Phillip Berry – Northwind Health

When it comes to American healthcare, we’ve become really good at highlighting its failings. Watching the flurry of lamentations, frustrations, denigrations, and prognostications, over the last few weeks, would lead any rational person to believe that nothing is working in our healthcare system. And, not only is it “not working,” many people conclude that it is actively harming people and society.

Broken “healthcare” has become a convenient scapegoat for almost everything ailing American culture: greed, indifference, incivility, evil, inefficiency, poor health, obesity, unhappiness, failing businesses, personal bankruptcy, government fiscal problems, decreasing lifespans, etc. Why not? There is more than enough room under the $5 trillion healthcare tent to throw all of life’s problems.

The problem with the big tent approach is that particularities tend to get lost the more zeros you add after a number. Especially if there are 12 zeros. Few of us can even begin to get our heads around what a trillion actually is – it is pretty much incomprehensible.

Big problems? Queue the big levers. At such scale, the only possible way to get things under control is to go to something bigger, right? Enter government. Curiously, U.S. Federal revenue is about equal to our healthcare economy. Hmmm, that starts to put things into perspective.

Of course, what does it mean to “get things under control”? Big levers from a government perspective means legislation, regulation, and bureaucracy. With the government, the big “fix” relies on legislating away the bad behaviors, putting controls on things like pricing, and creating more bureaucracy to monitor and enforce compliance. This approach further complicates a system that is complex beyond reckoning.

Health industry observer and consultant John G. Singer points out that “you can’t fix an embedded economic system.” Yet, the chorus of complaints and calls center on just that: fixing something that cannot be fixed. There are simply too many competing economic, and social, interests to repair what we call our “healthcare system.”

At this point, there is no stopping the train that is government regulation. The “what” of 2025 will center on big levers and the leviathans of healthcare will be fighting a political ground war to protect their interests. The result will be incremental change wrapped in tough words like transparency and accountability while total costs will remain high and the organizations targeted by regulatory animus, now publicly censured, reposition around “new” attitudes and policies demonstrating their good faith efforts to be better corporate citizens.

Forgive the cynicism, but this approach is not the answer that will produce a better system, better pricing, or better health.

The real question for 2025 is not “what will it be?” – the “what” will be a storm of public posturing, punishment, regulation, and populist politics. The real question for 2025 is “Who will it be?”

American healthcare doesn’t need big-lever “fixes,” it needs boots-on-the ground innovation and fundamental change. It doesn’t need more regulation to squelch the bad actors, it needs to remove barriers to those who have new ideas. It doesn’t need to focus control in a limited set of hands in one statehouse or another, it needs to unleash the creativity of those who are already way down the road of American Healthcare 2.0. Or is it 3.0?

To the real questions of 2025. WHO will…

Propose innovative alternatives to the systems as we know them? Not the “SYSTEM” as a whole but the parts of it that can be deconstructed and rebuilt. Part of this is leaving cliched terms like “discount,” “rebate,” “payer,” “network,” and “system” behind. We need a new lexicon. Think less “network” and more “direct contract.” Less “discount” and more “cost plus.” Less “rebate” and more “transparent price.”
Make the bold choices to take risks on business model ideas and new payment structures? This means redefining terms like “PBM,” “TPA,” “plan,” and “health” in the context of new measures of value and success with a radically different approach to executing on them. See #1 above.
Do the incredibly hard work at the grass roots level of putting the pieces in place to remove access, cost, and complexity, barriers? We’ve got so many great ideas but they take work. A lot of work. Many are really good at talking about it, complaining about it, hypothesizing about it. Who will put in that hard work and sustain it over a long period of time to achieve aims?
Take chances on lesser known solutions that approach it all differently? Change cannot happen if we keep calling-in the same players. We will not escape status quo until we leave the known and familiar.
Implement multi-year strategies knowing that deeper change requires a long game approach? Objectives need to be defined over a long enough horizon to implement changes and allow their effects to bear fruit. This is truly a game of sowing, nurturing, and reaping in the right time.
Dare to move off of the embedded system that holds their organization and their employees in a state of increasing costs and decreasing health? We’ve been sold a lot of solutions over the years. Can we believe that there are actually viable ways to change? Will we?
Work to remove regulatory barriers to innovation, fight against wide net legislation that impedes the innovators, and strive for simplicity in bringing government power to bear? Politicians and regulators do have a critical role to play. Will they see themselves solely as policemen and judges or can they imagine themselves as enablers helping the upstarts actually bring change?
See beyond short term profits and Imagine the “system” as being responsible for human flourishing through the continuous production of affordable health? Raw capitalism without a moral center damages trust in free markets. Do we have the courage to see business as a force for good and approach healthcare markets and consumers with a stewardship mentality? Can we see the economic and health wins in it?
Dare to believe that there is a fundamentally better way to deliver, support, and pay for, healthcare in the United States and we can get there in a matter of years? Movement forward begins with the faith that it is possible.

