Improving Healthcare Finance

UnitedHealth’s surprising earnings miss and sharp stock decline have been blamed on rising costs in its Medicare Advantage business. But the real issue isn’t the government’s fixed payments. It’s how those dollars are used. Medicare Advantage may look like a modern payment system: insurers receive a fixed monthly payment per member, per month. But in reality, most insurers still pay doctors and hospitals based on the volume of care delivered, not the value. This creates the same broken incentives we see in traditional fee-for-service medicine: more procedures and more hospitalizations along with grossly insufficient focus on prevention and long-term health. That’s a costly mistake. Poorly managed chronic diseases like diabetes, heart failure and hypertension account for the majority of medical spending. When patients bounce between emergency departments and specialists, complications from chronic conditions (including heart attacks, strokes, cancers and kidney failures) rise dramatically and insurers pay the price. And, increasingly, so do investors. The solution? Capitation AT THE DELIVERY-SYSTEM (PROVIDER) LEVEL. That means doctors and hospitals are paid a fixed, risk-adjusted amount to keep people healthy—not to do more. This kind of payment structure rewards incentivizes prevention, effective chronic disease control and superior clinical outcomes, not just volume. This moment is a wake-up call for insurers like UnitedHealth. It’s time to invest in a better model. That means: ▶️ Multi-year agreements with health systems to pilot new care models ▶️ Risk-adjusted capitation—funding that matches patient needs and rewards healthier outcomes ▶️ Shared savings—dividing the financial gains when population health improves over time ▶️ Investment in generative AI to help patients and doctors manage chronic diseases in real time ▶️ Expansion of primary care to prevent illness rather than just hoping to reverse medical problems when they arise. UnitedHealth’s results are the canary in the coal mine. The status quo won’t hold. The good news? With the right incentives in place, we can save lives, lower costs and reduce clinician burnout. But only if we act now. #HealthcareonLinkedIn #UnitedHealth #UnitedHealthGroup #healthinsurance #medicareadvantage https://lnkd.in/gycAts2x

India spends more on healthcare each year but, the key question persists: are health outcomes improving at the same pace?   After six months of cross-sector collaboration, the report “𝗪𝗵𝗮𝘁 𝗪𝗲 𝗩𝗮𝗹𝘂𝗲 𝗶𝗻 𝗛𝗲𝗮𝗹𝘁𝗵: 𝗔 𝗖𝗼𝗮𝗹𝗶𝘁𝗶𝗼𝗻 𝗩𝗶𝘀𝗶𝗼𝗻 𝗳𝗼𝗿 𝗕𝗲𝘁𝘁𝗲𝗿 𝗖𝗮𝗿𝗲 𝗶𝗻 𝗜𝗻𝗱𝗶𝗮” has been released. It sets out a clear and strategic roadmap to help shift India’s health system from a volume-led approach to one centred on value and outcomes.   I am proud to have contributed to this unique coalition and to have shared perspectives from an insurer’s point of view. Months of structured, constructive dialogue and collaboration have helped reimagine the future roadmap of healthcare in India. With a ringside, three-tiered view of the ecosystem – across my organisation, the insurance sector, and the broader system – I was particularly invested in exploring avenues to strengthen health financing and drive sustainable outcomes.   Congratulations to Leapfrog to Value and its CEO Dr. Balkrishna Korgaonkar for spearheading this important effort and bringing together diverse voices across the healthcare ecosystem.   The coalition’s work identifies core systemic gaps such as fragmented care, limited transparency of outcomes, and financing structures that reward service volume over improved health. It also highlights promising bright spots across the system.   The initiative has resulted in four catalytic proposals: ✅ People’s Commission for Health Improvement – transparent benchmarking to strengthen accountability ✅ Primary Health Care Design Laboratory – prototyping integrated, outcome-focused care models ✅ Business Case for Quality, Safety & Patient Experience – aligning incentives with what truly matters to patients ✅ Coordinated Care Bundles – piloting bundled payments for NCDs and surgeries   The roadmap presents a practical agenda aimed at improving alignment, equity and measurable outcomes. It is an important step toward a more resilient and health-focused future for India.   You can download the strategy here: https://lnkd.in/gErbNiFV Bindu Ananth, Dr. N. Krishna Reddy, Ravi Vishwanath, Sarang Deo, Tejasvi Ravi, Vishnu Vasudev, Rubayat Khan, Dr. Balkrishna Korgaonkar and Chintan Maru.

