Improving Healthcare Finance

A broker told a 165-person company they were "too small" for self-funding. That broker made $72,000 annually keeping them fully-insured. The company switched anyway and saved $340,000 in Year 1. Here's what "too small" actually meant. Fully-insured premium: $1.44 million annually. Renewal at 8.9%. The CFO asked about self-funding. Broker's response: "Companies your size can't handle catastrophic claims. One $500K cancer case could sink you. Fully-insured is safer." What he didn't say: His $72K commission was the same either way. But self-funded meant actual work—managing claims data, vendor relationships, quarterly reviews. Fully-insured meant forwarding emails and collecting checks. They brought in a second advisor. Level-funded structure: $103,000 monthly fixed payment covering admin, stop-loss, and expected claims. Total: $1.236M annually. Year-end actual claims: $847,000. Surplus refund: $73,000. Effective cost: $1.163M vs. $1.57M renewal. Savings: $407,000. The real win? Visibility. They discovered 6 employees with chronic conditions weren't getting proper care management. Added health coaching and medication monitoring. Year 2 claims for those employees: down 34%. Better health outcomes, lower costs. Also found their PBM charging undisclosed $180-per-claim admin fees. Renegotiated them out. Another $94,000 saved annually. Two-year savings vs. staying fully-insured: $763,000. "Too small for self-funded" means "I don't want to do the work." Most 50-250 employee companies can self-fund successfully with proper structure and stop-loss coverage. The question isn't size. It's whether your advisor will actually work. You're not too small for transparency. You're not too small for control. You're not too small to deserve an advisor who earns their commission.

My latest from Forbes: Empowering Employers to Enhance Health Care Quality Employers hold immense potential to drive quality improvements in health care, which is vital for the well-being of their employees. With nearly half of Americans depending on employer-sponsored coverage, the responsibility to provide accessible, high-quality health benefits has never been more important. Yes, employers face challenges in pushing for quality and scaling innovations that can help. Currently, only 21% of commercial insurance payments incentivize improvements in health outcomes, a stark contrast to 43% in Medicare Advantage. This gap not only affects costs but also directly impacts the care and support our workers receive. Most employers are focused on their core business, not driving innovation in their benefits. To support increased employer focus on quality, Morgan Health, in partnership with JPMorgan Chase benefits, has established a roadmap that empowers employers to effectively measure and enhance health care quality through five key steps. A link to the Forbes piece is in the comments! 1. Identify Today’s Improvement Opportunities: Understanding the current health status of your employee population helps identify gaps in care quality. For instance, high levels of A1c among certain groups may lead to targeted goals to reduce diabetes prevalence. 2. Select Measures Based on Your Quality Goals: Determine what matters most for your workforce’s health. This could include reducing hospitalizations, enhancing access to preventive care, or improving provider satisfaction scores to ensure that employees are engaged in their health. 3. Determine Measure Baselines and Set Targets: Utilize national benchmarks, like those from NCQA Quality Compass, to establish baselines for key health indicators. This can guide you in measuring improvements against evidence-based expectations. 4. Establish Performance Payments that Incentivize Improvement: Align payment structures with quality improvement goals. Discuss and agree on fees-at-risk for performance targets to ensure accountability from health plans, providers, and vendors. 5. Document the Timeline and Process for Measuring Quality: Clearly outline how baselines are set and how results will be calculated. This not only promotes transparency but also helps in aligning all parties involved in the contract, especially when mitigating risks. Together, we can ensure that employers are equipped to foster a healthier workforce. Improving health care quality is not just beneficial—it’s essential for the health and happiness of our workers. Let's make quality care a priority! #HealthCare #QualityImprovement #EmployeeWellbeing #MorganHealth