There is a rising tide of change in American healthcare and it is not appearing in most headlines. Innovation is happening at the ground level, particularly in the efforts of self-funded payers. Innovators are doing the hard work on the foundation of healthcare with new approaches, systems, technologies, programs, and models.

Can we stay out of their way long enough or maybe even help them by supporting them in their efforts? There is a necessary place for private and public collaboration, with profound innovation possible through well-meaning boldness by both.

There is plenty of “what” being thrown around. Who is going to do something creative, different, and impactful? 2025 promises to be a very, very, exciting year.

The Food and Drug Administration (FDA) approved three novel drug therapies in October. One of those therapies, Hympavzi (marstacimab-hncq), is a medication indicated for the treatment of patients with Hemophilia A and Hemophilia B.

Hympavzi utilizes a new pathway to help reduce the risk of bleeding episodes in patients with Hemophilia, a disease that impacts the patient’s ability to clot properly. The disease puts patients at risk for prolonged bleeding after an injury or spontaneous bleeding in muscles, joints or organs which can be painful, and in severe cases life-threatening.

Traditional therapy has involved providing intravenous infusions of clotting factors two to three times per week. Hympanzi is the first Hemophilia treatment that is available as once-weekly self-administered injection offering significant convenience for patients.

Due to the nature and cost of the disease (it has been estimated that the lifetime cost for a patient with hemophilia can exceed $20M), Hemophilia is an area of intense research interest. Hympanzi joins traditional therapies and more recently approved one-time gene therapies. Watch for more developments in this exciting area of drug development.

Pharmacists have a time-honored role as an integral contributor to the delivery of health care. From the earliest apothecaries to the retail stores of today, community pharmacists have provided guidance about health, wellness and medication therapy. Their expertise ranges from preventive care to the most advanced medications used in the treatment of complex disease.

Despite the significant value of a pharmacist’s knowledge base, perhaps their greatest contribution is being a readily accessible heath care resource for the community. They are there to answer questions from anxious first-time parents. They are there to uncover important clues about the health status of a patient based upon their symptoms and to discern when self-care is appropriate and when it is not. They are there to help patients with a new diagnosis learn the language of that disease and its associated lab tests and medications. And they are there to physically demonstrate how to use inhalers, nebulizers, continuous glucose monitors, injections and numerous other medication delivery devices and then ensure patients can reliably mimic the proper technique.

Unfortunately, news headlines continued to be inundated with announcements of pharmacy closures. CVS, Rite Aid and Walgreens combined are in the midst of closing well over 2,000 locations across the country. Thousands more independent pharmacies have closed or are at risk of closure. The term pharmacy desert – defined as the absence of a pharmacy within a 10-mile radius – has entered our lexicon. In fact, research published in the Journal of the American Medical Association in August estimated that 46% of all counties in the United States contain a pharmacy desert. The data utilized in this publication pre-dates the pharmacy closures recently announced, so it is likely that the study underestimates today’s reality.

As a pharmacist, I am saddened for our profession and for the communities that are losing access to an important health care resource. As someone who works with employers to improve the health of their workforce, I am concerned about the broader impact this will have on their efforts. All communities, big and small, will continue to have a need for an accessible medication expert. Over time, as therapeutic regimens continue to increase in complexity, this need will only grow.

As a society, it is imperative to ensure that resources are available to provide vital medication education for those in need. Some may point to on-line resources and AI as a solution. While those are certainly important tools that can be used, simply increasing the volume of information patients have available is not a substitute for the interactive dialog and human touch provided by a pharmacist.

I am proud of the work Northwind is doing to increase the reach and impact of our pharmacists and look forward to continued collaboration with others to ensure patients have access to this valuable resource.

The Beauty of Making a Difference

Beauty in health benefits? What does that even mean? Think back on your experience as an HR/benefits professional. What are the peak moments? Most would agree that the high points are moments when they see their work directly impacting an employee or plan member. A time when the health plan or supporting services really made a difference for someone else. Other moments might be when they saved their organization money through a decision or discovery.

