Healthcare Model Advantages

According to new research from Elevance Health, workplace wellness programs, when thoughtfully designed, do more than shift behavior - they may improve real health outcomes. 📊 Individuals with complex health and social needs participated in our Smart Rewards wellness program at higher rates than other populations. 📈 Participants were more likely to maintain blood pressure and blood sugar control, as measured by HEDIS metrics, which are important signals of chronic condition management.   This matters because people who face the barriers to care are often those least likely to be reached by traditional interventions. This study makes a powerful case for how aligning incentives with engagement, plus giving people tools to act on their health, can drive measurable improvement. With the right design, workplace wellness programs can deliver meaningful health value especially for those who stand to gain the most. #WorkplaceWellness https://lnkd.in/gn92p5cp

Insurance "Networks" - What are they good for? Half of Americans (~165 million of us) receive health benefits through health plans sponsored by employers. Most of these health plans pay a commercial insurance company to get access to the doctors in their "network". Most doctors participate in these commercial insurance networks. It's the accepted wisdom of how to find and keep patients. When a patient asks "Do you take my insurance?", it's assumed that the answer needs to be yes or the the patient will go to another doctor that does. Most doctors do NOT offer their services directly to employers and their health plan members. Direct contracting is growing rapidly, but it's still a foreign concept to many. Participating in insurance is still the accepted path to keeping waiting rooms full. But what else do doctors accept when they "take insurance"? Here's a partial list... - prior authorizations (time that's completely uncompensated) - coding/billing headaches (also uncompensated) - coding/billing costs (coders, billers, systems, space and other overhead) - less time with patients (see coding/billing headaches above) - collections hassles (chasing the insurance payer and the individual OOP) - collection costs (DIR and credit card fees, overhead, outsourced collection agencies) - write offs (because not everyone pays) - payment delays (typically measured in weeks and months) - clawbacks (because the insurance carrier has all the power) - little control over prices (unless you're part of a large health system) Most doctors accept all of the above because they believe insurance networks are the only way to get new patients and keep current ones. But it's just not true. Doctors all over the U.S. are discovering the benefits of going 'direct'... i.e. working more directly with employers in their community. What are the advantages for doctors? See that list above? All of these headaches go away with direct contracting. ALL of them. Why should employers care? How about doctors have more time for their patients? How about doctors have more autonomy to utilize their expertise and experience? How about doctors have less burnout and more joy? P.S. Doctors, this isn't an either/or proposition. You can do both. Keep 'taking insurance', but start 'going direct' too. Hopefully some day soon you can consider dropping the insurance networks who don't value you the way you deserve to be. P.P.S. it's also very easy to get started.

Yoga, meditation, pizza parties, and smoothie bars often get a bad rap—or become easy scapegoats—for ineffective wellness strategies. But these activities can support well-being when used alongside deeper organizational efforts. Real change only happens when organizations tackle the core drivers of burnout and embed well-being into their core values and culture. This includes: • Fair workloads and staffing levels to prevent chronic overwork • Clear roles and expectations to reduce confusion and stress • Psychological safety so employees feel comfortable speaking up • Supportive leadership that models healthy boundaries • Flexible schedules and work options where possible • Opportunities for career growth, learning, and personal development • Effective communication and alignment to reduce unnecessary stress • Access to mental health resources and peer support networks Sustainable and holistic well-being isn’t served by isolated activities or “wellness programs.” It requires building a culture of joy, purpose, and connection where people feel valued and empowered to thrive in their work and life. Have you seen organizational cultures that get this balance right? #JustOneHeart #Wellness #Leadership #Culture