One of the most exciting—and underutilized—developments in employer-sponsored coverage is the Individual Coverage Health Reimbursement Arrangement (ICHRA). For small businesses facing rising premiums and limited plan choice, ICHRAs offer a lifeline: a way to empower employees with greater plan flexibility while also managing employer costs. I just published a piece in Forbes about how ICHRA can change the game for small business health coverage. It’s time we broaden the conversation. The traditional group health model doesn’t work for most businesses under 50 employees. It’s rigid, opaque, and costly. ICHRAs shift this dynamic, allowing employers to offer defined contributions toward individual market plans—unlocking personalization and market competition. This is especially powerful in ACA marketplaces that are becoming more competitive thanks to plans taking a strong interest, and consistent subsidies from the Federal government. Leaders like Mario Schlosser and Dennis Weaver, MD, MBA at Oscar Health have long championed the potential of a more transparent and tech-enabled individual market. Their innovations—combined with ICHRA—can finally bring affordability and choice to millions of employees historically locked out of meaningful coverage. More policymakers, insurers, and benefits brokers should be leaning in here. We have a window to make the individual market really work—for small business America. Let’s use it. #healthpolicy #ICHRA #smallbusiness #ACA #healthcareinnovation #OscarHealth #insurance https://lnkd.in/eZ3e5Qxk

To everything, churn, churn, churn. Healthcare "churn," the idea that patients frequently change health insurance coverage, is a major roadblock to fixing the system. While thinking in 1-2 year cycles is actuarially sound, it makes little clinical or systemic financial sense. This approach keeps our system tuned to care delays and late-stage, reactionary treatment. As it stands, there is little penalty for denying or delaying treatment in hopes that paying for care eventually becomes someone else's problem. The ultimate goal is for that "someone else" to become Medicare (i.e., taxpayers). Pre-existing and chronic conditions lie on opposite sides of the same coin. We hold payers accountable for the former but less so for the latter. Utilization management, HDHPs that create a swath of the functionally uninsured, and an aversion to longitudinal thinking lead to worse outcomes and paradoxically higher costs. Hoping that someone else pays that cost is a zero sum game that hurts everyone. We're all "someone else." Churned patients don't magically disappear from the system, they become less healthy and more costly. Annual turnover for commercial insurance hovers around 22% while the average commercial insurance beneficiary stays with their plan for less than two years. Churn makes our health system allergic to innovation: if no one owns the lifetime, no one funds the breakthrough. Few want to pay for a product or service whose impact will be measured in life decades, not fiscal quarters. Meanwhile, "sticky" interventions have a much greater chance of achieving meaningful clinical and fiscal impact. How do we solve the churn problem? ▪️ Mandate coverage of early detection and intervention care services. The Women's Health and Cancer Rights Act of 1998 proved that guaranteeing access to full service, longitudinal treatment is effective. ▪️ Create safe harbors and new benefits classes for comprehensive health assessments with appropriate guardrails and evidence thresholds. ▪️ Leverage technology to enable focused risk assessments and personalized early detection and intervention protocols. Healthcare consumers (i.e., patients) are already going outside the traditional system to seek out these solutions on their own. The result is further care fragmentation, out-of-pocket costs layered on top of high deductibles, and a scattershot approach to evidence generation and long term outcomes tracking. Until we solve churn, we’ll keep paying for disease at its most expensive point. Fix churn, and we finally start paying for health.

