What if taking control of your health plan didn’t require a complete overhaul, but just the right starting point? In this episode of The Healthcare Heist Podcast, Lou Bernardi breaks down the first two steps of the P.L.A.N. System, where strategy turns into real-world results.
After exposing how the system works and why it continues to drive costs higher, Lou shifts the focus to what actually works. This episode dives into how employers can begin to take control by prioritizing employee health and leveraging transparency to eliminate waste. You’ll learn why most companies are stuck in a reactive renewal cycle, and how a purpose-driven approach flips the script. From strengthening primary care and prevention to introducing navigation and advocacy, Lou outlines how designing a plan around health, not just insurance, changes everything.
But caring alone isn’t enough. This episode also reveals how visibility and leverage unlock control. By unbundling the traditional model and working with independent, aligned partners, employers can expose hidden costs, reduce unnecessary spend, and turn healthcare from a passive expense into a strategic advantage.
Because the difference between companies that stay stuck…and those that win…comes down to what they do next.
What You’ll Take Away:
- The first two steps of the P.L.A.N. System, and why they work.
- Why most employers don’t actually have a healthcare strategy.
- How prioritizing employee health reduces long-term costs.
- The role of primary care, prevention, and navigation in better outcomes.
- How transparency and leverage expose hidden waste and reclaim control.
Perfect For CEOs, CFOs, HR leaders, and advisors who:
- Are ready to move from awareness to action
- Want practical steps to improve their health plan
- Are looking for better outcomes without unnecessary disruption
This is where the shift begins. Because the right first steps change everything.
—
Listen to the podcast here
From Purpose To Power: Prioritizing Health And Leveraging Control
Introducing The System That Changes Everything
Welcome to the show, where we pull back the curtain on one of the biggest, most misunderstood expenses in your business. I am your host, Louis Bernardi, founder of BritePath and a benefit optimization officer, certified healthcare fiduciary coach and health value advisor. If you’re a CEO, CFO or HR leader who knows something isn’t adding up with your health plan, you’re in the right place. Let’s get into it.
The Hidden Mechanics Of Healthcare
In the last episode, I introduced the plan system. A framework that takes back control of your health plan. We’re going to bring that to life because this is where the strategy becomes action. We’re going to focus on two critical parts of the system, prioritizing employee health and leveraging control over your health care spend. For most CEOs, healthcare has always been handled in good faith. You hire a broker, you trust a carrier and you assume the system was working in your favor. Here’s the truth. The system you relied on to protect your people has been protecting itself. You know this.
You’re hearing the noise out of Washington and in the media. It’s just because of the heist and the machine behind it has been way too complicated for the average American Healthcare consumer to understand how it works, the mechanics of healthcare and health insurance. What we know is it benefits, meaning the machine and all the players. It benefits when your employees need more care, not less. It inflates claims, manipulates pricing and it hides the data from you.
You didn’t build the problem but you’re in the best position to fix it if you’re a CEO or a business owner or a savvy entrepreneur or someone who is upset by being taken advantage of. Most companies don’t have a health care strategy. They have a renewal strategy. They react to increases, try to minimize disruption, and repeat the cycle. Rinse and repeat. Pay more, get less year after year. I’ve seen that play out for the last 34 years and I can’t be part of it anymore.
Most companies don’t have a healthcare strategy. They have a renewal strategy. Share on XPlanning with purpose changes that. It means designing your plan to keep people healthy. Not just pay for them when they’re sick. You don’t stop renting the machine. You start building something that works for you. Let’s break this down to what moves the needle. Prevention over repair. Most healthcare is crisis management. People enter the system when something breaks or when it’s already expensive. A better approach identifies risk early, manages conditions sooner and avoids unnecessary claims.
Aren’t these things that the health care system and your insurance company should be helping you with? If they were truly aligned with you and your employees and they were practicing care, if they care about the health of your employees. Wouldn’t they provide these resources? Wouldn’t they work with you? Wouldn’t they sit down with you at renewal time and explain what was happening within your plan?
