Improving Healthcare Finance

🔥 Monday Mornings With Michelle - CA wildfires, can something good come out of this tragedy? 🔥 In the wake of the utter devastation happening in Los Angeles, there is a lot of press being paid to the fact that some of the biggest names in homeowners insurance, like State Farm and Allstate, decided to stop writing policies in the state. With the magnitude of the devastation, if nothing changes, many of the remaining carriers may have no choice but to exit the market. This isn't just about corporate decisions—it’s a wake-up call for the state’s insurance market. Here are the three main reasons why insurers are leaving: 1️⃣ Rising Catastrophic Risks: Wildfires in California are more frequent, intense, and expensive than ever before. Insurers are paying billions in claims, outpacing the premiums they collect. 2️⃣ Regulatory Constraints: California's Proposition 103 makes it tough for insurers to adjust rates based on future risks. They're stuck using historical data that doesn't reflect the increasing challenges from climate change and rising costs. 3️⃣ Soaring Costs: Rebuilding after a disaster isn’t cheap. Construction costs, labor, and reinsurance rates are climbing, leaving insurers with losses higher than premiums. What can be done to fix this? Here are some solutions to stabilize the market and ensure homeowners can get the coverage they need: ✅ Wildfire Risk Mitigation: Invest in better land management and incentivize homeowners to adopt fire-resistant materials and maintain defensible spaces around their properties. ✅ Rate Regulation Reform: Modernize regulations to let insurers use forward-looking models and climate data to set rates that reflect today’s risks. ✅ State-Backed Reinsurance: Create a public-private partnership to spread catastrophic risks and stabilize the reinsurance market. ✅ Consumer Education: Help homeowners understand how to protect their homes and why premiums may increase due to rising risks. ✅ Fair Plan Improvements: Strengthen California’s insurer of last resort to ensure coverage remains available for high-risk areas. This situation is complex, but the stakes are high—for homeowners, businesses, and the state’s economy. We need bold, collaborative solutions to create a sustainable insurance market in California. What are your thoughts on this crisis? Let’s start a conversation about the changes we need to see. #Insurance #California #Wildfires #ClimateChange #Innovation

“Until women’s health is everywhere, women’s health is nowhere.” This new viewpoint by Andrea Edlow, Lynn M. Yee, Alison Cahill, and Cynthia Gyamfi-Bannerman, MD, in JAMA Health Forum is a good read for anyone working in research, policy, or women’s health. It makes a clear and urgent case: • Systemic underfunding of women’s health research has contributed to rising maternal mortality in the U.S. • Just 8.8% of NIH’s total budget over the past decade has supported women’s health research • An even smaller fraction has gone to pregnancy research • NICHD, long expected to carry this work, has among the lowest funding success rates across NIH • Early-stage investigators in maternal health face steep barriers to sustaining research careers The authors call for a whole-of-NIH approach, increased investment, and greater involvement of OB/GYN physician-scientists in setting research priorities. At GSD Health Research, this is exactly the work we’re building toward. Closing the women’s health research gap means investing in scalable, inclusive, participant-centered infrastructure and advocating for the policy changes required to support it. 🔗 to open access article: https://lnkd.in/gDCKqhge #womenshealthresearch #maternalhealth #researchfunding #healthpolicy #closethegap #GSDHealthResearch

A high-cost claim drove them to a fully-insured plan. A 40%, unjustified renewal increase brought them back to self-funding. This is the real story of a 230-employee manufacturer that learned the hard way that the perceived "safety" of being fully-insured is often just an escalator of rising costs. When they got news of their rate hike, they knew they needed a new strategy. In partnership with their consultant, they moved back to a smarter self-funded model with ParetoHealth and surrounded themselves with strategic partners like SmithRx, INTERLINK COE Networks & Programs (CancerCARE) and HealthJoy. The results over the next four years were pretty impressive: $1.25 million in savings, with $0 in contribution increases for their employees. This case study is proof that with the right consultant and a multi-year strategy, you can break the cycle, control your costs, and improve the quality of healthcare benefits for your people. #EmployeeBenefits #SelfFunding #CaseStudy #Manufacturing #HealthcareCosts #Benefits #fullyinsured #captive #pareto #paretohealth