For benefit advisors, the high points are also the big wins: either earning a new client relationship through exceptional service and innovation or watching your recommendations bear fruit in savings and member health outcomes.

The beauty of what we do reveals itself in what it produces. “Wisdom is vindicated by all her children.” The fruits of health benefits wisely stewarded can change lives while helping sustain the organizations for which we work.

This is the beauty of the health benefits world. Our opportunity to make a difference makes what we do mean something.

Clear Purpose Illuminates Right Choices

Why do we offer health benefits? We want them to benefit our employees and their families. The benefits we offer should attract great employees to our organization and help us retain those great employees while helping us manage costs and foster healthiness for those employees. Healthcare may be complicated but our “why” is quite simple.

Northwind sees this purpose through the lens of good stewardship. Rightly ordered, achieving the “why” of our health benefits is simply a matter of providing access to the right products and services, at the right price, at the right time, in the right way, to create the best possible results. In this way, stewardship is the path to fulfilling the purpose of our health benefits.

When we are clear on our “why” and know that good stewardship shows the way, then the right path forward begins to unfold. Fulfilling the purpose of our health benefits is both good economic stewardship and good health stewardship. The choices aren’t mutually exclusive but complementary; good stewardship is the right combination of cost and effectiveness. The challenge comes in identifying and assessing choices.

The Beauty of Health Stewardship

If the beauty of what we do reveals itself in what it produces, what exactly are we producing? Many years ago, Aristotle wrote that all knowledge comes through our senses. How we know the world comes through our experience of it. In this way, the beauty we create comes through the way others experience it. Choosing beauty in health benefits centers on its output – its results – the total user experience.

The major problems with healthcare and the benefits we provide center on access, cost, and complexity. Removing these barriers has the power to create a beautiful experience…for everyone involved. Good health stewardship occurs when we find the right balance in cost and results as we remove the barriers. That special equilibrium is beauty in health benefits.

From a member perspective, good health stewardship is reflected in feedback like this:

“You guys are heroes, no really, what you’re doing…you guys are heroes!”

“This is the best benefit I’ve ever had…it’s honestly the reason I’m still with xxxxxxx!”

The quotes above are literal comments made this week from real members enrolled in a Northwind Clinical Blueprint^Ò. For those of us providing and managing health benefits, getting encouraging feedback from plan participants is a beautiful thing. Knowing we all relish such results; how do we foster them? How do we choose beauty in health benefits by embracing good health stewardship?

Beauty in Simplicity

It turns out that the formula for creating beauty in health benefits is really quite simple. Remove the barriers and beautiful things start to happen.

How, when, and where, we access healthcare can create major obstacles to getting the best outcomes and best price for the care we receive. It can also create major beauty in our experience of care. In a world of shrinking access to primary care, pharmacy closures, and employee populations living in “healthcare deserts,” we may feel the pressure of limited options.

Northwind’s simple answer to access barriers? 1) Highly flexible, custom network design. 2) Home delivery pharmacy for prescriptions and supplies. 3) Clinical programs to engage and support members through the healthcare journey.

Geographic access can be a problem, but cost and complexity are even bigger barriers. Fortunately, there are simple solutions. Addressing rising costs really centers on a willingness to engage creative thinking and beauty is once again found in simplicity. Our answer? 1) Transparent, cost-plus pricing. 2) No rebate games or hidden incentives. 3) No chasing rebates through restrictive formularies. 4) Smart prior authorization, co-pay, and deductible, strategies to encourage and reward good choices.

So far, so good. But what about complexity? Our healthcare system is far too complex to make simple, right? We may not be able to design a better hospital (yet!), but we can certainly make the health benefits we offer easy to understand and navigate. The simple answer begins with plan design, moves through the process of navigation, on to tools to provide answers when needed, but ultimately rests with our human beings supporting your human beings.

Northwind believes in putting the plan sponsor at the center of healthcare universe and building a flexible, directly contracted plan around the payer in support of members. Networks shouldn’t restrict or steer for the benefit of the provider but should center on ease of access, clear pricing, and seamless management. Navigational support should be a call away or accessible at the touch of a button – but more importantly, easy to understand at the outset.