Identify conditions and members that need additional support. Every prevented claim is reclaimed profit for you, your employees, and your business. Primary care at the center of every high-performing plan is strong primary care. Whether it be virtual or in person, primary care is a game changer. It’s what’s lacking in most health plans because primary care doctors have been put out of business. They’ve been purchased, burnt out and retired from the healthcare system because they don’t generate profits.
The Role Of Direct Primary Care
They can be used by Shepherds to steer people towards care that maximizes the profits for the health plans that they work for. Traditional models have stripped it down to five minute visits and referrals, as I mentioned. Direct primary care, if you haven’t heard of that, is something that’s growing pretty rapidly throughout the United States. Direct primary care brings it back to what it should be, relationships, time and advocacy.
Direct primary care doctors are doctors who do not take insurance. Do not submit claims. You pay them a flat transparent monthly fee and they’re your doctor, 3-minute visits or hour-long visits or virtual calls or text messages. They’re there to keep you well. They’re passionate about being doctors. They’re sick of insurance company games. They’re sick of being burnt out, and they’ve seen a better way. When that happens, emergency room visits drop, hospitalizations drop and outcomes improve. Isn’t your health plan something that should improve the health of your employees?
Isn’t it there to keep people well? It should be. Mental health and the whole person cares. You can’t have a high-performing workforce if people are struggling silently. Mental health drives absenteeism, turn over and claims. When it’s addressed early, you don’t just help people. You improve the performance. Navigation and advocacy. Even the best plans fail if your people don’t know how to use it. The system is designed to confuse them. Navigation removes that confusion. Give your employees the resources, the tools they need to make smart healthcare decisions such as plain simple language, phone calls, or mobile apps.
There’s a host of different options that are available to your employees. At the end of the day, your employees need to be able to use something that’s simple, helps them make smart decisions and they know why they’re using it. There has to be an incentive for them to use it. Staying well is an incentive. I think human nature people respond to financial incentives. Even more if it’s going to save them money, make their life easier, save them time, and be convenient.
It connects employees to better care, better pricing, and better decisions. Every better decision lowers cost. As I mentioned in all of the previous episodes, lower claims cost results and lower premiums. We’re not just trying to save your company money for the sake of saving the money. We’re keeping your people well. We’re eliminating unnecessary care. We’re avoiding costly downstream care because we’re taking attention or paying attention to the wellness of your employees making it easier to access that care.
Caring isn’t enough. Here’s the shift. Caring about your employees is critical. Again, it’s not enough because the machine doesn’t care how well-intentioned you are. It feeds on inefficiency and opacity. Healthcare isn’t a fixed cost. It’s a negotiable business expense hiding in plain sight. You just need to know where to look. The difference between companies that win and those that stay stuck comes down to one word, leverage.
Healthcare isn’t a fixed cost. It’s a negotiable business expense hiding in plain sight. Share on XThis is the time where the American healthcare consumer for the first time in many years can leverage your business and where you take that business. Your health is your leverage. It’s like the insurance carriers used leverage to bully around the health systems early on in managed care and then the health systems understood that they needed leverage by merging, acquiring and growing into behemoth health systems.
Now it’s your turn. Your business, your premiums, and your claims dollars is the leveraging you need. You should be taking that and rewarding the best possible doctors because you can. It starts with visibility. You’re leveraged starts with visibility because visibility creates control. The machine depends on your blind spots. When you see the data, you shift the power. No one is knowingly going to bad doctors. They’re just unfortunately following blindly the advice of other doctors who they trust that also don’t know who the best doctors are. The data holds the details.
Regaining Leverage Through Unbundling
When you see that data, the cost, the quality, you may make smarter healthcare decisions just like you do when every other aspect of your life. Not too many people walk into an auto dealership and say, “I want to drive the car that had the lowest crash test ratings.” You just don’t. Not knowingly. For the first time in a long time, the leverage is available to you. Let’s talk about a couple of different levers.
