Insights & Analysis
Straight talk on health insurance, drug pricing, and what employers actually need to know — from someone who's seen it from the inside.
Follow one patient through the entire revenue cycle, from the operating room to the income statement.
Why two employers can pay wildly different amounts for the exact same hip replacement.
How fully insured pricing works, where the premium goes, and what changes when an employer takes control.
$800 charged. $200 paid. $600 kept. Legal. In your contract. And almost certainly in your top-50 drugs.
The rebate felt like a win. The $2M you overspent to receive it didn't show up anywhere visible.
$300K saved. $90K fee. The benchmark? Set by the same vendor collecting the fee. Convenient.
75% of large employers are already there. The ones winning aren't picking better vendors — they're writing better contracts.
How fully insured pricing actually works, where every premium dollar goes, and what changes the moment an employer takes control of its own plan. MLR, retention, IBNR, and trend — decoded.
Three companies process 80% of America's prescriptions. The rebate trap, spread pricing, DIR clawbacks, a $290M whistleblower verdict, and a $949M judgment — ten case studies in how the math doesn't add up.
Hospitals bill 3–10× Medicare for the same service, then brag about a "40% discount" off a price they invented. Here's why direct contracting is back, and what makes it actually work.
The ACA's MLR rule was sold as a check on insurer profits. But a spending ratio isn't a profit cap — and the biggest players have figured out exactly where the line is.
When an insurer owns the PBM, the pharmacy, and the provider group, it isn't just collecting premiums anymore. It's profiting at every stop — and the consumer pays the bill.
If you've ever stood at a pharmacy counter wondering how a pill could possibly cost that much, you're not confused — you're paying attention. Drug pricing doesn't move in a straight line. It moves through a maze, and at every stop, someone has a hand in the pocket.
Resources & Guides
Plain-English guides for employees and HR teams.
Downloadable explainers on the benefits decisions that actually move the needle. More coming soon.
A plain-English employee guide to Individual Coverage HRAs — how they work, what to ask, and what to watch for.
Read Guide →A plain-English guide to captive employee benefits — when they make sense, how they work, and what to ask before joining one.
Read Guide →A guide to episodic and bundled care — how flat-fee pricing works, why it saves money, and what to look for in a vendor.
Read Guide →A guide to Direct Primary Care (DPC) — what it is, the new HSA-compatibility rules, and why it's the cheapest path to better access.
Read Guide →A guide to care navigation — why employees can't use what they can't find, and how to fix the engagement problem at the root.
Read Guide →A guide to claims data and analytics — what you're entitled to, what to ask for, and how to use it to actually lower spend.
Read Guide →Fifteen questions every self-funded employer should be able to answer about their PBM. If you can't answer the first five, you don't have a transparent contract.
Read Guide →
