Episode 17: Bending the Healthcare Cost Trend with Matt Harmon

Join us for another episode of Bending the Trend hosted by Norm Volsky, where we sit down with Matt Harmon, Benefits Consultant at Higginbotham, to discuss practical strategies employers can use to control rising healthcare costs while improving employee outcomes.

In this episode, Matt shares how organizations can move beyond traditional cost shifting and instead focus on preventative care, employee engagement, and targeted healthcare solutions that create long-term value. From pharmacy savings strategies and benefits engagement platforms to high-touch care models and behavioral economics, this conversation explores the tools helping employers make smarter healthcare decisions without sacrificing quality.

The discussion also highlights why employee engagement is one of the most overlooked drivers of healthcare ROI. Matt explains how digital health solutions, preventative interventions, and personalized benefits strategies can help employers reduce unnecessary spending while creating a better healthcare experience for their workforce.

"Managing healthcare costs requires more than simply shifting expenses to employees."

Matt shares some of the strategies employers are using to bend the healthcare cost trend today:

• Green Circle Life
• HealthTrust Performance Group
• Hinge Health
• Lantern
• Virta Health
• Benefits Engagement Platforms
• Pharmacy Cost Reduction Strategies
• Preventative Care Programs
• High Touch Healthcare Solutions
• Digital Health Solutions
  
  

Matt Harmon is a Benefits Consultant at Higginbotham, where he helps employers design innovative healthcare strategies focused on improving employee outcomes, increasing engagement, and controlling long-term healthcare costs.

📉 Healthcare Cost Management: Why sustainable savings require more than cost shifting
📱 Employee Engagement: How benefits platforms help employees make better healthcare decisions
💊 Pharmacy Savings: One of the biggest opportunities to reduce employer healthcare spend
🎯 High Touch Care: Why targeted solutions improve outcomes for employees with complex conditions
🚀 Smarter Benefits Strategy: How digital health and preventative care are reshaping employer healthcare

Like, comment, and subscribe for more conversations on bending the healthcare cost trend through smarter benefits and better employee experiences!

Transcript

SPEAKER_00 0:00

We have to find real solutions, and this is bending the trend. Hello, welcome back to bending the trend with your host Norm Volski. And today we are thrilled to be joined by Matt Harman. Matt, welcome to the pod.

SPEAKER_01 0:15

Great to be in the pod. And as I can see, bending the trend is not a spectator sport.

SPEAKER_00 0:20

No, it isn't, and we're fighting rising healthcare costs together. So I know you have, you know, many people are fighting on the same team as us. So appreciate all you've done and all you do within the employee benefits world. And for all of our viewers and listeners that aren't as familiar with Matt, Matt is currently a benefits consultant at Higginbotham, who previously served employees at some of the nation's largest retailers and benefits providers throughout his career. Matt has helped organizations navigate employee benefit strategy, healthcare costs, and innovative programs designed to improve outcomes for both employers and employees. So, Matt, really excited to have you and talk all things, you know, bending the trend. So uh appreciate you joining.

SPEAKER_01 1:07

Absolutely glad to be here, Norm. It's my favorite topic.

SPEAKER_00 1:10

I love it. I love it. Me too, as you can tell. So we'll cut right to the chase. You've worked with a variety of employers and benefits organizations. Looking back on those experiences, what are some of the most innovative programs you've seen used to help bend the healthcare cost trend?

SPEAKER_01 1:27

Yeah, so there's two things. One, obviously, uh there is no silver bullet, but there are silver BBs. And I like to say that because it does take the village to get the trend bent. It didn't get, you know, skewed overnight and it won't be resolved. So I'm going to give you four categorical things that I think are the best of the best when it comes to saving trend. Number one, I implemented a company called Green Circle Life that was an engagement platform. And that was something I did with a give without an ask. And what does that mean? That means don't ask your management team for money, recycle what you've got that isn't working, and put in something that is. So the adage here is you can't engage someone in a great program you're offering them if they don't use it. And in the words of Metallica, nothing else matters. Okay. So you have to get the people to be in it to win it. So to be able to offer that program absolutely turbocharged access for everybody, not just full-timers, part-timers, spouses, family members, because betting the trend is a family exercise too, guys. It is. Let's make no mistake, a lot of times spouses are the most expensive on the plan. And if we can't reach those spouses, then we're not going to bend the trend. So putting in a platform that literally gets inserted into someone's life where they're making those healthcare decisions is paramount. So I'd advise our viewers out there, our practitioners, make sure that you're getting your people connected to it. Because if you have the best mouse trap that nobody's using, you're not going to capture the mouse. Okay. Yep. Then let's get into some other areas, Norm, that are a little bit more in your face, like medical, okay? Yeah. Medical trend has been running hot. Okay. That's not new. There's been cycles of that in the past. Make sure that the program that you have, that you're negotiating stiff trend guarantees.