GST Reform & Healthcare: A Step Toward Affordability? The revised GST framework effective September 22 simplifies rates to Nil, 5%, 18% and 40%. For healthcare, three changes stand out: 1️⃣ Medical essentials at lower rates – Thermometers, medical oxygen, test kits, devices, and spectacles now fall from 12–18% to 5%. This directly reduces the cost burden for patients. 2️⃣ Insurance at nil – Health and life insurance now attract no GST. This could accelerate penetration, especially in Tier II and Tier III cities where affordability has long been a barrier. 3️⃣ Compliance simplified – Streamlining into four slabs reduces administrative complexity for pharma and medtech companies. For an industry already navigating stringent GMP, GCP, and GDP regulations, this matters. But the bigger picture? Lower GST doesn’t just make products cheaper. It can improve adherence, drive wider insurance coverage, and ease compliance costs for the ecosystem. The real test will be in execution. Will lower device costs translate into deeper rural access? Will nil GST insurance drive mass adoption or remain urban centric? Will simplified slabs reduce disputes and bottlenecks for pharma manufacturers? For me, this reform is less about tax slabs and more about strengthening the affordability and access loop in healthcare. 📌 As we move forward, one thing is clear. Policy design and industry action must converge to make these benefits visible at the patient level. For pharma leaders and policymakers, how do you see GST shaping affordability and compliance over the next 2–3 years? (Reference: Ministry of Finance release, Angel One report, 2025)

HCA just previewed its Q2 earnings. But the headline isn't really about HCA. It's about what may be happening across the industry. HCA Healthcare reported that an increase in uninsured patients resulted in an estimated $400 million unfavorable impact to pre-tax Q2 income. Perhaps even more important than the Q2 impact, HCA lowered its full-year 2026 guidance - an indication that leadership expects these payer mix pressures to persist. We’ve long expected that the expiration of enhanced ACA Marketplace subsidies would result in more uninsured patients. Now we're beginning to see the financial impact. None of this should come as a surprise. This should be a wake-up call. The payer mix shift we’ve been anticipating is here. …and it's about to get worse… In less than 6 months (1/1/27), HR1/OBBA will require states to implement Medicaid work requirements & move to biannual eligibility redeterminations. Many healthcare policy analysts project that those changes will result in an even larger uninsured/underinsured population. To prepare: CFOs, CEOs, & Revenue Cycle Leaders, need to start focusing on the following more closely: - Medicaid eligibility & enrollment - Patient financial clearance - Self-pay volume - Patient financing solutions - Point-of-service collections - Bad debt & charity care - Financial counseling Organizations that strengthen these capabilities today will be better positioned to manage the financial impact as uninsured volumes continue to rise. HCA may simply be the first large health system to quantify what many across the industry expected was coming. The real question is: Will others report the same story over the next several weeks? #HealthcareFinance #RevenueCycle #ACA #HealthcareAffordability

Rising insurance premiums should not be explained by medical loss ratio alone. MLR is useful, but it is only one indicator. A more credible assessment should also consider claims cost per insured life, case mix, provider price growth, utilisation growth, administrative expense ratio, underwriting margin, capital adequacy, and the out-of-pocket burden shifted to patients. To tackle rising insurance premiums, I find it helpful to use a simple 5-part framework: 1. Measure properly Look beyond a single ratio. Separate price growth from utilisation growth, and distinguish real medical inflation from administrative inefficiency or margin expansion. 2. Moderate demand intelligently Use co-payments, deductibles, and benefit design carefully to reduce low-value care, without deterring necessary care. 3. Manage provider incentives Strengthen fee benchmarks, episode-based payment where appropriate, panel governance, and pre-authorisation for selected high-cost services. 4. Monitor insurer behaviour Require greater transparency on expenses, margins, claims denial patterns, and service performance, not just claims payouts. 5. Minimise patient harm Any premium control strategy should protect affordability, access, and continuity of care, especially for patients with genuine healthcare needs. This matters because the same premium increase can mean very different things. It may reflect genuine medical inflation and more appropriate care. But it may also reflect higher operating costs, preserved margins, weak cost control, or greater transfer of financial risk to patients. In healthcare finance, the real issue is not whether spending rises. It is whether the increase is proportionate, transparent, and tied to real value. As Program Coordinator for the Master of Health Management and Policy at Newcastle Australia Institute of Higher Education, I am interested in these questions because they sit at the intersection of policy, economics, regulation, and clinical reality. If you are interested in health insurance, healthcare finance, and the design of sustainable health systems, connect with me. Newcastle Australia Institute of Higher Education https://lnkd.in/gtHAXi8m

