By Jens Thorsen, Valhalla Business Advisors
In an unpredictable economy, every dollar matters – especially the dollars flowing into employee health plans.
Healthcare costs continue to rise, yet many employers remain locked into opaque, inflexible
group insurance arrangements that offer little insight into how dollars are spent or whether those dollars are doing any good. The time has come to challenge conventional wisdom and explore smarter, more transparent ways to structure benefits. Forward-looking employers across our region are beginning to do just that.
Local Innovation: Gloria Gates Care and Regional Partnerships
One example close to home is the emergence of Gloria Gates Care, a community-based
clinical solution now partnered with payers like Geisinger. These partnerships offer employees
lower out-of-pocket costs and greater access to primary care, which helps prevent chronic
issues before they require costly intervention. For employers, this model aims to improve
patient satisfaction, reduce claims, and lower stop-loss risk.
National Momentum: Direct Primary Care (DPC)
The rapid growth of Direct Primary Care (DPC) is also reshaping the benefits conversation.
DPC eliminates traditional insurance billing in favor of a flat monthly fee that gives employees
direct access to primary care doctors. This model promotes more meaningful doctor-patient
relationships and reduces downstream costs – particularly when paired with a high-deductible or level-funded plan structure – and leads to improved worker productivity.
New Tools for Employee Engagement and Population Health
Today’s health-savvy employers are also leveraging population health strategies that blend
technology with personal engagement. Whether using continuous glucose monitors (CGMs) for metabolic awareness or administering health surveys, these tools help employers understand employee needs and guide more informed decisions. When employees are equipped with actionable insights, they make better choices – and those choices drive real savings.
Innovation in MSK: Avoiding Costly Surgeries
Another promising frontier in benefits innovation is musculoskeletal (MSK) care, particularly
for employees suffering from knee osteoarthritis (OA), a leading cause of disability. In a recent
peer-reviewed article by Drs. Michael Suk and Matthew Bartels, research highlights a non-
invasive, home-based biomechanical intervention that has shown measurable reductions in
symptoms and improvements in mobility – offering a meaningful alternative to costly total knee replacements (TKRs).
One such solution, AposHealth, offers an FDA-cleared medical device that is already a
covered benefit under medical policy for many employers using GHP and Highmark,
though many employees are unaware it exists. Apos originated in Israel and has been adopted
widely in the UK, earning a recommendation from NICE (the National Institute for Health and
Care Excellence). By realigning biomechanics and retraining muscle memory, the Apos device
helps patients offload pressure on the knee and correct abnormal gait, which can potentially
delay (or obviate the need for) surgery.
For employers, this is more than clinical innovation. It is cost avoidance in action. Total knee replacement surgeries can cost upwards of $30,000 per case. By offering evidence-based,
non-surgical alternatives, employers can reduce high-cost claims while dramatically improving
employees’ quality of life.
Structural Change: Self-Funding, Captives, and ICHRAs
Beyond clinical solutions, employers are rethinking the very structure of their health plans. Self-funding, benefit consortia, and captive insurance models allow employers to pool risk, gain data transparency, and implement more targeted cost controls. Similarly, Individual Coverage HRAs (ICHRAs) are gaining traction, offering employees choice and employers predictability.
But caveat emptor: while vendors often promote these solutions as simple and low-risk, many
employers have been disappointed when actual results fell short of optimistic projections.
Proceed with caution – and an informed analysis and supportive consultant relationship!
The Call for Fiduciary Thinking
Amid all these innovations lies one common truth: traditional broker relationships often obscure true costs. As investigative journalists like Marshall Allen (Never Pay the First Bill) and physicians like Dr. Marty Makary (Unaccountable) have demonstrated, hidden markups and conflicted incentives remain widespread.
That’s why employers must hold advisors to a fiduciary standard, as advocated by John
Torinus Jr. in The Company That Solved Health Care. Brokers should be accountable not to
carriers but to clients—pushing for transparency, cost control, and aligned incentives at every
step.
Two essential questions every employer should ask: ‘Who pays my broker?’ and ‘Do my
decisions as a client affect their compensation?’
If the answers aren’t crystal clear, it’s time for a change.
Final Thought: A Better Path Is Possible
This moment demands action. Economic uncertainty should not be an excuse for inaction – it should be a catalyst for better, smarter solutions. The tools to create healthier workforces and healthier balance sheets already exist, right here in our community. All it takes is the will to
prioritize employee well-being, demand transparency from advisors, and embrace innovative care models that keep problems small – and costs smaller.
Let’s not wait for stability to do what’s right – this is the year to act.