unknown 3:23

Okay?

SPEAKER_01 3:24

That it is integrated so that your people aren't getting lost along the way. That is worth $20 to $30 million at scale if you're doing it properly. And it lowers lowers the volatility risk that you have as an employer and as the employee. As an employer, you don't want to have this spike every year. As an employee, you don't want to have premiums go up every year. And as an employer, you don't want your employees to go, I'm going to go somewhere else where premiums aren't going up. So this is kind of the top of the stack. Then let's move to pharmacy, right? Pharmacy used to be 20% of the cost. Now in some cases, it might be up to 50% of the cost. So Health Trust Performance Group is the largest group purchasing organization in the world, single sourced, started out of hospitals. And to be able to put that in is something that got our employees either negative trend or flat costs and the ability to go anywhere they wanted to get those drugs, which was a great thing when everybody else was struggling with compounds and now GLP1s and cell in gene therapies. So think about five to seven years of no trend or negative trend.

SPEAKER_00 4:35

Incredible. And I want to throw this out there on uh LinkedIn today. Mark Cuban posted that if someone does an audit on their health plan and their PBM contract, and in that audit they don't find savings, he's willing to pay for the audit himself.

SPEAKER_01 4:52

I totally agree. And that's what Health Trust Performance Group does. They have Milliman, which is the end all be all of actuaries, offering it, and they always find something, Norm. So Mark's right. They always find something, and it's usually very large. And at scale, when you find something and you're in a large group of almost 400 customers, they're gonna pay up when you find that significant item. But I think there's something even more important about it is it's a hundred percent of the rebates are coming back, not a hundred percent of 50%, 100% directly from the aggregator. But the most important piece is they are incentivized by total savings, not total spend. There's a perverse incentive for all providers to sell more, to make more, whereas Health Trust Performance Group actually makes more if you spend less. So that is what I call alignment of the win. And so that is why it delivers time and time again. No additional costs, no adders, all services are included. So when you're out there looking for that, make sure you're finding somebody that not just promises success, but delivers it time and time again in a sustainable way.

SPEAKER_00 6:00

I love that pricing model. Like vendor wins when you know their customer wins.

SPEAKER_01 6:06

It's almost like Fisher Investment says we win when our customers win. And that edge is very true because it aligns those incentives. And let's be honest, in healthcare, incentives have been misaligned for years and years. And then that's what we as trend vendors have to go do to beat the trend is we have to disconnect those perverse incentives and put in the right ones. All right, so engagement, number one, can't go anywhere if you don't get engagement. Medical, you know, 70, 80% of the cost, pharmacy being the ballots. So those are super important areas. But then let's talk about things like high-touch areas that just don't get explored by the carriers. Yep. Let's talk about point solutions. What in America is everybody's top five conditions, Norm? Everybody knows what they are. They're cardiovascular, they're musculoskeletal, they're surgeries. And when you start to look at how much these high-cost services are, you don't want to take away those services. Those are valuable services for your employees, but they're often unattainable because there are barriers of cost that don't enable them to partake in those services. So categorically, you need an MSK provider who is going to be somebody your employees talk about and say, isn't it great that they offer us this product at no cost? And I have my own counselor who's taking care of me. I don't have to go to the doctor, I don't have to just work. Yep. And I don't, I don't have to get surgery because guess what? People don't want surgery. But they didn't know that there was an alternative.

SPEAKER_00 7:39

Our friend Dan Perez taught me that one.

SPEAKER_01 7:42

100%. And Dan knows what he's talking about because he's got the science that works.

