Proactive Care Strategy Today

Here’s some total cost of care math for a Monday. Biologics for psoriasis average roughly $20,000–$40,000 per year. GLP-1 receptor agonists average $12,000–$16,000 per year. If improved weight control from GLP-1 RAs reduces psoriasis severity and allows some members to avoid or delay biologic therapy, employers could see meaningful net savings. Depending on drug prices, that difference can range from approximately $4,000 to $28,000 per member per year. Evidence supports this

Should self-insured employers and other large groups that bear healthcare risk during midlife adopt strategies to mitigate risk in later years, especially when the average employee stays only three to five years? Obesity offers a clear case study. While employers often question whether investing in obesity treatment today delivers a return decades later, a broader, whole-person and whole-life perspective changes the answer. Today’s employees will eventually retire, while futu

It is urgent to change the revenue cycle and payment model for primary care and other relational care providers because the current reimbursement structure works against what all stakeholders want. Providers enter medicine to connect with and serve people. Patients come seeking connection and personalized, whole-person care. When payment models do not allow reimbursement for the time required to build that connection, they undermine what ultimately drives healing: a trusting

Optimizing mental health across the lifespan should be both proactive and reactive, with meaningful downstream benefits. We can intervene at any stage of a chronic condition, not just after decline begins. This requires a shift in how we view populations. They are not collections of diseases to be treated, but people to be served. When we focus on the person, our thinking becomes more proactive and centered on continuous optimization. A disease may have occurred, but a person

Nicotine use is important to consider in any population health or wellness strategy. It increases member risk and should be factored into benefit design, including the potential for increased member cost share. While there is often debate about whether vaping or nicotine pouches are safer than cigarettes, evidence shows that nicotine itself is harmful regardless of delivery method. Research demonstrates consistent increases in blood pressure, vascular damage, and higher cardi

Ongoing member education that steers individuals toward primary care and urgent care remains a smart strategy, especially as medical technology continues to advance. Care that once required higher-acuity settings can now be delivered safely and effectively in lower-cost, more convenient locations. Urinary tract infections are a common driver of avoidable emergency department utilization, despite there being little clinical justification for ED care in most UTI cases. Waiting

Around 26–30% of Californians and 48% of all Americans have hypertension, making it one of the most prevalent and costly chronic conditions. Getting just 2.5–5 hours per week of moderate physical activity, such as brisk walking, cycling, or swimming, or 1.25–2.5 hours per week of vigorous activity, such as running or fast swimming, can reduce the risk of death from hypertension by approximately 30%. This activity can be spread across the week or concentrated into one or two d

Optimizing vitamin D 25-OH blood levels continues to warrant support as part of a proactive medical and pharmacy benefits strategy. When low serum levels are identified, vitamin D3 supplementation is a low-cost, evidence-aligned intervention with meaningful potential impact. Annual immunotherapy costs for multiple sclerosis can approach $80,000, while vitamin D3 supplementation averages roughly $52 per year. That contrast alone highlights the value of prevention. Emerging evi

Women and men experience very different clinical journeys across the lifespan, and a one-size-fits-all approach to medical and pharmacy benefits carries real risk to both outcomes and total cost of care. Treating women’s health as a series of disconnected services rather than a unified strategy overlooks important clinical nuance and creates avoidable inefficiencies. Emerging evidence reinforces the need for this distinction. Recent research shows that early menopause, while

A solid utilization management strategy for GLP-1 receptor agonists (GLP-1 RAs) is good fiscal responsibility and an important lever in managing total cost of care. A nimble approach that adapts to emerging clinical evidence is essential, particularly because increased pharmacy spend can often reduce downstream medical costs. Pharmacy strategy is most effective when evaluated through a total cost lens, not pharmacy spend alone. Ensuring convenient access to GLP-1 RAs for memb

When we develop health and wellness benefit strategies, especially medical and pharmacy, we must remember that we are caring for whole people, not isolated diagnoses. Obesity, type 2 diabetes, cardiovascular disease, and depression rarely exist alone. In many cases, they affect the same individual at the same time. One person. Multiple diagnoses. Addressing rising healthcare costs should therefore begin as close to the origin as possible, not with each downstream condition in

Obesity is more prevalent than previously reported, affecting an estimated three in four U.S. adults, and it is a chronic disease with risk rising as waist circumference increases. It drives significant medical costs and productivity losses. While weight loss is possible, obesity cannot be cured and requires ongoing management, similar to type 1 diabetes. Environmental changes, healthy eating, and physical activity can reduce weight, but disease-related physiological factors

Want to reverse the trend in escalating medical costs? Start by reducing avoidable inpatient utilization for heart attack, stroke, and heart failure through earlier identification and management of chronic underlying conditions such as obesity, diabetes, hypertension, and hyperlipidemia. This is not a groundbreaking strategy, but few have executed it well. Success requires removing barriers that delay access to high-value care, especially primary care, and eliminating adminis

Is hidden cardiovascular disease already costing employers through reduced productivity, or does it only matter once a claim occurs? Even if employers expect to retain workers for only three to four years, the case for proactively optimizing weight (including waist circumference), blood pressure, cholesterol, and blood sugar remains strong. Progressive atherosclerosis and the resulting arterial stenosis can reduce blood flow to the brain, contributing to presenteeism through

There are always risks and benefits to any medical intervention, and they are both clinical and financial. In today’s healthcare environment, a strong provider–patient relationship can minimize clinical risk and maximize therapeutic benefit, but it rarely addresses the financial dimension, raising important questions about whether cost should be part of treatment decisions and whether patients should be supported to act as informed consumers alongside those bearing financial

Diabetes, hypertension, and hyperlipidemia are all associated with increased risk of earlier mortality, yet we have been far more effective at creating urgency around blood sugar control than we have around managing blood pressure or blood lipids. This imbalance in perceived risk shows up in patient behavior, as evidence suggests people are more reluctant to discontinue diabetes medications, particularly insulin, than statins or antihypertensives, even though all three condit

Dementia should scare everyone into more proactive action, it certainly scares us, because brain disease carries a far greater potential for lifelong burden than many other chronic conditions, including heart disease. One of the most practical strategies we have is setting realistic and achievable healthy movement goals, while immediately removing the myths around “fitness” created by the industry, because it does not take much movement to generate meaningful health benefits.

When we review quarterly and annual benefits data, we often group by place of service, clinical category, or average member total cost, which is valuable only if it is paired with a deeper understanding of the unique whole people seeking care and creating those costs. Continually looking for ways to better understand each person is essential: is it hypertension or chronic pain, depression or chronic pain, or chronic pain leading to depression? Medical trainees are taught to “

We have discussed why including waist circumference is valuable in creating definitions of obesity for better PROACTIVE CARE strategy and better health outcomes for members, not to create cliques or judgment, but to define cohorts who carry increased risk for morbidity and mortality due to higher amounts of adipose tissue. In medicine, we create cohorts to create action, diagnosing appropriately so we can treat appropriately and attribute limited healthcare resources to thos

Every medical intervention carries both potential benefits and risks, and expecting individuals to diagnose and manage their own care based primarily on advertising or consumer marketing is neither realistic nor appropriate. Over time, increasing barriers to care and the erosion of the doctor–patient relationship have diminished the role of medical expertise, leaving many health decisions influenced more by digital media than by clinicians. Women using GLP-1 receptor agonists