Beauty begins with a great experience that is easy to navigate. On the frontside, healthcare complexity is beaten by overwhelming service – trained navigators available and ready to help with immediate needs and to anticipate those yet to come. Over time, the experience is curated by knowledge, understanding, and simple design…always supported by caring, engaged human beings. It really doesn’t have to be complex.

Stewardship and the Beauty of Health Benefits

“Before I started, my A1C was up in the 9’s with sugar in the high 200’s. Now, my sugar is in the low 100’s, sometimes even 95 and my A1C is 7.5. I’m not eating nearly as much as I used to and have added tons of blueberries and cantaloupe to my diet and my weight is down from 230 to 213!”

“Northwind is a key contributor to the care of our members. In addition to supplying medications for convenient onsite prescription fulfilment, Northwind provides services to our patients such as evaluation of medications for health conditions, curation and delivery of kits and phone support for questions about medications and home delivery. Northwind simplifies our vendor administration by accommodating our medication needs nationwide and with transparency of medication cost which is important to us as we manage our self-funded healthcare plan.”

“I used to have sugars in the 500s, A1C over 11, I was so sluggish and felt horrible! My sugars are now down to 85-110 I feel so much better. I’m no longer excessively thirsty and completely cut out sugar, cut back on pastas, no potatoes in months…now, at the end of the day instead of falling asleep on the couch, I can stay awake and actually see my children.”

This is the beauty and possibility of the health benefits world. The story of our experience in supporting our members on their health journey. The story of our stewardship of our organization’s critical resources. These are the stories that matter and our opportunity to make a difference makes what we do mean something. That is a beautiful thing.

Click here to listen to Katherine Lurke, PharmD and Steve Zetzl, PharmD discuss Northwind’s member focused approach to pharmacy benefit management.

Unlike traditional PBM models like you are used to hearing about, Northwind’s PSA (Phamacy Administration Services) prioritizes continuous patient engagement. Steve and Katherine break down how their team works to ensure that once medications are in hand, patients have what they need to succeed—whether that’s navigating complex treatment plans, addressing concerns, or improving overall health outcomes.

Listen to the full episode here and discover how Steve and Katherine are helping change the pharmacy benefits landscape and are setting a new standard for pharmaceutical care and patient outcomes.

Employers and unions have begun to realize that they are very much in the business of healthcare and that they are the “payer.” The move toward self-funding continues to build momentum as costs increase and employers discover that the healthcare universe revolves around a few massive payers.

American healthcare has become a $4.5 trillion galaxy revolving around a BUCA center that continues to extract more and more value from the system. Stuck in it’s gravitational pull, employers and unions are scrambling to figure out how to address ongoing issues with rising costs and increasing complexity amid decreasing access to timely and quality care. For all employers, the big movements around that center have outsized impacts on budgets and reinforce a sense of limited options.

To increase options, and leverage, more and more employers are moving toward self-funding and discovering a new universe of options for increasing their ability to influence costs and outcomes. In this move, they realize that they are the “payer” and the control point begins to tip with more visibility on the moving parts that create a medical and pharmacy plan. Today, every employer is in the business of healthcare and few can afford to accept the rising tide of increases with little hope of innovation or mitigation.

Self-funding is just the ante to the game. To create the necessary leverage to shift toward a new center-of-gravity requires a new point of view, new partnerships, and the willingness step away from the perceived safety of the traditional insurer. Necessity is the mother of invention, and of boldness. Opportunities to create leverage are no longer limited to large employers as groups of all sizes are seizing the initiative to make meaningful changes.

As self-funded plans evolve amid the changing healthcare landscape, the notion of health stewardship is becoming the watchword as it captures the essence of both financial and member health journey responsibility for the plan sponsor. Recognition of the growing barriers related to access, cost, and complexity, are redefining the self-funded plan sponsor’s role in helping members navigate options responsibly and effectively.

What are the elements of a health stewardship point of view?