SPEAKER_00 7:47

And so when you think of it-I've been known to the science for a dozen years since I've known him. The second I met him, I'm like, this guy knows more about MSK than anyone on earth.

SPEAKER_01 7:56

So so let's talk about that. So you have lantern care surgery plus, if you think about Virgo, what they're doing in weight loss and diabetes reversal.

SPEAKER_00 8:06

Look at what we've had him on, you know, I mean, I gotta tell you, it's possible if you unpack the secret sauce that each of those providers has, it's high touch with the employee.

SPEAKER_01 8:17

The employees have zero barrier to go engage in that. Often they're getting concierge-level service to navigate this healthcare system that we all know they can't navigate, right? Yep. Nor do they want to. And then they're getting the results, and then they're telling their co-workers, their family members, and on the cost side, you're seeing 50% of the spend that you would have seen. 50 cents on the dollar norm. Where else can you get that kind of discount? If you got that kind of discount norm, I want to know. That's right. So think about those solutions of attacking those top conditions, yeah, because everybody in America has that, whether it's with the employee or the spouse, just how your demographics are shifted, slightly shifts the ball to the left or to the right. Then when you talk about things like how do we reach the end all be-all of future proofing against healthcare costs? So what are the things that are going up in cost? Procedures, special treatments, infusions. How about infusions, Norm? Infusions are very small things that are done on site at a huge markup. A huge markup.

SPEAKER_00 9:32

Infusion and imaging are the two easiest like carve outs where it's like, hey, go to a provider that does this at a cost-contained basis, and you get massive savings.

SPEAKER_01 9:44

And to the employee, you're getting the same or better service. Actually, it's easier because if you're going to an imaging center, you're not waiting in line in a hospital and spending your entire day. You're in and you're out. It's the same machines, the same text, but the only thing that's different the cost.

SPEAKER_00 10:02

Well, it's more convenient and like less weight costs than an infusion. Some of these newer uh you know companies that are bubbling up in the point solution space, they'll do the infusions in your home.

SPEAKER_01 10:14

At your home. Where else can you be more comfortable? I mean, you could be bending trend while you're watching bending the trend.

SPEAKER_00 10:21

That's right.

SPEAKER_01 10:22

So think about this, Norms. If you are a practitioner and you have a responsibility to your employees and to your company, you got to think about these big buckets of how do I have countermeasures that defend against them? Because those things are coming and they're coming fast. And I have to say this, I say it every time. The biggest enemy of bending the trend is doing nothing.

SPEAKER_00 10:48

Yes.

SPEAKER_01 10:48

You're getting further and further behind each time you might get analysis, paralysis, and not be able to take action. Yes, some things will work perfectly, or you might need what I call a minimum viable product. Let's say that saves you 75% of the total pie. Great. That's 75% more than you were saving. And then the next year you can iterate and iterate. If you wait, you're literally lighting money on fire every single day that you're not taking action and getting further and further behind. And the problem with that isn't just systemic to the employer, it's that wide range of premiums you might have to hit the employees with in year three because it has built up to the point where inflation is so high the employer can no longer afford the cost share percentage and they try and pass it along. Well, I don't know if you've seen inflation these days. Employees don't have it in their pocketbooks to spend more on healthcare. And if they have to spend more, they just won't.

SPEAKER_00 11:47

The employees and the benefits departments don't have any more money either. So, like, we're finally seeing, all right, like we have to change how we've been operating because status quo and the current trend is not going to be sustainable. A couple years more of this, it's gonna break.

SPEAKER_01 12:05

No, I mean, data carby, you know, not no data wouldn't be proven at this juncture. If you're not doing something, you're doing yourself a disservice. So if anybody takes anything away from this, do your homework, do your diligence, look at these areas. And yes, it's a lot of work, but it's a lot less work than having to unpack millions of dollars of lost opportunity that you could have provided for your folks up front and been a hero versus not do anything, and then on the back end, your employees go somewhere else because they can, because somebody else is doing what they need to do to take care of that trend.

SPEAKER_00 12:43

Totally. Love it. So, what was the impact of implementing Green Circle, Verda, Hinge? You mentioned Lantern. Walk me through like, all right, you implemented it, like what were the results and why they're the ones that you're recommending over everything else you've seen and looked at.

