As a CEO, you bear the responsibility of controlling costs, attracting and retaining top talent, and ensuring your organization thrives. Yet, many businesses unknowingly undermine these goals by adopting a passive approach to health insurance—relying on off-the-shelf plans from big-box carriers and hoping for the best. While this “drive-through” strategy may seem convenient, it falls short of delivering the value it could.
To complicate matters further, employees are at their financial breaking point. Health insurance premiums and out-of-pocket expenses have been rising faster than wages for years, leaving your workforce unable to bear any additional financial burden. This status quo isn’t just unsustainable for your business; it’s eroding employee well-being, morale, and productivity—harming the very foundation of your organization’s success.
For many employers, achieving the 'Triple Aim'—reducing costs, improving health, enhancing the quality of care —has remained out of reach.
The good news? A better way exists. By shifting to a proactive, strategic approach, you can align your health insurance strategy with your broader organizational goals. With the right mindset and partners, you can create a more effective system that supports your employees, strengthens your business, and delivers meaningful, measurable results—a true win-win-win.
A System Designed to Fail Employers
The current health insurance purchasing culture perpetuates inefficiency and rising costs. Here’s why:
- Renewal Bias: Brokers often steer clients toward renewing the same carrier year after year. While they present elaborate spreadsheets of options, their financial incentives—commissions and persistency bonuses from carriers—bias them toward the status quo.
- Lack of Transparency: Many carriers provide limited claims data or none at all. This lack of transparency obscures true costs and prevents employers from effectively managing their plans.
- Medical Loss Ratio (MLR) Rules: Carriers must spend 85% of premiums on medical expenses, leaving only 15% for administrative costs and profit. This creates zero incentive for carriers to reduce costs, as higher spending simply increases their revenue.
- Primary Care Crisis: The U.S. healthcare system drastically underinvests in primary care, leading to:
- A shortage of primary care physicians and a shrinking pipeline.
- Burnout and rushed appointments, resulting in excessive specialist referrals and avoidable ER visits.
- Over-reliance on expensive medications as quick fixes instead of addressing root causes.
This broken system pushes costs higher every year while delivering fragmented, inefficient care. Employers bear the brunt of these inefficiencies, footing the bill for unnecessary referrals, inflated hospital charges, and costly prescriptions.
The Solution: Active Health Insurance Management
It’s time to skip the “drive-through” and embrace an active health insurance management strategy—the equivalent of owning your health insurance plan. Active management involves taking control of your purchasing strategy and building a high-value care ecosystem tailored to your organization and your employee's needs.
At AMR Benefits Management, LLC, we’ve developed the Power of Three solution, which addresses systemic issues to achieve the Triple Aim for employers.
- Certified Health Rosetta Advisor Who Is Not Paid Commissions or Bonus Income:
Acting as the equivalent to a fractional Chief Health Plan Officer, this advisor designs a plan customized to your organization’s needs. Through creative financing you only pay for the care your employees use, eliminating waste and improving cost efficiency.
- Highly Skilled Nurse Advocates:
These highly trusted professionals build deep personal relationships with employees, guiding them to high-value care. They ensure employees get the right care at the right time, reducing costs and improving outcomes.
- Family Medicine Physicians:
By embedding high-quality primary care into your plan, you empower doctors to:
- Solve root problems instead of providing temporary fixes.
- Manage 80% of healthcare needs without unnecessary referrals.
- Build long-term relationships with patients, improving satisfaction and outcomes.
The Results: High-Value Care in Action
Active management can deliver measurable savings and better outcomes. Consider these straightforward examples:
- Primary Care: A family medicine visit costs $150, while an ER visit can exceed $2,000.
- Labs: Freestanding labs cost 80% less than hospital-based labs for the same tests.
- Imaging: Freestanding imaging centers charge $500-$800 for MRIs, compared to $3,000 at hospitals.
- Pharmaceuticals: Generic medications and preventive treatments can reduce drug costs by 80-90%.
By prioritizing high-value care, businesses have the potential to save 20% or more on healthcare costs year-in and year-out while improving employee well-being.
Questions Every CEO Should Ask
To evaluate your current strategy, ask yourself:
- Are employees accessing cost-effective, high-quality care, or defaulting to any option that shows up?
- Are employees financially incentivized to be smart consumers?
- Do you want employees to address root problems through unlimited primary care access, or settle for Band-Aid solutions?
- Are you comfortable with a lack of transparency in your healthcare spending?
- Should your annual insurance renewal feel like a rushed negotiation or a controlled, strategic process?
- Are employees paying more out-of-pocket than necessary for care?
If you are unsure or answer NO to these questions, it’s time to consider a new approach.
The Path Forward
Employers who quit the drive-thru and actively manage their health insurance plans gain control over costs, enhance employee satisfaction, and create a competitive advantage. By contrast, those who stick with passive management are left with spiraling costs, inefficiencies, and disengaged employees.
Act Now
- Stop paying for inefficiencies.
- Invest in high-value care.
- Build trust through transparency and employee advocacy.
The tools and expertise to flip the script on low-value health insurance purchasing exist. Future-proof your business and turn your health insurance plan into a great asset for your organization.
