We Don’t Need to Burn Down the House to Fix the Plumbing
Healthcare reform always leads with the promise of transformation, but let’s pause for a second on what that really means. When people talk about “fixing” healthcare, the conversation usually jumps straight to things like care delivery, new technologies, or training doctors with better bedside manners. And while all of that has merit, it’s missing a critical piece: how we actually pay for care in the first place.
Here’s the truth. The biggest gains in healthcare don’t come from flipping the care model on its head. They come from changing what sits underneath it: the funding model. The financial infrastructure determines which services get encouraged, which ones are buried in red tape, and which ones balloon in cost. That’s where the leverage lives. You don’t need to redesign hospitals or retrain half the workforce. You just need to stop rewarding inefficiency and start funding smarter pathways.
If care delivery is the outcome, funding is the input. And when you shift the incentives, the entire ecosystem responds. Costs start making more sense. Outcomes improve without twelve committees trying to fix patient experience. And employers, even mid-market businesses stuck in 10% margin purgatory, finally get the clarity and control they’ve been begging for.
The Real Problem with How We Pay for Healthcare
Let’s break down the fee-for-service model without the jargon. Under this system, hospitals, doctors, and clinics get paid each time they provide a service. That means the system rewards volume over value. More appointments? More money. More tests? More money. More band-aids rather than long-term solutions? Still more money. But better outcomes? Better health? Not necessarily rewarded.
That misalignment drives up costs unnecessarily. It shoves both employers and employees into this weird space where they’re spending more and getting less. What we need is a structure that ties payment to results, not activity. Value-based payment models do exactly this. They focus on results like fewer hospitalizations, improved management of chronic conditions, and better patient satisfaction.
This isn’t wishful thinking. Payment models like Accountable Care Organizations and bundled payment systems are showing real proof. By tying provider compensation to health outcomes, not just procedures, these models take a massive step toward smarter, sustainable healthcare. And they don’t require rebuilding the entire delivery system, just changing how we fund it.
You Get What You Pay For, Literally
The shift to value-based care isn’t just a buzzword tossed around at conferences. We know it works. Several studies show that when providers are paid differently, patient outcomes can improve. One review found that targeted payment reforms increased the rate of appropriate screenings, reduced complications, and cut avoidable hospital readmissions. Not minor wins by any measure.
Think of it this way: when providers have an incentive to prevent problems instead of just treating emergencies, the whole game changes. Preventative care becomes a priority. Communication between clinics and specialists improves. And your employees? They get care that’s timely, coordinated, and focused on results, not just billing codes.
Most importantly, the ripple effect reaches your bottom line. Reduced emergency visits, better chronic condition management, and fewer unnecessary tests lead to real, measurable business results. Less waste, more predictability, and a plan that finally works how it’s supposed to: efficiently and effectively for both the employer and the employee.
How Business Leaders Can Take the First Step
If you’re running a company with 100 to 1,000 employees, you don’t have to wait for the entire healthcare world to overhaul itself. You control your plan design and funding strategy. Start there. The biggest mistake mid-sized employers make is assuming this is someone else’s problem, or that complexity protects the current system from change. It doesn’t.
Begin by evaluating how your existing plan is structured. Are you rewarding efficient, outcome-driven care? Or are you just signing checks for the next generic PPO renewal? Spoiler: those PPOs are not your friend. Then, talk to your brokers or benefits consultants. If they can’t walk you through a value-based payment model or show you where hidden incentives are draining your dollars, it might be time for new partners.
This doesn’t have to be a high-risk leap. In fact, most of our clients start by piloting value-based payment models within a small group or key geography. We measure results, adjust, and scale once we see the outcomes. It’s controlled, data-driven, and designed to keep employees supported without the hand-wringing theatrics of a major overhaul.
This Is Your Leverage Point
You’re not powerless here. When you adjust how care is paid for, not just how it’s delivered, you reclaim control. You get a plan that finally aligns with your goals: predictable spending, strong outcomes, and employees who aren’t bogged down by a confusing, outdated system. It’s not disruption for disruption’s sake. It’s precision-level change where it matters most.
If you want to make that shift, let’s talk. You’ll get a real-world plan that works in the real-world margins you’re operating in. No fluff. No gimmicks. Just a better way to fund care, and the tools to actually run your plan like… well, the rest of your business.
Book a call here and let’s build something better.
Want to stop overpaying for healthcare without flipping your care model upside down?
It’s not your network. It’s not your broker. It’s not your HR team.
It’s the funding model. Change that, and you change everything.
Start here:
Download the Instant EBITDA eBook
to see how optimized funding puts control back in your hands (and dollars back on your balance sheet).
Or if you’re ready to talk real numbers:
Book a call with Allison, no pitches, just data.
Prefer to go deeper first? Explore the books or watch the documentary.
