic Approach: Investing in Primary Care to Reduce Overutilization</h3>To address these challenges, consider implementing strategies that encourage primary care engagement and reduce unnecessary medical services:1. Promote Primary Care Relationships:Incentivize PCP Selection: Offer lower co-pays or premiums for employees who designate and regularly visit a PCP. Onsite or Virtual Clinics: Provide accessible primary care options through onsite clinics or telemedicine services. 2. Educate Employees:Health Literacy Programs: Teach employees about the appropriate use of medical services and the benefits of primary care. Transparent Communication: Share data on how overutilization affects both personal and organizational costs.3. Implement Value-Based Insurance Design:Align Costs with Value: Adjust plan designs to lower barriers for high-value services like primary care and increase them for low-value, overutilized services. Data-Driven Insights: Use analytics to identify patterns of overutilization and target interventions accordingly. 4. Partner with Providers:Collaborative Care Models: Work with healthcare providers who emphasize coordinated care and share accountability for health outcomes. Preventive Care Focus: Encourage providers to prioritize preventive measures and chronic disease management.<h3>Conclusion: A Call to Action</h3>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.&nbsp; Dr. Scott Conard is a physician and healthcare strategist dedicated to improving organizational health outcomes through innovative approaches to employee wellness and healthcare management.

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

person wearing orange and gray Nike shoes walking on gray concrete stairs

<h3>By Scott Conard MD &amp; Brian Uhlig&nbsp; </h3><h2>Understanding Health Plan Contracts</h2>Health plan contracts are complex agreements that dictate the terms between healthcare providers and insurance companies. These contracts outline everything from reimbursement rates to the types of services covered. However, when these contracts are inefficiently managed, they can lead to substantial financial losses for healthcare providers. Understanding the intricacies of these contracts is crucial for optimizing their financial impact.Many healthcare providers often overlook the detailed clauses within these contracts, which can result in unexpected costs or reduced reimbursements. It's essential for providers to have a robust understanding of the terms and conditions to ensure they are not losing money on services rendered. The financial ramifications of not doing so can be significant.<figure id="figure-e68ppyx36m3syubad"><img id="e68ppyx36m3syubad" src="https://images.unsplash.com/photo-1639189702833-8de5ecf2ca8f?crop=entropy&amp;cs=tinysrgb&amp;fit=max&amp;fm=jpg&amp;ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHwxN3x8ZmluYW5jaWFsLWFuYWx5c2lzfGVufDB8fHx8MTczMjI5MzUzMXww&amp;ixlib=rb-4.0.3&amp;q=80&amp;w=1080" alt="financial-analysis" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9;" data-mce-src="https://images.unsplash.com/photo-1639189702833-8de5ecf2ca8f?crop=entropy&amp;cs=tinysrgb&amp;fit=max&amp;fm=jpg&amp;ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHwxN3x8ZmluYW5jaWFsLWFuYWx5c2lzfGVufDB8fHx8MTczMjI5MzUzMXww&amp;ixlib=rb-4.0.3&amp;q=80&amp;w=1080" data-mce-style="aspect-ratio: 16/9;"></figure><h3>The Hidden Costs of Inefficient Contracts</h3>Inefficient health plan contracts can lead to numerous hidden costs that may not be immediately apparent. These costs can include administrative burdens, delayed payments, and increased claim denials. As these issues accumulate, they can severely impact a healthcare provider's bottom line.One of the primary hidden costs is the administrative effort required to manage complex and inefficient contracts. This includes the time spent by staff to interpret contract terms, negotiate with insurers, and handle discrepancies. Additionally, delays in payments due to contract inefficiencies can lead to cash flow problems, further exacerbating financial strain.<h3>Impact on Patient Care and Satisfaction</h3>Beyond financial implications, inefficient health plan contracts can also affect patient care and satisfaction. When providers are forced to deal with cumbersome contracts, it can divert resources away from patient care. This can lead to longer wait times, reduced access to services, and ultimately, decreased patient satisfaction.