Cracking Health Costs Delivers Relief

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Tom Emerick and Al Lewis expose "How to Cut Your Company's Health Costs and Provide Employees Better Care."

Cracking Health Costs (Wiley; June 2013)

“However you view Obamacare as a whole,” noted coauthor Tom Emerick, “enshrining wellness programs as a major financial incentive is a mistake that can and should be fixed in the law.”

Cracking Health Costs: How to Cut Your Company's Health Costs and Provide Employees Better Care (Wiley, $45.00, July 2013; ISBN: 978-1-118-63648-0), a new book by two of America’s most respected health care experts Tom Emerick and Al Lewis, shows small and large business how to fight against rising health care costs and gain more effective treatments for employees. The book proposes multiple, practical steps that executives and small business owners can take to control costs and increase the effectiveness of the health benefit. Key strategies can be put into effect immediately; in many ways, people can “read the book on Monday and save money on Tuesday,” coauthor Al Lewis said.

Published as every business must make major decisions relating to health reform and the Affordable Care Act, the book exposes the boondoggles and counterproductive gimmicks foisted on executives and benefits managers by consultants and other vendors who capitalize on the duplication and inefficiencies of the current American health care economy. Cracking Health Costs shows how wellness initiatives are a wasteful sham, a fact that escaped the architects of the Affordable Care Act (ACA) which legislates a major role for workplace wellness. “However one views Obamacare as a whole,” noted coauthor Tom Emerick, “enshrining wellness programs as a major financial incentive is a mistake that can and should be fixed in the law.”

For finance, human resources, and all executives concerned with health care spend, the book will show everything benefits consultants didn’t want their clients to know about where their money is really going. For individuals, Emerick and Lewis expose the hazards of overtreatment, hospital errors, and overly aggressive surgical interventions, and provide hard facts and questions to ask providers. The authors do more than expose the shortfalls and charlatans. They show employers, policymakers, and health care experts viable strategies and market principles that they can use to restore common sense and accountability to the frustrating, upside down world of health insurance…mostly by simply undoing the hodgepodge of ill-considered and oversold vendor and consultant programs employers have been convinced to implement for the last ten years.

Readers of this groundbreaking expose and guidebook will find out:

  • Why companies and health plans mistakenly invest most of their health budget on the healthy 94% who generate comparatively minor costs, and naively trust the medical system to treat the 6% with chronic, severe, or disease issues, who generate a hugely disproportionate share of health care budgets. This outlier group is the major driver of health costs, and the source of over-diagnosis and overtreatment.
  • How and why virtually every vendored wellness program makes up outcomes numbers because they fail to achieve their goals … and what to do about it.
  • The misleading practices and self-serving advice of health insurance brokers and benefits consultants, while learning from America’s most ethical and effective brokers and consultants who truly do act in their clients’ best interest even at the risk of forgoing extra fees.
  • How the pharmacy benefits management industry hides its economics through opaque fees, rebate schemes, and other hidden markups that even savvy employers have only the minutest chance of deciphering…thus explaining the 30,000% increase in their stock prices over two decades.
  • Why too much health care can be hazardous to employees’ health as well as the bottom line. Emerick and Lewis expose unnecessary tests, biopsies, and surgical procedures generated by widespread biometric screenings that are so ineffective that it costs $1 million to avoid a heart attack, and cancer screens generate false diagnoses at such a high rate that (for example) overscreened Nebraska state employees got cancer diagnoses at a rate 40 times that of former residents of Love Canal.
  • How to adopt the “Company Sponsored Centers of Excellence,” (CSCOEs) a medical center partnership that reduces spending while saving money, improving outcomes, and raising productivity. Companies using CSCOEs include WalMart, Lowes, Pepsi, and Boeing; small businesses can join into purchasing coalitions to contract with a CSCOE.
  • How to arm executives and employees to use safer hospitals, according to the highest objective standard, The Leapfrog Group Hospital Safety Score.
  • How to create a workplace well-being program truly addresses financial, emotional, and physical health, as well as productivity improvements and upgrades to the work environment.
  • What true care coordination looks like and how to get it.
  • The advantages of consumer-driven approaches such as private insurance exchanges, and guidance on whether to move employees to the Affordable Care Act pubic exchanges.

About the Authors:

Tom Emerick is a leading expert in health benefits design, global healthcare challenges, healthcare economics, evidence-based medicine, and process improvement. Currently, he is the President of Emerick Consulting LLC. Tom spent fifteen years at Walmart, designing and managing benefits for over 1.6 million employees. He has held positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company.

Al Lewis, President of the Disease Management Purchasing Consortium, is widely credited with inventing disease management. Lewis is also the author of the award-winning Why Nobody Believes the Numbers (Wiley). He provides procurement and outcomes consulting to health plans and human resources/benefits departments, and administers the industry certification program in Critical Outcomes Report Analysis. He holds undergraduate and graduate degrees from Harvard, where he also taught economics.


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