I’m excited to share my new article in the Harvard Environmental Law Review: “Obamacare for Homeowners Insurance: Fixing America’s Broken Insurance Markets in a Time of Climate Change.” 👉 https://lnkd.in/gbD7q3Aw Over the last decade, U.S. homeowners insurance markets have entered a period of unprecedented instability. Insurers are withdrawing from states, premiums are skyrocketing, and millions of Americans are left exposed. This isn’t just an insurance problem—it threatens housing markets, financial stability, and our collective climate resilience. So far, state and federal reforms have largely failed. Florida blames litigation. California relies on aggressive rate regulation. Neither approach has solved the deeper issue: climate change is reshaping risk in ways that current insurance markets can’t manage. My article argues that we should look to an unexpected model: the Affordable Care Act. Just as Obamacare stabilized health insurance markets, an “Obamacare for Homeowners Insurance” could stabilize property insurance markets. That means: Federal minimum coverage standards (including major climate risks like floods) Anti-discrimination rules so insurers price fairly and transparently State-run insurance exchanges to encourage competition and consumer choice Progressive subsidies to keep coverage affordable for lower-income households The stakes are enormous. Without reform, instability in homeowners insurance could cascade into a broader housing and financial crisis. With reform, we can harness insurance to promote climate adaptation, reward resilient construction, and protect vulnerable communities. I’d welcome thoughts, critiques, and conversations about this approach.

It’s time to harness the economic power of women’s health. 📈 I’m excited to share my article in Femtech World, highlighting the immense opportunity in women’s health investment—and why the time to act is now. As The WHAM Report shows, the current lack of funding in women’s health research isn’t just a gap—it’s a missed business opportunity. 🔹Lung cancer is the #1 cause of cancer deaths in women (more than breast, ovarian and uterine cancers combined)—yet only 15% of research focuses on women. 🔹2/3 of Alzheimer’s disease patients are women—yet just 12% of research focuses on women. 🔹80% of autoimmune disease patients are women—yet just 7% of research focuses on women. 🔹Heart disease is the #1 killer of women—yet only 4% of research focuses on women. By adding $350M in research investment in just four disease areas, we could generate $14 billion in returns.   Women make up over half the population and workforce, drive 85% of consumer spending, and make more than 80% of healthcare decisions. Yet, research continues to leave them out. This isn’t just about closing a gap—it’s about driving results: ✅ Better health outcomes ✅ Greater economic growth ✅ Stronger returns for investors and society The evidence is clear: Funding women’s health and analyzing sex-based differences is one of the smartest investments we can make. I’m calling on colleagues, leaders, and investors to join WHAM in building a future where research and investment prioritize sex differences. Let’s lead the way. Read the full article here:  https://lnkd.in/ewbqUksX    #WomensHealth #InvestmentinHealth #WomensHealthInvestment #HealthInnovation #WomensHealthResearch #WHAMNow #3Not30

Of all the tragedies to emerge from the wake of devastating fires around #LosAngeles this week, one that is certain is the acceleration of the crisis gripping California's already deeply troubled property #insurance market - see the POLITICO article linked below. Already hanging by a thread with spiking premiums, rampant dropped coverage, and insurance carriers exiting the state, the market for homeowners and business insurance covering #wildfire is on the brink of collapse. With more than 10,000 structures damaged or destroyed and losses expected to exceed $100 billion, even #California's new insurance rules designed to ease market failures may be insufficient. Likely outcomes include large-scale government intervention to patch together a system of coverage, exorbitantly expensive subsidies that cripple public budgets, an even more acute regional #housing crisis, and continuing difficulties with the provision of affordable and accessible insurance coverage, contributing to the #inflation and cost-of-living crisis in general across the state and beyond. In this manner, an already large crisis will increasingly harm homeowners and businesses far from the flames. #climaterisk #climatecrisis #costofliving #climatesolutions #riskmanagement #realestate https://lnkd.in/eY5cZivX

