Risk & Resolve
In this episode of Risk & Resolve, Ricky Hancart and a panel of healthcare innovators unpack why employers feel stuck in a “pay and pray” system—and what it takes to break free. Featuring leaders across underwriting, pharmacy, surgical care, and finance, the conversation explores how strategic partnerships, data transparency, and aligned incentives can transform employer health plans. From skyrocketing cancer drug costs to bundled surgical pricing and smarter risk management, this episode delivers a practical blueprint for building a more predictable, sustainable healthcare strategy. Main Talking Points * The core problem: healthcare as the most unpredictable and uncontrollable line item on the balance sheet * Why traditional plans feel like a losing game: “good year → rates go up, bad year → rates go up more” * The shift from reactive “pay and pray” to proactive, strategic health plan design * Building a custom health plan using modular, adaptable components (the “Lego” approach) * The importance of control, transparency, and protection for employers * How underwriting actually works: identifying risk drivers and aligning solutions to reduce claims * The biggest emerging cost threat: cancer and high-cost specialty drugs (J-codes) * Price variation shock: the same drug costing $250K vs. $1M depending on facility * TrueRx’s “TrueCodes” strategy: moving infusions to lower-cost, patient-friendly settings * Real patient impact: home infusions, improved quality of life, and reduced employer spend * Welbridge Surgical model: transparent, bundled pricing with 50% lower costs * Why zero-dollar (zero-tier) care drives employee adoption and better outcomes * The power of steerage: guiding patients to high-quality, lower-cost care options * The role of TPAs and integrated partners in simplifying complexity for employers * Case study: Process Alliance’s shift after a 50% premium increase * The importance of curiosity, leadership buy-in, and willingness to challenge the status quo * Balancing cost control with employee experience and access to care * The Conner “Pathway” framework: moving from reactive to intentional healthcare strategy
50 episodios
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