Sustainability isn’t a coat of paint. It’s part of the blueprint. In digital health transformation, “green” has moved from a nice-to-have to a core part of responsible change. And lately, it’s a recurring topic in many meeting rooms. Ignoring sustainability in transformation isn’t just bad for the planet, it exposes organizations to rising energy costs, regulatory penalties, and reputational risk. Every transformation decision, from strategy to procurement, deployment to retirement, carries an environmental footprint. Treating sustainability as an afterthought leads to waste: 🔸 Systems overbuilt for prestige rather than need 🔸 Infrastructure running far below capacity 🔸 Devices replaced on schedule, not condition I’ve seen entire racks of perfectly good hardware decommissioned, not because they failed, but because refresh cycles didn’t account for reuse or repurposing. It’s a reminder that sustainability isn’t always obvious at first glance. In one study comparing two T-shirts: 🔹 The one labelled as “sustainably produced” wore out quickly, requiring multiple replacements. 🔹 The other, not marketed as green, lasted far longer, and over its full lifecycle, had a smaller environmental footprint. Digital transformation works the same way. True sustainability comes from durability, efficiency, and total lifecycle impact, not just how “green” it looks at launch. Embedding sustainability means building it into every phase of transformation: 1️⃣ Strategy & design Set sustainability goals alongside clinical and operational goals.  Select cloud providers with renewable energy commitments. 2️⃣ Build & deploy Use modular architectures to extend system life.  Prioritize energy-efficient code, devices, and configurations. 3️⃣ Operate & maintain Monitor resource usage, consolidate storage, and optimize workloads for off-peak energy demand. 4️⃣ Retire & replace Plan for secure decommissioning, refurbishment, and recycling from the outset. Before approving your next transformation initiative, run it through the "Green Lens": ✅ Can we meet the need with fewer resources? ✅ Can this run on renewable-powered infrastructure? ✅ Can we extend the life of what we already have? If the answer is “no” across the board, you don’t have a sustainable transformation plan. If you’re leading digital transformation today, are you building it for the next launch… or the next generation? 💡This post is part of 'Rethinking Digital Health Innovation' (RDHI), empowering professionals to transform digital health beyond IT and AI myths. 💡The ongoing series and additional resources are available at www•enabler•xyz 💡Repost if this message resonates with you!

Our systematic review on the carbon footprints of medical devices is now out! Medical devices are estimated to contribute around 6-10% of national health system carbon footprints. In this review, we analysed 59 studies measuring the carbon footprints of 61 medical devices, mainly across surgical, endoscopic, and anaesthetic specialties. We identify three key findings. 1. Reusable devices are generally more carbon efficient than single-use alternatives. However, this advantage is not universal. In settings where reprocessing relies on fossil fuel-intensive energy grids, reusables can have higher footprints. 2. Carbon hotspots differ by device type. For single-use devices, emissions are dominated by production and manufacturing. For reusable devices, reprocessing (cleaning and sterilisation) is the main contributor. 3. We found variation in how carbon footprint methods are applied, often with limited transparency around data sources and assumptions. These findings support the preferential use of reusable devices where feasible, alongside efforts to decarbonise reprocessing systems. They also point to the need for more transparent and consistent carbon footprint methods, while recognising that any methodological standardisation must remain flexible and sensitive to local contexts. Importantly, growing interest in device carbon modelling should not delay action! Reducing the climate impact of medical devices requires action across the system: policymakers reforming regulation to enable safe reuse; manufacturers embedding circular design principles into products; healthcare facilities optimising reprocessing; and clinicians prioritising reusable options in practice. This is a call to action! https://lnkd.in/ebs-enee Sara Shaw Dr Stuart Faulkner Sanay Goyal Monika Chowaniec #sustainablehealthcare #climatechange #carbonfootprint #medicaldevices #circularity