Imaging accounts for 6–11% of total healthcare spend for plan sponsors. Prior authorization delays imaging, but rarely prevents it. Meanwhile, charges add up quickly — professional fees, facility fees, separate charges for contrast, post-read services. The bottom line: imaging may be the next great frontier for direct contracting. This week’s Relentless Health Value Podcast with Cristin Dickerson, MD discusses all of this and more. It’s well worth a listen, and the conversation highlights just how big of a “win–win” direct contracting for imaging can be. A similar model has already proven successful with ASCs. Shifting site of service leads to lower costs, better access, and improved experience. Quality remains the same or better. Just like procedures, imaging costs can vary by 10x for the same scan depending on site of service. Direct contracting removes intermediaries, creating price consistency, transparency, and less friction. Under today’s system, silly PA games often delay patients to the point they use the ER to get scanned. Paradoxically, this leads to wasted time and money. Frustration mounts. With better technology, a push toward early detection, and rising healthcare consumerism, imaging is an obvious area for disruption. Thread together ASCs + imaging + high-quality, cost-efficient care, and a new model emerges: less friction, lower costs, better access, higher quality. Traditional vertical integration has meant consolidation that drives costs up. But imagine flipping that model (“vertical disintegration") where linking diagnostics, surgery, and specialty care lowers costs by removing intermediaries, streamlining access, and aligning incentives. Great work as always Stacey Richter! (Link to show in comments.)

As leaders, we often separate mental and physical health initiatives. But at OpenUp, we've learned that these two aspects of well-being are deeply intertwined, regardless of work environment. The mind-body connection is powerful, and addressing both can create a multiplier effect on overall employee wellness. Here's what we've discovered: - Physical activity boosts mental well-being: Encourage regular movement breaks, even for desk-bound employees. We've seen how simple activities like lunchtime walks or stretching sessions can reduce stress and improve mood. - Mental well-being impacts physical health: Stress management techniques (like meditation or deep breathing) can lower blood pressure and improve sleep quality. - Sleep affects both mental and physical performance: Educate employees about sleep hygiene and consider flexible schedules to accommodate different chronotypes. - Nutrition influences mood and energy: Provide healthy snack/food options in office settings. - Mindfulness practices enhance physical awareness: Introduce mindfulness sessions that focus on body scans and present-moment awareness. This can help employees recognise early signs of physical or mental strain. Implementing a holistic approach isn't always easy, but the benefits are clear. It's an investment that pays dividends in the long run, not just for individual employees, but for the organisation as a whole.

With Sidney Haitoff, Joseph Puthumana, Addison Dama, Yang Wang, PhD, our article Health Affairs Forefront: Employer-Provider Direct Contracting: Practice And Policy The rising premiums burden both employers and workers. Self-insured employers are also increasingly exposed to legal risks for ERISA fiduciary duties due to imprudent health benefit management. Direct primary care has been shown to reduce overall health care demand by 12.6% and emergency room visit by 40.5%. Direct contracting transactions are similar to cash-pay ones. Providers are willing to offer competitive cash prices due to the absence of administrative complexities and the fraction of price-sensitive patients. Direct contracting may put further downward pressure on cash prices by bringing higher patient volumes to the contracted providers. Therefore, using cash-pay channels—through direct contracting with payer platform companies, cash-pay pharmacies, or direct primary care providers—offers a promising strategy for containing health care spending for employers and workers. It’s worth emphasizing the tradeoff inherent in direct contracting: similar to insurance plans with narrow networks, employers and workers save money by using direct-contracting providers rather than a broad network of providers. Workers themselves should also be encouraged to directly purchase from providers. After a worker pays cash to use a lower-priced provider, the worker should receive full reimbursement from the employer. Employers should have the option to offer workers low-premium plans that cover only insurable events, accompanied by large contributions to their HSAs. This approach would allow flexible worker-provider direct purchase, accommodate the diverse health care preferences of workers, and protect workers’ risk exposure. Workers with sufficiently funded HSAs would personally and directly benefit from cost savings and enjoy the freedom to choose providers and treatment options without network restrictions or insurance interference, thereby stimulating provider competition in the direct-pay market and further benefiting patients. Congress should remove the requirement that HSAs must be coupled with high-deductible plans, thus expanding access to HSAs for employers and workers. Direct contracting has the potential to help self-insured employers remove exposure to misaligned incentives from TPAs and enhance affordability and quality. Workers would benefit from expanded choices, lower premiums, better quality, and higher take-home pay. Providers would experience less administrative burnout, fewer insurance restrictions, allowing them to focus on serving patients and innovating care delivery. The Johns Hopkins University - Carey Business School Johns Hopkins Bloomberg School of Public Health https://lnkd.in/eYzwq5GU