Unbundling. What does unbundling mean? Most employers think they’re buying insurance. You’re not. You’re bundling a bunch of services all controlled by one entity. Your health insurance carrier, the largest health insurance carriers in the country, have, if not thousands of affiliated companies all implemented, designed and wrapped into your health plan all different profit centers for them.
Pre-authorization departments. You have claims departments, billing departments, pharmacy benefit managers, specialty providers and different arrangements that they have with your insurance company. Again, they’re making all decisions. Their decisions are tied to their profits. Remember, they have a fiduciary responsibility to maximize their profits. When they plug and put a different component into the health plan, they are almost certainly making money on that component.
They’re calling all the shots. They’re building a plan. What if you could build the plan that was superior to what your insurance companies are doing? Not that you have more ability than your insurance company, but your intention is different. If they wanted to build a plan that performed perfectly, took better care of people to control costs, they certainly could but that’s not their intention. It never will be. That’s like letting one company design your plan, pay your claims, audit their own work, and control your data. That’s what’s happening.
That is the framework of the traditional health insurance system. Unbundling breaks that apart. It gives you control. Whoever controls your plan document controls the plan. This is why we talk so much about self-insurance because under a properly orchestrated self-insurance plan, the plan sponsor controls the plan document. That plan document is the Bible. It’s where you decide what’s covered and what’s not covered. Not you personally but your partners. Your trusted partners are constructing a plan document that takes advantage of all the best-in-class solutions partners, contracts, discounts and third-party arrangements.
We’re talking about independent partners that come together under a rebundled plan. A plan that is truly designed to work for you. When you unbundle, you can choose partners who are aligned with you. Partners who win when you win, share your data and are accountable for their performance aren’t afraid to be audited because they know their intentions are aligned with yours. Not partners who profit from your spending.
When companies do this, they find things like pharmacy markups, rebates, spread pricing horribly orchestrated pharmacy formularies, inflated provider cost, and missed savings opportunities. Once you see that and you have access to that information, you regain claim control. If you accept the numbers, you’re betting your business on their honesty. When you don’t use your leverage, if you accept the numbers that your insurance companies are currently giving you without any access to what’s happening behind the curtain or under the hood, then you’re letting your business be taken advantage of.
This isn’t about managing benefits. It’s about leading your company out of a system that has been managing you. Share on XIf you demand the data, your bedding on your own intelligence. You’re saying, “I want to see the data. I want to see what we’re paying for. I want to see where our employers are going. Why are you offering a health insurance plan paying tens of thousands, hundreds of thousands or even hundreds of millions of dollars for something that’s inferior? You know it is not working. Your renewals aren’t neutral. They’re compounding losses. This is where it becomes real.
Every dollar you reclaim can go into growth, hiring, technology, or retention. This is how you turn healthcare into a strategic advantage. We’re at a crossroads. There’s been a slew of legislation enacted since the Affordable Care Act. This is your opportunity to take that leverage so you have to make a decision. You’re at a decision point. You can stay the course and keep funding the machine or lead differently and start building something better.
What will be your legacy as a business owner, a CEO, a CFO, or a HR director? Will you take this head on? Do you believe strongly enough that your people are your greatest resource? Are you going to just trust the insurance company or take the path, less traveled. This isn’t about managing benefits. It’s about leading your company out of a system that’s been managing you. For years, the machine had to leverage. Now, you do. You can. The only question is, are you going to use it?
Thanks for joining me. I hope you learned a thing or two. Thanks for tuning in to the show. More importantly, I hope it gets you to get the results you and your people deserve. If this resonated with you, I’d love to connect for a conversation. Until next time. Don’t settle for a health plan that isn’t working as hard as it should for you and your team.
Important Links