A consultant asked me to write down "how a customer-first health insurance company would operate?" Here's my limited perspective, based on observation and interaction with customers over decades👇 1. Start with clarity. Every company should publish an open document that explains every complicated word and condition in simple language. No fine print. No room for interpretation. They should also list real-life scenarios and clearly show how each will be treated. No surprises at the time of claim. 2. Every policy should come with a short, personalized video explaining what’s covered, what’s not, and what to remember. 3. Only certified, trained people should be allowed to sell policies. They must pass an exam, follow a code of conduct, and face strict action if they don’t. 4. Health insurance should come with an option for a thorough medical check-up. If you take it, the company should guarantee your claim won’t be rejected for non-disclosure. Charge for the test if you want. 5. The proposal form should be Doctor AI voice led, to capture nuances, intricate details in the medical history. Make it easy for customers to be honest. 6. Pricing should be fully transparent. Customers should know how premiums are calculated, why they increase, and what to expect in the future. There should be clear guidance for senior citizens, with flexible and empathetic options to manage payments. 7. Proactive, preventive healthcare to ensure hospitalizations are avoided, creating a win-win situation for everyone - from customer to the insurer. 8. The company should be clear, open and social-media-first.Every question, complaint, or doubt deserves a human, clear response, not a template reply. 9. The claims process should be simple, transparent, and fair. Customers should know what is happening and what to expect at every step. 10. Grievances should not be hidden behind process. Every complaint must be answered, tracked, and used to fix the root problem. 11. The grievance team should fight for the customer, not the company. There should be an independent customer advocacy board or ombudsman inside the company, someone who can call out unfair treatment. 12. Once a year, the company should publish a public report showing claims, grievances, and how they were resolved. Let data, build credibility. Leaders should be accountable not just for profit, but for customer outcomes. Because in insurance, trust is the real product. An insurer built like this won’t need advertising. An insurer built like this won’t need to pay fat commissions. People will stay not out of compulsion, but because they feel safe.

WHO issues guidance to address drastic #globalhealth financing cuts The World Health Organization today released new guidance for countries on ways to counter the immediate and long-term effects of sudden and severe cuts to external funding which are disrupting the delivery of essential #health services in many countries The guidance “Responding to the health financing emergency: immediate measures and longer-term shifts” provides a suite of #policy options for countries to cope with the sudden financing shocks and bolster efforts to mobilize and implement sufficient and #sustainable financing for national health systems External health aid is projected to drop by 30% to 40% in 2025 compared with 2023, causing immediate and severe #disruption to health services in low- and middle-income countries #LMICs. WHO survey data from 108 LMICs collected in March 2025 indicate that funding cuts have reduced critical services including #maternal care, #vaccination, health #emergency preparedness and response, and disease #surveillance by up to 70% in some countries. More than 50 countries have reported #job #losses among health and #care workers, along with major disruptions to health worker #training programmes “Sudden and unplanned cuts to aid have hit many countries hard, costing lives and jeopardizing hard-won health gains,” said Tedros Adhanom Ghebreyesus, WHO DG. “But in the crisis lies an opportunity for countries to transition away from aid dependency towards sustainable self-reliance, based on domestic resources. WHO’s guidance will help countries to better mobilize, allocate, prioritize and use funds to support the delivery of health services that protect the most vulnerable” This year’s funding cuts have compounded years of persistent health financing challenges for countries, including rising #debt burdens, #inflation, economic uncertainty, high out-of-pocket spending, systemic budget underfunding and heavy reliance on external aid WHO’s guidance urges policy-makers to make health a #political and #fiscal priority in #government budgets even during times of #crisis, seeing health spending as not merely a cost to be contained, but an investment in #social #stability, human #dignity and #economic #resilience The guidance emphasizes the need for countries to cushion the immediate impact of reductions in foreign assistance for health and to adapt to a new era of reduced assistance Key policy recommendations include: prioritize the health services accessed by the #poorest protect health #budgets and essential health #services improve #efficiency through better procurement, reduced overheads and strategic purchasing integrate externally-funded or #disease-specific services into comprehensive #PHC-based delivery models use health #technology assessments to prioritize services and products that have the greatest health impact per $ spent https://lnkd.in/enwmhgwg