The real value in direct contracting isn’t the price. It’s the promise of new payment rails. Hear me out. Modern Healthcare is highlighting the growth of direct contracting platforms - and included a fair question from one commentator: are employers just inserting another intermediary? (Shawn Gremminger) That’s a legitimate concern. If “direct” simply means replacing a traditional carrier with a tech-enabled administrator that has more favorable direct contracts with a set of select providers, then structurally not much has changed. And while better price transparency is a benefit, it is the payment transparency that matters. Think about it - if the contracted price is 10 but 100 leaves the employer’s funding account after spreads, percentage-of-savings fees, card interchange, and payment processing costs, then price transparency becomes largely cosmetic. It can even create a false sense of security. So, direct contracting isn't just capable of solving a pricing problem. It has the potential to solve a payment infrastructure problem. Today, an employer typically funds an account for claims payments but does not execute the payments itself; instead, a TPA adjudicates the claim, a network repricer may apply contracted rates, etc., TPA requests funding (prefunding or reimbursement) from employer for claims, TPA instructs a payment vendor to release the funds, a clearinghouse transmits remittance data, and payments are often issued via virtual card rails or ACH - introducing potential interchange, repricing, and percentage-of-savings fees along the way. In short, money moves through multiple entities before it reaches the provider. each needing to take their piece along the way. BUT, with direct contracting models, the employer could have more control. Employer funds trust account, direct contracting platform has authority to pull funds, claims is adjudicated with transparent pricing logic, and the payment is executed directly from the employer controlled financial rail to the provider through ACH or other low friction method - full visibility into timing, settlement and fees. Above that financial transaction sits the claims layer: line-item detail, unit price, modifiers, adjudication logic. Below it sits the money movement layer: exact payment amount, date, method, confirmation of receipt. No invisible toll collectors clipping basis points simply for moving funds. That is a fundamentally different payment architecture. That’s why the real value in direct contracting isn’t just the price. You don’t just bypass a carrier, you are removing layers of invisible toll collectors that exist purely to move your money. Clearinghouses. Repricers. Payment integrity vendors. Card networks. Settlement platforms. Each one takes a slice. And employers never see it. This is where I see the real financial upside of the direct contracting model - not just better prices, but transparent, auditable payment rails the purchaser controls.

Can India's Ayurveda and Siddha Be the Future of Corporate Wellness? As burnout, anxiety, and lifestyle disorders reach alarming levels in today’s corporate world, Indian companies are waking up to the power of ancient healing systems—Ayurveda and Siddha. These time-tested sciences offer more than just remedies; they offer a holistic philosophy of living that integrates physical health, mental clarity, emotional balance, and spiritual grounding. Forward-looking organizations are now incorporating Ayurvedic and Siddha-based wellness programs that go beyond gym memberships and diet plans. From seasonal detox protocols and personalized diets (based on body types or prakriti) to herbal therapies, pranayama, and yoga, these practices are being redesigned for the modern work environment—bringing calm to chaos and balance to burnout. Siddha medicine, one of the oldest healing traditions rooted in Tamil Nadu, emphasizes longevity, rejuvenation, and alignment with nature’s rhythms. When integrated into corporate wellness, it can offer powerful lifestyle interventions to boost immunity, improve focus, and increase energy levels naturally—without dependency on quick fixes. Several leading Indian corporations have started embracing traditional wellness systems. Infosys has introduced Ayurveda-based modules across its campuses, offering consultations, herbal therapies, and mindfulness sessions. Tata Consultancy Services (TCS) has hosted AYUSH sessions for employees, focusing on preventive care using Ayurveda and Siddha. Aditya Birla Group has established Aditya Birla Wellness Centers, where Ayurvedic therapies and naturopathy are part of routine preventive healthcare—aimed at reducing stress and building immunity. Public sector and government-backed institutions are also setting benchmarks. Indian Railways has implemented AYUSH health centres in key zones for employee wellness. ONGC and IOCL have conducted workshops promoting Ayurvedic and Siddha self-care. In the startup world, wellness brands like Cure.fit integrate ancient healing into digital platforms—bridging heritage and technology. These developments mark a real shift in workplace wellness, where ancestral knowledge meets today’s professional demands. India has a unique opportunity to lead the global wellness revolution by blending traditional knowledge with modern workplace demands. If scaled responsibly, Ayurveda and Siddha could not only heal individuals but transform work culture—making well-being central to productivity. Isn’t it time we moved from reactive health policies to proactive, preventive, and deeply rooted wellness ecosystems? The answers may already lie in our own heritage. #Ayurveda #Siddha #CorporateWellness #WorkplaceHealth #IndianKnowledgeSystems #BurnoutRecovery #AncientWisdom #HolisticHealth #MindBodyBalance #ProductiveWorkforce #WellbeingAtWork #MentalHealth #Ayush Shirodhara: Ayurvedic Treatment to Calm the Mind

