Healthcare Rebuilt.

Inside New Jersey's $100M Horizon Settlement

If a state health plan with lawyers, auditors, and subpoena power can get systematically overcharged for their healthcare for years, what's happening to your company?  In this episode of Healthcare Rebuilt, host Boe Hartman welcomes Chris Deacon, former Director of New Jersey's Public Sector Health Plans and author of The Great American Healthcare Heist. Chris shares her journey from being a lawyer to running one of the largest public health plans in America, overseeing healthcare for 820,000 people and $7 billion in taxpayer money.  Chris reveals the alarming discrepancies she discovered when auditing claims processed by Horizon Blue Cross Blue Shield. The state had a "lessor of" provision in their contract; a straightforward protection requiring Horizon to charge whichever was less: what providers billed or Horizon's pre-negotiated rate. Instead, Chris found Horizon was doing the exact opposite. For example, a hospital billed $674,856, but Horizon charged the state over $2 million—a $1.35 million overcharge on a single claim.  When internal complaints were ignored due to political dynamics and industry influence, Chris made the difficult decision to become a whistleblower. Her actions led to a $100 million settlement, though Horizon denies wrongdoing, doesn't have to admit fault, and remains the state's vendor.   This episode serves as a wake-up call for self-insured employers, CFOs, and benefits leaders because if this could happen to a sophisticated government entity, leaders need start asking what's happening at their own company?    In This Episode  * Chris's journey from lawyer to overseeing one of America's largest public health plans.  * The role of Horizon Blue Cross Blue Shield as third-party administrator.  * How the "lessor of" provision was supposed to protect taxpayers.  * Discovering $18 million in overcharges on just 50 claims.  * Why Horizon refused to provide additional claims data.  * The political dynamics that prevented internal resolution.  * Making the decision to become a whistleblower.  * Details of the $100 million settlement (and why it's just a slap on the wrist).  * Why self-insured employers are even more vulnerable than government plans.  * What employers should demand from carriers and TPAs.  * Chris's vision for a more transparent, accountable healthcare system.  Thanks for listening. To learn more about Nomi Health visit https://www.nomihealth.com Key links for social media: Follow Nomi Health on LinkedIn: https://www.linkedin.com/company/nomi-health/ Follow Boe Hartman on LinkedIn: https://www.linkedin.com/in/boe-hartman-70a194/ Listen on Apple Podcasts Listen on Spotify Subscribe to our YouTube channel: https://www.youtube.com/@nomihealth

The 3% Problem: Why Cutting GLP-1s Won't Save Your Healthcare Budget

As employers face a third year of double-digit health insurance increases, CFOs and HR leaders are scanning their budgets for cuts. One line item keeps standing out: GLP-1 spending on weight loss and diabetes drugs like Wegovy, Ozempic, and Mounjaro. In response, the natural question most employers are asking is "What if we just cut these drugs to get our budget back on track?"  But here's what might surprise you: GLP-1 drugs account for only 3% of total healthcare spending. In this episode of Healthcare Rebuilt, host Boe Hartman sits down with Dr. Rani Aravamudhan, Vice President of Analytic Consulting and Medical Director at Artemis, who analyzed millions of healthcare claims to understand what's really driving skyrocketing costs. While GLP-1 spend rose 124% in two years, Dr. Aravamudhan reveals the real culprits: outpatient visits up 33.7%, professional services up 27.9%, and emergency room visits up 34.3%.  The conversation challenges the impulse to simply cut GLP-1 coverage and instead advocates for a more holistic approach. Dr. Aravamudhan explains that dropping coverage might save money in the short term but could lead to significantly higher long-term costs from diabetes complications, heart disease, and kidney disease. The real issue isn't GLP-1s; it's employers' lack of cost visibility and control across all care categories.   In this episode: * Why 2026 health insurance renewals are showing 6-9% increases (or higher for smaller companies).  * What Artemis's analysis of millions of claims revealed about GLP-1 spending.  * The real cost drivers: outpatient, professional services, and ER visit increases.  * Why GLP-1s represent only 3% of total healthcare spend.  * Long-term health benefits of GLP-1 medications beyond weight loss.  * How cutting GLP-1 coverage today could lead to higher costs tomorrow.  * The role of prior authorization in managing appropriate GLP-1 use.  * Why employers are "buying blind" without complete claims data.  * How direct-to-provider contracting and real-time analytics change the game.  * Practical actions employers can take right now to get ahead of rising costs.  * Dr. Aravamudhan's optimism for employers navigating healthcare cost pressures.  Thanks for listening. To learn more about Nomi Health visit https://www.nomihealth.com Key links for social media: Follow Nomi Health on LinkedIn: https://www.linkedin.com/company/nomi-health/ Follow Boe Hartman on LinkedIn: https://www.linkedin.com/in/boe-hartman-70a194/ Listen on Apple Podcasts Listen on Spotify Subscribe to our YouTube channel: https://www.youtube.com/@nomihealth