Over the past 15 months, I have had the privilege of working with an exceptional group of professionals and researchers across the UK and the US on policy recommendations for sustainable health research. This work has culminated in the Academy of Medical Sciences and National Academy of Medicine report: For People, For Planet: Improving the Environmental Sustainability of Health Research Here are some reflections on why this matters, what we found, and what we can do going forward.   Why sustainable health research matters: Health research is vital, but it also has an environmental footprint – from energy use in laboratories, water consumption, plastic waste, travel, large-scale clinical trials, data storage and computational demands. As climate change becomes ever more pressing, we need research that is sustainable for both people and planet.   What we discovered 1. Data and metrics: We need standardised tools and methodologies to measure the environmental impact of health research, beyond carbon emissions alone. 2. Funding: Funders can accelerate sustainable practices by setting environmental requirements, offering incentives, and investing in capacity building. 3. Regulation: Regulatory frameworks must evolve to embed sustainability while supporting innovation and ensuring fairness for both large and small institutions. 4. Procurement and supply chain: Sustainable procurement policies and greater transparency from suppliers are critical to reducing research’s environmental footprint. 5. Infrastructure: Long-term investment in sustainable buildings, energy systems, and digital infrastructure is essential to reduce environmental impact. 6. Capacity building: Researchers and organisations need training, resources, and support across all career stages to embed sustainability into health research. What we can do next: 1. Adopt and refine shared metrics, tools and methodologies for all research activities – including digital and AI-driven methods – to ensure transparent, comparable reporting. 2. Embed sustainability requirements incrementally in funding, regulatory and publication processes, pairing them with accessible guidance and financial support. 3. Invest in people and infrastructure, prioritising training, accreditation schemes and green facilities that can be scaled up across diverse research settings. 4. Foster international collaboration and data sharing, recognising that climate change knows no borders and that solutions developed in one context can benefit many. If you are interested in this space, whether as a researcher, funder, policy maker, or practitioner you can read the report here: https://lnkd.in/eqshC2an And summary here: https://lnkd.in/e6ayB92r

Singapore’s Medical Insurance Problem Is Not Cost. It Is Incentives. Premiums rise. Claims escalate. Benefits tighten. It looks like a cost problem. It is actually an incentive problem. Our current insurance structure rewards utilisation, not value. From clinical training, public health systems research, and business strategy work, I have seen one truth repeat across countries: human behavior follows incentives more consistently than clinical guidelines. Three forces drive over utilisation: 1. Moral hazard When individuals do not feel cost, the internal question shifts from “Do I need this?” to “Why not?” 2. Fee for service rewards activity The system pays based on volume. If we reward quantity, we get quantity. If we want value, we must reward value. 3. Information imbalance Patients often lack the context to judge necessity. In uncertainty, the default becomes “do more.” These forces increase utilisation without improving health outcomes. What will actually fix the problem? We redesign incentives. A. Value Based Insurance Design Lower barriers for high value care. Shared accountability for low value care. B. Bundled or episode based payments One price for the entire episode of care. Providers focus on outcomes, not procedures. C. Predictive analytics and prevention Use data to identify risk early. Prevent expensive hospitalisation instead of reacting to it. D. Primary care as the coordinator Right care, right level, right time. The mindset shift The goal of insurance is not to maximise claims. The goal is to maximise health. When incentives change, behavior changes. Patients make grounded decisions. Providers prioritise outcomes over activity. Insurers shift from bill paying to health investing. For those who want to shape health financing and policy If you want to learn how to: • Analyse insurance and financing models • Evaluate cost effectiveness • Influence health policy Consider the Master of Health Economics, Management and Policy at Newcastle Australia Institute of Higher Education in Singapore. Healthcare needs leaders who think deeply, analyse clearly, and design systems that work. https://lnkd.in/gRYTNp8x

Attention self-insured employers and commercial insurers. Times are changing and you need to keep up with the science and what's true in practice. Lifestyle Medicine is real and can create real change. For every employee who reverses their diabetes, rids themselves of nagging headaches, stomach problems and anxiety there is a benefit to the company. Lower claims and a more engaged employee. Make sure your network includes clinicians certified by the American College of Lifestyle Medicine. If you're large enough, you might even bring a clinician onsite or contract to create a Direct Primary Care model. If you want to improve the chances of lasting change, you'll need to address your workplace as well. It's much easier to make lasting behavior change when working in a supportive environment, both from the physical surroundings as well as the leadership and co-workers. If you're not sure where to start, you might turn to Blue Zones. #CHRO #LifestyleMedicine #HumanResources

Did you know that energy-intensive, poorly matched, and under-maintained medical devices are contributing to poor health outcomes and increasing operational strain in healthcare facilities in developing countries? A new report by Sustainable Energy for All (SEforALL) and CLASP highlights the urgent need to improve the performance, procurement and deployment of medical appliances in #healthcare facilities operating in weak- and off-grid settings. I am drawn to the report's practical solutions, such as integrating #energyefficiency into procurement policies, establishing minimum energy performance standards, and investing in local innovation. I echo the report's rallying call that 'effective healthcare in developing countries requires more than electricity; it demands the right equipment, designed and supported to work where it’s most needed.' Find out more in this story by ESI Africa: https://lnkd.in/d2mmAwGp You can also download the report here: https://lnkd.in/dHgZx6Pg