The Most Profitable Investment? Your Team's Well-being. Let me share what I discovered studying women-led companies that doubled their growth last year: They weren't focused on overtime. They were obsessed with inner time. The data hits hard: Companies prioritizing wellness see: • 65% higher employee performance • 41% lower burnout rates But here's the game-changer: Women leaders aren't just offering meditation apps. They're restructuring how work works. The New Playbook: Mental Health Matters → Regular check-ins replace annual reviews → Therapy benefits are non-negotiable → Stress management is a core skill Boundaries Are Beautiful • No weekend emails • Meeting-free days • True vacation respect Physical Wellness 2.0 → Standing desks are basic → Movement breaks are scheduled → Nature time is prioritized Smart leaders know: Exhausted teams don't innovate. Stressed minds don't create. Burnt-out talent doesn't stay. The future of leadership isn't about pushing harder. It's about powering better. Because when you invest in well-being, Performance takes care of itself. P.S. What's one wellness practice that transformed your team's performance? Share below - let's learn together.

Direct Primary Care dropped a 240-person company's healthcare costs 38% in 18 months. Their employees are healthier. Their broker told them it was "too risky" to try. Here's what actually happened. A distribution company in the Midwest was spending $1.84 million annually on health insurance. Deductibles at $2,500. Employees avoiding care because of cost. Three diabetics not checking their blood sugar regularly because test strips weren't covered until they hit the deductible. A benefits advisor suggested adding Direct Primary Care. $85 per employee per month for unlimited primary care access. No copays. Same-day appointments. Direct messaging with their doctor. The broker pushed back: "You'll have dual costs—paying for DPC and your health plan. Plus employees won't understand it. Stick with what works." What was "working": rising costs, delayed care, and a workforce that saw the doctor once every 18 months when things got bad enough. They implemented DPC anyway. Paired it with a high-deductible health plan that dropped premiums from $1.84M to $1.21M. Added the DPC membership: $244,800 annually for all 240 employees. Total Year 1 cost: $1.45 million. Savings vs. old plan: $390,000. But the real change wasn't the budget. It was utilization. Employees started actually going to the doctor. One member discovered Stage 1 hypertension during a routine visit he never would have scheduled before. Got on a $4 generic medication. Cardiologist later told him, "You probably avoided a heart attack in the next 5 years." The three diabetics? Now checking blood sugar twice daily because test strips are covered through DPC. All three hit their A1C targets within 9 months. Their endocrinologist said the engagement level was "unlike anything I typically see." Year 2 claims data: ER visits down 41%. Hospitalizations down 23%. Specialist referrals down 16% because primary care was catching things early. Year 2 total cost: $1.14 million. They saved another $310,000. Two-year savings: $700,000. But more importantly: people are getting healthier instead of waiting until things are expensive. Most brokers won't show you DPC because it requires rethinking the entire benefits model. It's easier to just renew what you have and collect the commission. You didn't become an HR leader to ration healthcare. The right partner makes sure you never have to.