Systemic healthcare problems of access, cost, complexity, and outcomes, cannot be “fixed” with a top-down approach. There is a growing understanding that regulatory and statutory intervention are exacerbating issues by adding complexity and limiting plan sponsor flexibility. Siloed fixes create new problems and generally serve the special interests sponsoring them.
The massive, fixed structures currently operating as the backbone of American healthcare cannot make the changes needed to remove the barriers. Self-funded plan sponsors are realizing that the financial and competitive incentives to keep things as they are, work against plan and member interests and the need for innovation.
Existing systems and approaches to healthcare must be reimagined in new ways, centered on the needs of those paying for healthcare in the form of self-funded plans and their members, and incorporating fundamentally different models for access, experience, outcome, and payment. In this way, innovation will be led bottom-up by plan sponsors themselves and their demand for new options. Options that are appearing rapidly.
Self-funded plan sponsors need effective points of influence and compelling programs to engage members as a steward of financial resources and their personal health. Strong primary care is a key part of the equation but must be paired with the right health solutions horizontally coordinated rather than vertically siloed. Data access coupled with meaningful insights become the backbone to direct stewardship in this new healthcare world order.
Plan sponsors and their members must be empowered in new ways to make better decisions and enabled with less complex pathways to the overall production of better health. Digital technology is part of this but must be effectively integrated with the analog world of high-touch healthcare and experience management.

Self-funded employers and unions are embracing health stewardship in the form of directly contracted healthcare relationships to increase their influence over costs and outcomes. Local hospitals are a key point of influence, but the move toward direct relationships, and the creation of a “nexus of care” for total healthcare influence, requires municipalities to embrace a new care and stewardship infrastructure to support it. This approach is fundamentally shifting the health benefit, the cost model, and the plan sponsor’s ability to influence both.

Waiting for my turn to present at recent health system executive conference, I noticed that presentations before mine spent a significant amount of time lamenting “payers” and “reimbursements.” Strategies and solutions to address these challenges centered on cutting costs, pooling resources to increase negotiating leverage, lobbying, and aligning with larger health systems to bolster positioning. I was struck by the oppressive feeling of impotence in the face of the outside forces shaping the worlds of these health providers.

Given our focus on self-funded employers and novel approach to managing healthcare costs and chronic disease through direct contracted offerings, I understood my place in the line-up to be a voice of hope and encouragement by sharing innovative possibilities. However, my first step was to lay the groundwork for the situation confronting these healthcare providers and the their patients. “Who controls the healthcare of our population in America? My 85 year old mother-in-law sums it up concisely: ‘I go where insurance tells me to go.’

The Federal Trade Commission (FTC) minces no words in its recent report, Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies. Among the many observations of this report, one of the most striking conclusions is that “PBMs have gained significant power over prescription drug access and prices through increased concentration and vertical integration.” How significant? The top three (CVS Caremark, Express Scripts, and OptumRx) manage 79% of prescription drug claims for about 270 million people in the United States. Add-in the next three largest PBMs (Human, MedImpact, and Prime) and the total jumps to 94% of prescription drug claims.

The FTC’s primary argument centers on ownership and vertical integration as the source of the problem. Here is their graphic depicting the extent of the vertical integration:

Why is this a problem? The FTC report concludes that the concentration of power raises drug prices, squeezes out competition through steerage and restrictive agreements, and discourages lower cost generic utilization and development due to exclusionary agreements with manufacturers. Essentially, these massive players what we get, how we get it, and how much we pay for it. The four biggest are part of conglomerates whose revenue exceeds $1 trillion, over 22% of total U.S. healthcare expenditures.

So, what’s your center? If you’re in the healthcare business or providing health benefits to employees, it is one of these massive organizations, also known as “payers.” Though the FTC report focuses on PBMs, the issue is much larger as the organizations holding this concentration of power hold it over all of healthcare. These are the players dictating how we pay for care, how we access care, and even how we are cared for.

Their massive size stunts innovation by focusing on squeezing more out of the existing model and centering efforts on shareholder wealth creation by extracting value from the healthcare system. The result is a lumbering giant of entrenched mediocrity that is unable to flex to address changing populations, new payment models, dynamic technology, or the real underlying issues of our spiral into more cost and decreasing healthiness.

Where does the center need to be? We need to focus on the real payers in healthcare: employers and their employees. As evidenced by recent lawsuits, employees are beginning to demand more out of their company-sponsored health plans and the center of gravity is shifting quickly to employers and the decisions they are making in their health benefits. The employer plan, especially the self-funded employer, is the harbinger of change in American healthcare.

The shift has already begun. Right now, the focus is on tweaks to the existing system and the structures on which it sits. Reworking the veneer will help a bit but lasting change will require more fundamental redesigns in payment models, care strategies, data visibility and interpretation, and careful stewardship of the overall healthcare investment. Siloed looks at pharmacy and medical claims need to evolve to deep insights into overall spend, the implications of decisions, and the efficaciousness of the care being delivered – whether that is a medication or a procedure.

