Change is part of running a business. The hard part is balancing what could go wrong with what could go right. If you only scan for landmines, you freeze progress. If you ignore risk, you light a match in a dry field. Real leadership is seeing both, then acting on the full picture.
I see this every week in health benefits and cost strategy. CEOs, CFOs, and HR leaders want better results without chaos. That is possible, but only if you weigh risk and reward with the same discipline you use for pricing, safety, and operations.
Understanding the Dynamics of Risk and Reward
Stop choosing sides, start choosing outcomes
Risk in change is the chance of an adverse result. In benefits, that might be member confusion, a bumpy vendor transition, compliance exposure, or a missed service level. Reward is the upside you get for doing the work. Lower trend, steadier renewals, better access to care, stronger retention, and a healthier P&L.
Problems show up when leaders pick a side. The all risk view treats every change like a lawsuit waiting to happen. The all reward view chases shiny solutions and forgets the day two reality. Both miss the point. Your job is to advance the strategy, not win an argument.
Balanced decisions tie risk and reward to a clear business goal. If your margin is in the single digits, every point of trend matters. The right change may bring short term friction, yet protect EBITDA for years. That trade is not reckless. It is responsible, when you quantify it and set guardrails.
Strategies for Balanced Decision-Making
A practical way to weigh both sides
Start with a comprehensive risk scan that is specific, not theatrical. Identify operational impacts, regulatory obligations, stakeholder pushback, and the cost of inaction. In parallel, model the reward as cash, quality, and control. Use real claims data, service metrics, and timelines, not vendor promises.
Run scenarios. What happens if adoption is slow, or if the incumbent resists, or if a clinical program underperforms. Define the thresholds that trigger a pause, an adjustment, or a rollback. Decide who owns which decision and when. Document the path, then communicate it in plain language.
Pilot when you can. For example, a distributor replaced a spread priced PBM with a pass through contract in one division first. They set a training calendar, put a clinical pharmacist on prior authorizations, and measured approvals, member feedback, and net cost by drug and site of care. The pilot met targets, the rollout followed, and noise stayed low.
Real-World Application and Conclusion
What balanced change looks like in the field
A mid sized manufacturer we advised had 700 employees and a pharmacy trend that jumped 22 percent in a year. We reworked the contract, moved infusion to the right site of care when appropriate, and added a simple member outreach program before renewals. In twelve months, pharmacy net cost fell 17 percent, member satisfaction rose, and the CFO saw the change flow through to EBITDA. None of that required a hero move. It required a balanced one.
Here is the truth. If you look at change like a lawyer, all risk, you will miss the upside that funds your future. If you only chase the reward, you invite problems you could have prevented. The leaders who win build a clear risk plan, a credible reward model, and then decide. That is how you protect the business and take care of your people.
If you want a simple way to evaluate your options, book a conversation with me at https://calendly.com/acdepaoli/chat-with-allison/. If you prefer to dig in first, download the Instant EBITDA guide at https://go.altiqe.com/instant-ebitda, or explore the books at https://go.altiqe.com/books.
Leadership isn’t about eliminating risk—it’s about mastering it. If you’re only seeing what could go wrong, you’re missing what could go right. That mindset limits growth—and leaves opportunity on the table.
Want the frameworks that help CEOs and CFOs weigh both sides smartly—and act strategically?
- Download the Instant EBITDA eBook — Discover how small benefit changes can drive major financial impact without disruption.
- Browse our Book Collection — Real examples. Real results. Clear guidance for confident decision-making.
- Book a Strategy Call with Allison — No sales pitch. Just sharp questions, candid insight, and clarity on your best next step.
The risk you’re avoiding might be the result you’ve been chasing. Let’s find out.