SPEAKER_01 13:02

Yes. So Green Circle did an actual Aeon study that showed a 10% savings for anybody that used a platform. Wow. So there's so many things you can dial in, participation. There was maybe 3 million hits a year and growing it every year. It went up. It increased and increased and increased. Not just how many people were using it, but how frequently they were using it. Because we all know healthcare happens every day, not once a year when people are selecting their programs. Yep. And so that high-touch, concentrated ability to talk directly to the employee about things that were relevant drove them to action. It included family members, four family members. So the whole family had an account and was able to use those tools, right? And then if there was something relevant for the next best dollar someone could spend, it was being recommended and served up in an easy click the button single sign-on sort of way, because people get derailed very easily in healthcare. And if you don't keep them on the rails and the tracks, then they're not going to be able to sustainably continue to do that. And I liken it to teach them to fish, show them where to go, teach them to fish. And guess what? If you continuously saved money or you continuously got a bag of $50 bills somewhere, would you not go back? I know I would. So at the end of the day, Nort, it's it is this behavior change. We've all talked about behavioral economics. Yep. But people will learn if it values them personally, they're gonna go back. So it's so simple yet so hard.

SPEAKER_00 14:42

Yep. A key to you know business is like how can you help others achieve what they want to achieve? And if you're able to do that, then you'll have a very successful business. If you're worried about your own interests, you have a very flawed business model. I love that. We ask everyone who comes on this podcast, what doesn't exist in employee benefits that you wish did.

SPEAKER_01 15:07

Yeah, so this will be no surprise. But what doesn't really exist, but I think technology is getting us really close to having the ability to do this, is intercepting bad healthcare decisions before they happen. I'm not talking about once or twice. I'm talking about somebody who's sitting on your shoulder here that goes, You sure you want to go to that hospital diagnostic center for that $10,000 stand that is available for $2,000 tomorrow at the imaging center? And oh, by the way, you have to wait two months to get into this one over here. So I'm not telling you go here, not there. I'm telling you, this is a better path for you and your family, both from a convenience standpoint, from an outcome standpoint, from a financial standpoint. Having that good person sitting on your shoulder, giving you good advice, is something that almost every American needs, but we just don't have. However, with AI being what it is, with data and information being what it is, and what digital health has blossomed to in the last decade, this is where we sit in the need to go solve this problem, not just for ourselves, but for everybody. This is the solution for all. So that is the one area because when you get people to people, you usually work. However, it's very costly to do that, and that limits people's desire or ability to go all in and invest. Some will, some won't. However, if you were able to do it cost effectively for everybody, who wouldn't want to direct their employees to the best decision? So that is by and large the one area of healthcare that is the channel that we all need to start to drive the funnel towards, which is nobody has any more money to pay more, nobody has any money to be less efficient, nobody has money for fraud, waste, and abuse. Everybody needs efficiency and steerage to the most efficient, highest quality care. And that's you know, like a lantern, 50 cents on the dollar for surgeries. And guess what? You may not need that surgery. And so if you're having 50% less surgeries, and then when you do need surgery, it's 50 cents on the dollar, you've now created a combination that is winning. Then let's take even more combinations, Norm. What if you had a hinge who says, I'm gonna help you maybe avoid surgery because you might not need it? Great. So if you go through that and you don't need surgery, kumbaya, you've spent nothing and you're healthy. You're doing things you used to do 10 years ago, and you thought without surgery you couldn't do. However, if you do need surgery, you're one of those few people who just need it, then you go over and get it done at the most efficient place possible with the highest quality surgeons out there. You spend nothing out of pocket. Who loses in that equation?

