Illuminating Healthcare Benefits Blind Spots

Why do savvy business leaders treat healthcare spending as a black box? Despite often being the second-largest expense for most organizations, healthcare benefits frequently escape the rigorous fiduciary oversight applied to every other department.

Healthcare Rebel Alliance Founder Ann Lewandowski discussed this problem and potential solutions in a recent episode of Moving to Value Unscripted. To transition from a passive payer to an active purchaser, Ann says, plan sponsors must take steps to eliminate the blind spots that can drive up costs and diminish care quality.

Step 1: Trust, but Verify

In most sectors, trust is earned through performance and verified through data. In healthcare, however, plan sponsors have historically operated on blind faith, relying on advisors and brokers whose incentives are often not aligned with the organization's financial health. When an advisor prioritizes hidden rebates and administrative spread over member outcomes, it’s a betrayal of fiduciary duty. Reclaiming control begins with a model of trust, but verify.

Step 2: Use the CAA

The legal landscape has shifted. The Consolidated Appropriations Act (CAA) is a powerful tool for transparency, providing legal leverage to demand full fee disclosure from Pharmacy Benefit Managers and Third-Party Administrators. Fiduciary duty is not a box to be checked once a year during renewal, but a consistent, documented process. Use the CAA to pull back the curtain on hidden fees and misaligned incentives.

Step 3: Prioritize Patient Experience

When a system is entrenched to the point of patients feeling dismissed, downstream costs like delayed care, emergency visits and poor adherence are borne by the employer, and years of delayed care may lead to excessive utilization when it's perceived as free. High-deductible plans can incentivize members to avoid care until a crisis occurs. Prioritizing patient experience and removing barriers to high-value care addresses the human cost of the blind spot and can decrease long-term financial risk.

Step 4: Choose Clinical Autonomy

Move toward models like Direct Primary Care that prioritize the doctor-patient relationship over billing codes. When physicians have the time and intuition to understand each patient’s unique health needs, they can save lives and reduce unnecessary spending. Supporting these models ensures that healthcare spending goes toward clinical outcomes, not administrative arbitrage.

The Mandate for Change

The emperor has no clothes moment for traditional healthcare brokerage has arrived. For those willing to look directly into the blind spots and follow these steps, the opportunity to build a more equitable, transparent and effective healthcare ecosystem is within reach. Stop being a passive payer and start being an active purchaser. Employers have the power.

Listen to our full conversation with Ann to learn more.

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