𝐏𝐮𝐫𝐩𝐨𝐬𝐞: 𝐓𝐫𝐚𝐧𝐬𝐟𝐨𝐫𝐦 𝐲𝐨𝐮𝐫 𝐞𝐱𝐩𝐞𝐧𝐬𝐞𝐬 𝐢𝐧𝐭𝐨 𝐚𝐬𝐬𝐞𝐭𝐬 𝐚𝐧𝐝 𝐭𝐫𝐚𝐧𝐬𝐢𝐭𝐢𝐨𝐧 𝐞𝐱𝐩𝐞𝐧𝐬𝐞𝐬 𝐟𝐫𝐨𝐦 𝐭𝐡𝐞 𝐏&𝐋 𝐭𝐨 𝐚𝐧 𝐚𝐬𝐬𝐞𝐭 𝐨𝐧 𝐭𝐡𝐞 𝐁𝐚𝐥𝐚𝐧𝐜𝐞 𝐒𝐡𝐞𝐞𝐭. Why It Matters: Right now, you’re burning money—paying premiums that disappear forever. With a better strategy, you can turn those payments into savings, building a reserve that allows you to stop reaching into your pocket for these bills. Over time, your expenses stabilize, and your unused premiums stay with you, not the insurance company. Self-Funding with a Captive: Switching from a fully insured plan benefits plan to a self-funded model with a captive significantly reduces your financial risk while providing greater flexibility and cost-saving opportunities. Here’s how: Reduced Risk: With a captive, you’re pooling risk with other like-minded organizations, which provides stability and protection against large claims. This setup allows you to avoid the volatility of fully insured premium increases while maintaining coverage for unexpected events. Cost Control: A self-funded plan enables you to create a domestic network tailored for your employees. For example, your own employees could have zero co-pay, no deductible, and no co-insurance when they receive care at your practice or surgery center. This eliminates the current inefficiency of paying full carrier rates when your employees use your own services. Transparency: Unlike fully insured plans, self-funding gives you direct access to your claims data. This means you can identify cost drivers and implement strategies to lower healthcare spend. Long-Term Savings: By retaining unused premiums in the captive, you can build reserves over time. Instead of premiums disappearing into a carrier’s balance sheet, you’re building equity within the captive, which can be used to offset future costs. Property and Cash Flow Optimization Your surgery center and clinic are both incredible assets, and your plans for a new surgery center demonstrate a strong commitment to growth. Here’s how we can help you lower risk and premiums on these properties: Captive for Property Insurance: By pooling your property coverage with other physicians in similar situations, we can negotiate better terms and rates through a captive. This not only reduces premiums but also stabilizes your costs over time by spreading risk across multiple high-quality assets. Unused Premiums Stay in Your Captive: One of the most attractive benefits of a property captive is that any unused premiums remain within the captive. Over the next 3–4 years, depending on claims activity, you could find yourself with little to no out-of-pocket expense for property insurance. Aligned Incentives: Captives reward strong risk management and proactive property maintenance, allowing you to benefit directly from keeping your properties in excellent condition. #healthcare #legacy

❓ Does NIH Need a New Institute for Women's Health ❓   🚨 Breaking News in Women’s Health Research! A new report from The National Academies of Sciences, Engineering, and Medicine calls out The National Institutes of Health of Health (#NIH) for decades of underfunding #WomensHealthResearch and recommends funding a new NIH institute to create meaningful improvements in women’s health and well-being. 🔑 Key Findings: - Despite an increase in NIH’s budget, women’s health research funding fell from 9.7% to 7.9% (2013 to 2023). - There has been inadequate attention to sex-based differences and limited research on conditions that exclusively affect women (#endometriosis, #PCOS), and disproportionality impact women (#lupus, #HeartDisease). - The current Office of Research on Women's Health (ORWH) is underfunded and lacks authority to enforce NIH policies. - The report demands interdisciplinary research efforts and stronger enforcement of policies on sex-based variables in studies. 🚀 Proposed Solutions: 1. Elevate ORWH into a grantmaking institute with $4 billion over 5 years. 2. Create a $11.4 billion Women’s Health Research Fund for innovative and cross-disciplinary studies. 3. Increase accountability and incentives for researchers to include sex differences in studies. 💪 This bold vision has drawn mixed reactions—some question the feasibility of a new institute vs. a more dedicated group in the existing structure. Many are concerned about the incoming administration’s vow to reduce spending and the number of NIH institutes. 💬 “Women’s health research has, for too long, been underfunded and overlooked, and as this report makes clear, there’s still a long way to go.” #WomensHealth #ResearchMatters #EndTheGap #NIH #HealthEquality   https://lnkd.in/gKmbzjhK

We’ve all been there. You need a doctor, so you search online, check if they’re in-network, read reviews, scan star ratings—and hope for the best. Sounds familiar?   The problem? Stars and price tags rarely tell the real story about quality care. They don’t reveal if a patient healed well, returned to daily life faster, or felt truly supported through their recovery.   I was glad to partner with Self-Insurance Institute of America, Julie Mueller, Brooks Goodison, Phil LeFevre and journalist Bruce Shutan for 'The Self-Insurer' to explore how self-insured employers can go deeper in defining and delivering quality care.   Here’s a snapshot of what I shared:   1️⃣ Right Match, Right Metrics – Connect people with the right providers, track what matters, and keep improving.   2️⃣ Beyond the Stars – Pair claims data with actual outcomes, access, and patient experience.   3️⃣ Shared Accountability – Work with providers and other partners to demonstrate both clinical and functional results—and learn + refine when outcomes fall short.   For a broader view on connecting the dots in employee benefits—and how to uncover blind spots, meet unmet needs, and leverage benefit partners, #pooling, and #captives to advance health equity—see our 'Health at Work & People' collaboration ⥋ 🔘 https://lnkd.in/e9YdQv25 - - - 💭 Could these three points make quality care assessments more impactful? What else should be on the list? 📄 Full SIIA article added under comments. #metrics #healthcare #providers #health #quality. #equity #healthequity #employeebenefits #selfinsured