<figure id="figure-oypel5qtbm3syufnv"><img id="oypel5qtbm3syufnv" src="https://images.unsplash.com/photo-1533093818119-ac1fa47a6d59?crop=entropy&amp;cs=tinysrgb&amp;fit=max&amp;fm=jpg&amp;ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHwxOHx8cGF0aWVudC1jYXJlfGVufDB8fHx8MTczMjI5MzUzNnww&amp;ixlib=rb-4.0.3&amp;q=80&amp;w=1080" alt="patient-care" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9;" data-mce-src="https://images.unsplash.com/photo-1533093818119-ac1fa47a6d59?crop=entropy&amp;cs=tinysrgb&amp;fit=max&amp;fm=jpg&amp;ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHwxOHx8cGF0aWVudC1jYXJlfGVufDB8fHx8MTczMjI5MzUzNnww&amp;ixlib=rb-4.0.3&amp;q=80&amp;w=1080" data-mce-style="aspect-ratio: 16/9;"></figure>Moreover, when providers receive lower reimbursements due to unfavorable contract terms, they may have to make difficult decisions about the types of services they can offer. This can limit patient options and potentially affect the quality of care provided. Ensuring efficient contracts can help mitigate these issues and improve overall patient experience.<h3>Strategies for Optimizing Health Plan Contracts</h3>To minimize the financial impact of inefficient health plan contracts, healthcare providers can employ several strategies. These include:<ul><li>Conducting regular audits of contract terms and performance.</li><li>Negotiating more favorable terms with insurance companies.</li><li>Investing in contract management software to streamline processes.</li><li>Training staff to better understand and manage contract details.</li></ul>By adopting these strategies, providers can better navigate the complexities of health plan contracts and enhance their financial outcomes.<figure id="figure-spsvsfn6dlm3syujs1"><img id="spsvsfn6dlm3syujs1" src="https://images.unsplash.com/photo-1637763723578-79a4ca9225f7?crop=entropy&amp;cs=tinysrgb&amp;fit=max&amp;fm=jpg&amp;ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHwxNXx8Y29udHJhY3QtbmVnb3RpYXRpb258ZW58MHx8fHwxNzMyMjkzNTQyfDA&amp;ixlib=rb-4.0.3&amp;q=80&amp;w=1080" alt="contract-negotiation" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9;" data-mce-src="https://images.unsplash.com/photo-1637763723578-79a4ca9225f7?crop=entropy&amp;cs=tinysrgb&amp;fit=max&amp;fm=jpg&amp;ixid=M3wyNjI5NjF8MHwxfHNlYXJjaHwxNXx8Y29udHJhY3QtbmVnb3RpYXRpb258ZW58MHx8fHwxNzMyMjkzNTQyfDA&amp;ixlib=rb-4.0.3&amp;q=80&amp;w=1080" data-mce-style="aspect-ratio: 16/9;"></figure><h3>The Role of Technology in Contract Management</h3>Technology plays a pivotal role in optimizing health plan contracts. Advanced contract management systems can automate many of the administrative tasks associated with these agreements, reducing the burden on staff. These systems can also provide valuable insights into contract performance, helping providers identify areas for improvement.Moreover, technology can facilitate better communication between providers and insurers, ensuring that both parties are aligned on contract terms and expectations. This can lead to more efficient negotiations and a reduction in disputes over contract interpretations.<h3>Conclusion: Taking Control of Health Plan Contracts</h3>In conclusion, the financial impact of inefficient health plan contracts cannot be underestimated. By understanding these contracts' intricacies and implementing effective strategies, healthcare providers can significantly improve their financial health. Investing in technology and training staff are crucial steps in this process.Ultimately, taking control of health plan contracts not only benefits the financial standing of healthcare providers but also enhances the quality of care and patient satisfaction. By prioritizing efficient contract management, providers can ensure a more sustainable and successful future.

Unveiling the Financial Impact of Inefficient Health Plan Contracts

Pathway to Zero Trend

Employer health insurance
premiums are up 7% annually for
past 2 years with premiums for
family coverage reaching nearly
$25,000/year. Employees are
burdened by higher out-of-pocket
costs and payroll contributions
impacting not only their physical
health but also their financial health
and mental wellbeing.

Poor contracting and oversight by
employers and their broker/consultants
leads to potential waste of $1,000 per
enrolled employee per year.

Current population health programs are
not designed to identify the hidden risk
in a population nor provide the
appropriate care pathways for
members needing care.

Engage the Pathway to Zero™ team to
conduct an evaluation of your current
contracts, population risk and current
medical and pharmacy trend to
determine the opportunity for
improvements with your current
medical and pharmacy programs.

Pathway to Zero Trend

Blog

Health Risk Engagement Strategies: Driving Change Before ...

Revolutionizing Population Health Risk Reduction: A Shift...

The Hidden Cost of Overutilization and Lack of Primary Ca...

Unveiling the Financial Impact of Inefficient Health Plan...