The ultimate answer will sit atop a new care and stewardship infrastructure built on precision networks, real-time access to decision enhancing insights, seamless technology, flexible direct contracts, and less complex payment models. The only way to remove the barriers of costs, access, and complexity, will be to redesign our clunky system, relocalize health, and give employers and employees more control. We need to put them at the center of our healthcare universe.

Healthcare is the name of this $5 trillion game but the real aim is human flourishing and health is just one of its pillars. Once we’ve re-centered and began to remove so many distracting healthcare barriers, we can begin to dig deeper on the root causes of so many of the diseases affecting our capacity to thrive in mind, body, and soul. The center of gravity is shifting and we’ve just started to scratch the surface of all that is possible in the ultimate quest toward full human flourishing.

In the health benefits world, the mad scramble toward January renewals/starts has subsided and attention has turned to the annual cycle of review necessary to gauge progress. How did we do? The plan review process generally centers on analytics to gauge progress or regress and to identify “areas of opportunity.” Good. The right data with the right insights is critical to assessing efforts made to manage costs and improve outcomes.

However, the big look at data and associated insights often misses a key perspective: that of the member. What is the view of the plan participant, employee, mother, son, or husband who is actually impacted by the decisions we make as health plan sponsors? In the big look on data, we look for big levers to pull across big groups of members hoping to have a big impact on costs. But real change happens in the little: the step by step, patient by patient, call by call, and day-in-day-out efforts to impact individuals who ultimately determine the success, or failure, of our health plan strategies.

In recognition of this “little way” of making a big difference, we’ve compiled below some of the voices that often get lost in the noise of the big machinery driving U.S. healthcare. By focusing on smaller units of impact, doing the hard work centered on individual progress, and showing up with a stewardship mindset along the way, we see a path to fundamental and lasting change for the people struggling to manage it all as well as compelling validation for the companies wanting to sponsor success.

“As the mother of a child in this program, we couldn’t believe how much was covered. We were blown away. Before we had to use Optum’s “ship once every 3 months model” and worry that something my daughter needed wasn’t going to be in the shipment. We also appreciate the local aspect, the comfort it brings knowing if we ever need anything you are there. Diabetes is such a burden to deal with, but this has made it manageable for my family.”

“I’ve lost 87 lbs! At the beginning I was pre-diabetic with sugar in the 300’s – now I’ve learned I’m no longer a Diabetic AT ALL and my A1c is down to 5.4.”

“I just wanted to tell you how much it means to me that when I call you, you pick up the phone. I can’t seem to get answers anywhere else – wanted you to know I appreciate that.”

“Tuesday morning I received a call from Northwind saying they realized that I have been without my medicine for a long time and they were going to have an employee drop the medicine off at my house, (OMG Excellent Customer Service) I said you don’t have to do that, she said there is a snow storm coming tonight and we want to make sure that you have your medicine. When I got home from work two large boxes with all my medicine was there. My glucose number is within a normal range and my health is feeling better! Thank you for the new Diabetic Management program.”

“I feel better than I have in 25 years. I think that says it all, don’t you?”

Yes, we do.

A request came in to our company at 3:43am this morning from the employee of a group that just transitioned to our pharmacy services program. It was short but powerful:

“I’m a person who is fighting against diabetes. 2nd year fighting it and I heard about this program called Clinical Blueprints.”

I like to monitor requests from members and patients and this one stuck out to me this morning. I’m a person who is fighting against diabetes. Fighting is a really strong word. For this individual, the fight is serious enough that he is sending messages to us at 3:43am seeking help with his battle. Fortunately for him, his employer is stewarding their benefits investment, and his health, by putting a targeted program in that will actually help him.

Consider that diabetes is most likely not the only thing this individual is fighting. He may be fighting obesity. He may be fighting high blood pressure. He may be fighting sleeplessness or depression. He may be fighting to keep his job. At 3:43am this morning, his mind was on his fight with diabetes.

The CDC reports that over 38 million American adults suffer from diabetes – over 14% of the population. Generally speaking, we see an incidence of diabetes in our self-funded groups of about 10%. Over 22% of them don’t realize it or don’t report it. Fierce Healthcare reports that employers spend $20,000 per member on diabetes care annually and that diabetics spend 240% more on medical care than non-diabetics. That’s a pretty serious financial fight.