SPEAKER_00 18:07

Well, I could tell you who loses, but I don't think we all consider way more for that surgery for an arbitrary reason. So I really, really appreciate that. And I think where a lot of people miss, you know, that don't come from our industry, that, you know, just need education is that people my age, you know, people in their 30s are projected to spend over half their income on healthcare between themselves, their families, taxes, you know, Medicare, like all out, like half of your working life will be spent on healthcare, which is like just crazy and sickening. And when you go through your employer-sponsored health plan and you make smart decisions and you get the best quality, but also at an efficient price, that's money they can put back into you and your coworkers' pockets. Like that's how they are able to lower deductibles, lower premiums, you know, give their employees more money on base salaries and hourly, and you name it, because essentially healthcare is a payroll deduction. So if you're having your company spend more on healthcare, it's less money they can pay you and your you know fellow employees. And I think what also gets missed, and like I think we want to like really change the narrative, is hospitals make more money when you're sick. Health plans make more money when you're sick. Pharmacy companies, PBMs, big pharma, they make more money when you're sick. Want to know who makes less money when you're sick? Employers. So they're the only ones who are actually incentivized to keep you healthy. So when they're offering you programs, they are betting for quality first and cost second, because otherwise they're going to be paying for more later if we're not preventing avoidable diseases, conditions, you name it. And I think that is the most misunderstood thing in the entire healthcare system that I want every person who doesn't know to start thinking that way.

SPEAKER_01 20:10

100%, Norman. You want to know why that happened? I'm a little bit older than you, Norm. So let me give you the history on this one. For years and years, employers pushed cost share to employees. And employees said, What are you doing to me? They got classically conditioned to go, oh, the employer's doing something. What is that? They're inseting, they're trying to take something away from me. So that has been a stigma that we have to get rid of because I do believe that has shifted long ago. However, people still have that in their brain that wait a second, why are you doing that? Not just what are you doing, but why are you doing that? And is it for you or is it for me? And so I think one of the things we are incumbent in solving this healthcare cost problem is helping people understand we are in this together. You have to participate, and pulling yourself out of the equation is only hurting yourself. If you are a large claimant that's not getting help with your critical condition, not only is it affecting your quality of life, your ability to recover and things of that nature, it's affecting your long-term pocketbook, your ability to work for the long term. All of these things are kind of in that same bucket. So we have to help people understand yes, you need to participate in these programs. And guess what? If there's something you don't like, provide your feedback and people will make it better for you. But if you just walk away from it, no one's going to be able to make it better. And trust me, there are hundreds of practitioners out there spending their entire day trying to help their employees. So I would encourage everybody, just take a look. What's the harm? If it doesn't work out and you only say $500, I mean, that's just terrible. Right?

SPEAKER_00 21:56

It's it's so true. And uh ultimately the employers and the employees of these organizations are floating the entire healthcare system. If you look at the data, employers spend 262% on average of what Medicare pays for the exact same clinical services. You, one way or the other, as a working American, are floating the entire healthcare system. You're getting ripped off, your employer's getting ripped off, and we at bending the trend are trying to make people aware that this is going on so that people can actually do something about it.

SPEAKER_01 22:31

So hey, Norm, Norm, let me tell you. So let's talk about that for a second. So what it'll health takes something out of the equation that's exactly what you were just talking about. If you've ever seen a map of the United States and the RAND uh study that shows what percentage of Medicare you're paying by state based on the healthcare in your state, some states are 400% of Medicare, others are 290. You can average it out however you want. The equation here is if you're a multi-state employer, you're gonna have variances just based on demographics. However, if you have the ability to put that into a digital solution, that digital solution doesn't see those barriers, right? Correct. So that should be that should be your first option. Then if you need to go somewhere, you need that pre-negotiated, you know, one imaging maybe, where you're gonna get that same price, same place, same thing, versus paying 400% of Medicare. Those are the types of things that should almost be illegal, but they're not. So how do we fix them? And the only way we're gonna fix them is exactly what you just said awareness and action.

SPEAKER_00 23:42

Yep. Driving people to high-value care forces the incumbents to change their strategy until we get there at the right volume. Nothing's changing. So one day at a time, my friend. Thank you, buddy. Appreciate it, Matt. Well, thank you for joining us on Bending the Trend. Matt Harman, awesome, appreciate it, and uh keep doing the great work.

SPEAKER_01 24:05

Always a pleasure, Norm. We'll see you next time.

SPEAKER_00 24:07

Thanks for watching Bending the Trend, where we are looking to fight rising healthcare costs. We are asking benefits leaders what digital solutions they've implemented that has helped them bending the trend.