admin | October 1, 2019

Value-based care, ACOs, Fee For Service, Total Cost of Care–buzzwords or business critical knowledge?

If you’re an employer ready to take back control of your second largest expense–healthcare coverage–while providing high-quality care to lower retention and boost productivity, then it’s the latter.

Healthcare benefit costs are eating away at your margins and your employee’s raises. The articles below provide the healthcare industry knowledge required to give accesss to more quality care to your employees while paying less (and why you weren’t invited to your healthcoverage benefit cost negotiations by your large, national carrier).

It’s time for competition and true innovation in healthcare. Customization is not enough.

This isn’t a marketing campaign.

The only sustainable solution for healthcare benefits that provides savings year-over-year while improving employee health outcomes long-term is a self-insured, value-based care health plan.

Read the articles below to better lead your company to a sustainable, high-quality benefit solution.


VALUE-BASED CARE vs FEE-FOR-SERVICE: What’s the Difference (And how does it affect our bottom line?)

“Value-based care” (VBC) and “fee-for-service” (FFS) are key terms for self-insured employers seeking financial control over annually increasing employee health benefit costs. VBC is a viable, long-term solution to the healthcare system’s cost and service inefficiencies. It’s critical for employers to become familiar with these terms and how VBC can impact them, their employees, and their bottom line: click here.


Fee For Service vs Capitation: What, Why & How It Affects Employers (And how does PMPM fit in?)

Capitation, Fee For Service, and PMPM work together to in a well-designed plan to protect your profits through savings year over year–or burn through them. Read the details here.


Why Inappropriate Healthcare Matters & What Employers Can Do About It

You understand the financial perils of the Fee-For-Service (FFS) model, you know pharmacists are qualified to aid employees along their healthcare journey (though underutilized), and you regularly share articles about the power of value-based care to lower healthcare costs for you and your employees while improving their health outcomes over time on LinkedIn. (Catch up on these concepts and more, here.) While each of these is a critical part of a benefits plan that gives financial control back to your company, inappropriate healthcare must be addressed for long-term health improvements for employees and maximum savings for employers. Read more.


What Are ACOs? (And How They Affect Your Company’s Health Benefits)

It’s necessary to work inside of an ACO model to lower the Totoal Cost of Care (TCOC) because this model brings alignment between primary care, specialists, and often hospital systems. The coordinated structure provides the platform for achieving this goal. Read more.


Fee For Service vs Capitation: What, Why & How It Affects Employers

Value-based care can come in the form of more than one model, like capitation. Making the most prudent financial decisions requires knowing the differences in their incentives. Read more.


Retain Talent With (Sustainable) Healthcare Benefits

Creating sustainable, timely care delivery models designed to help patients achieve improved health outcomes is a challenge. The complex, chronic conditions of America’s workforce are driving the need for these models forcing employers into the position of leading health care delivery innovation to retain top talent and remain profitable.


You weren’t invited to your health coverage negotiations. (Here’s why.)

In Part 1 of a three-part series: The Illusion of Choice in Health Care Negotiations, we delve into how the major insurance carriers build their broad provider networks, how those agreements mislead buyers, health coverage negotiations and the impact they have on premiums, quality of care, out-of-pocket costs, and what you can do to protect your bottom line. Read more.


Creagh_Milford_DO_MPH_FACOI_Chief Medical Officer of Healthcare Highways

Creagh Milford, DO, MPH FACOI | Chief Medical Officer, Healthcare Highways Chief Medical Officer of Healthcare Highways, Inc., and a National Academies of Medicine Fellow, Creagh Milford DO, MPH, FACOI has held senior executive positions with FullWell, Mercy Health, Massachusetts General Physician Organization, Massachusetts General Hospital, and Partners Healthcare. He holds a Doctor of Osteopathy from the Chicago College of Osteopathic Medicine, and a master’s degree in Health Management and Policy from the Harvard School of Public Health, where he continues to guest lecture. He also held positions with the Centers for Medicare and Medicaid Services and the Department of Health and Human Services. Follow him on LinkedIn and Twitter and enjoy more of his industry insights, here.

Marc_Pinney_Chief of Operations of Healthcare Highways


MARC PINNEY | Chief Operations Officer, Healthcare Highways Mr. Pinney’s extensive career began as a sales representative and later Vice President of Sales for Gallagher Benefit Administrators. A Senior Benefits Consultant at Holmes Murphy & Associates after that, he then brought his deep expertise to Healthcare Highways.


Vice President of Provider Networks of Healthcare Highways Brian_Wallach_Rounded

BRIAN WALLACH | Vice President of Provider Networks, Healthcare Highways Mr. Wallach has more than twenty-five years of provider network management experience.   His extensive experience and knowledge of provider network management comes from diverse roles such as  planning and building provider networks at a start-up company like Oscar Health to managing Cigna Healthcare’s 90,000+ provider network in 18 states located throughout the southeastern U.S. to being responsible for network assessment, building and maintenance of the provider network around the globe for Cigna International. Mr. Wallach holds a Juris Doctor degree in Healthcare Law form the University of Houston. Read more of his industry insights here.

Chris_Wilson_Senior Vice President of Health Plan for Healthcare Highways


CHRIS WILSON | Senior Vice President, Business Development; Healthcare Highways Mr. Wilson brought his experiences founding brokerage firm CJW & associates, LLC and serving as Senior Producer for Arthur J. Gallagher to the role of Vice President of Sales for Healthcare Highways. Now Senior Vice President of Health Plans of Healthcare Highways, Inc. his dedication to excellence has proven invaluable. Follow him for more insights here.


Read more about our contributors and their backgrounds here.