🌍 Building Resilient and Sustainable Health Systems in Europe 🌍 Today, I'm excited to share insights from an article in The Lancet Regional Health which I had the privilege to author with WHO Regional Office for Europe Regional Director Hans Kluge, highlighting the need for transformative work in health systems across the WHO European Region. Health systems are facing unprecedented pressures, from demographic shifts to economic and environmental challenges. The COVID-19 pandemic has further underscored the need for robust, adaptable health systems. In response, a new vision was adopted by all 53 countries in the WHO European Region during the 74th Regional Committee, aiming to make health systems more sustainable and resilient. The vision is anchored around the trust that people are able to receive the right care at the right time, from the right person without financial hardship. Key points from the framework include: Primary Healthcare: Reorienting health systems towards primary care, especially for ageing populations. Community-Based Interventions: Integrating health and long-term care systems, addressing mental health, and involving local authorities. Health Workforce: Focusing on caring for and optimizing the contributions of health workers. Technology and Digitalization: Investing in high-end technologies while bridging the digital literacy gap. Financial Protection: Strengthening mechanisms to prevent out-of-pocket expenses from pushing people into poverty. Emergency Preparedness and Climate Adaptation: Enhancing health systems' ability to respond to emergencies and adapt to climate change. This comprehensive approach requires collective effort, trust, and strategic investment. Let's continue to advocate for and work towards resilient health systems that ensure well-being for all. 💪🏥 HealthSystems #WHO #PublicHealth #Sustainability #Resilience #GlobalHealth Thank you to all colleagues across the house, to our fantastic WHO representatives in countries, for being behind this transformative work to support countries across and beyond our region. Grateful for all we achieved together in 2024 and looking forward to continuing our work in 2025. Tamas Evetovits Melitta Jakab Tomas Zapata Ledia Lazëri David Novillo Ortiz, PhD JOAO BREDA Christine Brown Rasmus Prior Gjesing Govin Permanand Ramy Srour Gauden Galea Robb Butler Ihor Perehinets

From Siloed Projections to System-Wide Planning: How We Built Singapore’s Healthcare Capacity Framework 3 years ago, our healthcare demand projections were done in silos. Today, we have a coherent, system-wide framework that links demand to infrastructure, manpower, and budget planning. Honoured by the recognition on the work done by the team. Here’s the transformation journey. The Challenge We Faced Demand for each care setting is projected independently, using different assumptions and methodologies. 2023: Building the Foundation Introduced more granular inputs: added parameters e.g. functional impairment levels and family support in long-term care projections. Linked patient flows: Connected across settings (e.g. ED visits to acute inpatient to community hospital). 2024: Achieving System Coherence The coordination challenge: Working across 8+ divisions (IPP, HSD, PCC, APO, MP&S, HF) while handling new policy simulations & evolving capacity decisions. The solution: Set up Capacity Planning Committee (CPC) as single decision platform, replacing piecemeal EXCO discussions. The breakthrough: Obtained approval for our projections alignment framework: • Single baseline model across all projections • Common parameters where models intersect • Systematic accounting for care transformation impacts Real impact: Secured approval for new hospital beds through white space activation and new hospital sites. 2025: Advanced System Modelling Healthier SG simulation: Collaborated with Duke-NUS to quantify HSG’s long-term impact on healthcare demand and costs - answering our persistent questions. Disease-based projections: Piloted new method for mental health services, endorsed and used for service planning Tight deadline delivery: Completed baseline and care transformation projections across all settings that should have taken a few years to complete within one year. The Framework That Changed Everything Our Long-Term Capacity Planning Framework now seamlessly connects: • Demand drivers (population aging, functional impairment) • Care settings (from acute to community to home-based care) • Resource planning (manpower, infrastructure, budget) Policy interventions like HSG, right-siting efforts, and palliative care strategies are incorporated. Key Lessons Learned 1. Coordination is as important as methodology - The CPC structure solved more problems than technical improvements alone 2. Resilience matters - When our HSG model wasn’t endorsed initially, we went back to fundamentals and rebuilt stakeholder confidence 3. Granular parameters drive better insights - Moving from broad assumptions to specific factors like family support levels improved accuracy The result? A coherent planning system that helps Singapore prepare for demographic transitions while optimising resource allocation across the entire healthcare continuum. What challenges are you facing in system-wide planning and coordination across multiple stakeholders?

New modelling shows that government will need to deliver on NHS productivity and prevention promises to prevent health costs spiralling. Joint analysis by LCP and IPPR projects the cost of government-funded healthcare to 2034/35 under various scenarios. If recent trends continue, healthcare spending will grow to over 9.5% of GDP in 2034/35. However, improvements in productivity and prevention could almost completely flatten this growth, with spending remaining at around 8% of GDP in a decade’s time. If delivered, these improvements would provide annual savings of over £50bn in 2034/35, comparable to the current UK defence budget. Excellent work from Andrew Pijper and Dr Godspower Oboli updating previous LCP Health Analytics modelling to reflect the latest data and developments, and new scenarios developed with IPPR for their new report. It was a pleasure to collaborate with Annie Williamson, lead author of the insightful new report "Realising the reform dividend: a toolkit to transform the NHS", which is out today. Links in comments to LCP blog and analysis and the IPPR report.