Statistics tell part of the macro story but probably don’t mean much to the individual who is wrestling with daily decisions like: should I pay my co-pay for insulin this month or buy groceries for my family? Should I take that extra shift or go to the appointment with my endocrinologist?

What other barriers besides cost might stand in the way? Access? Complexity? The report above states that costs for diabetics are growing at over 20% annually. Clearly money is being spent. But is it being spent in the right way to produce the best results?

We see many headlines highlighting our healthcare woes, high costs, and our need for additional regulation. Much of the finger pointing is at organizations that charge “too much” and vendors that “make too much.” There are certainly opportunities for efficiency and room to slim down some of the grabbing hands in the kitty. However, we all get lost in the broad sweep of a $4 trillion healthcare economy – a number so big that only an economist has any sense of what it really means.

Let the economists, politicians, and titanic enterprises, duke it out over the size and scope of the spoils. The only change to happen in that multi-trillion dollar stratosphere is one of reallocating the pie. At that scale, no one really wants to skinny it down.

Real stewardship happens at a lower denominator – the one we can actually influence. The fight is happening at 3:43am, in the home, amid the discomfort and fear of what it means to be in such a fight and whether or not anyone cares to help. There is an emerging playbook for this fight and it isn’t being executed in the hallowed halls of our capitals or the boardrooms of the titans working to carve the pie in their favor. It is happening in HR, Benefits, and Employee Health departments. It is happening in the self-funded plan.

The reality is that all of us holding seats of responsibility want to be good stewards. We want the money we invest in our employees to help them flourish. The world tells us we need to stay the course in the fixed world of our current healthcare and benefits system, however, good stewardship demands that we look outside of it and press the envelope of the known and the “safe.” After all, is it safe for employees to be fighting diabetes at 3:43am? Is it safe for members to ration their insulin for the first six months of the year as they try to reach a deductible?

Can business be a force for good? Is it supposed to? We think so. Good for the world. Good for our customers. Good for our employees. Good health stewardship is good business – morally and economically. It really is worth the fight.

Thanksgiving has arrived once again and this week, the Northwind Family feels particularly grateful for the employers, unions, primary care providers, advisors, and patients, who give us the opportunity to work with them every day. The pharmacy and health benefits world is full of options and we feel very blessed that you choose our team to be your partner in health.

Part of our Thanksgiving process is to consider those with whom we work, and remember what makes them so special. Looking across the broad base of organizations and individuals who choose Northwind every day, we found some common traits, and today seems like a great day to celebrate them.

Thank you for your…

Vision. When it comes to health benefits and the healthcare they enable, status quo seems to be the name of the game. Self-funded plan sponsors have become very frustrated with the high costs, the resistance, the obfuscation, and the lack of innovation, that have cemented much of what we call American healthcare in entrenched mediocrity. It takes vision to see beyond the barriers to a better place. Today, we thank our partners for their amazing vision, born of optimistically creative thinking.
Boldness. Seeing a better future is one thing, but having the courage to pursue it is something quite different. Every day, we see our clients pursuing their vision for a better healthcare future with incredible boldness. Their efforts and impact, inspire other plan sponsors, and their boldness encourages their members to take the initiative in managing their own health. Today, we thank our partners for their bold choices, bold execution, and bold faith in what is possible.
Perseverance. No great thing is ever accomplished without the persistent effort to push through when challenges come, and setbacks threaten to derail the vision. Our clients aim for great things, and their perseverance through the tough times separates them from so many others who stopped short of the goal. A willingness to face the resistance and continue to exert the effort can move mountains. Today, we thank our partners for their perseverance in moving the healthcare mountain to a better place.
Heart. Saving money is important. Being a good steward is important. We see it in our clients but it’s their heart for the health of their members that really inspires us. Heart is the engine driving the vision, the boldness, and the perseverance. Heart is the energy source that keeps these leaders rolling when things get tough. Heart is the source of compassion that calls such visionaries to take the risks, make the choices, and push for more, when they see their members in need. Today, we thank our partners for their heart in seeing the dignity of every human being and the opportunity to serve them through innovative health programs.

We see these, and so much more, in the individuals and organizations with which we work and we thank you. Thank you for calling us to more. Thank you for inspiring us. Thank you for demanding more for your members. Thank you for resisting the status quo. Thank you for believing there is a better way, and having the courage to pursue it.

From our Family to yours, please have an amazing Thanksgiving with those you love as you remember all who are counting on you. Thank you for continuing to show up to change the world.