The Prevention Perspective
Research and insights to help benefits leaders build workforces that stay well
Benefit abrasion is quietly undermining your preventive care strategy
The claims payment infrastructure of modern health plans has created a hidden economic penalty for the employees with the highest clinical risk—the exact people your preventive care investment is designed to help. Understanding the mechanics of “benefit abrasion” reveals why traditional plan designs can’t fully deliver on the promise of free prevention.
The Executive Take: Greg Mansur, CEO
One national carrier’s preventive care claims payment guidelines runs 49 pages. Forty-nine pages of rules determining whether your employee’s flu shot, blood panel, or colonoscopy is classified as “screening” (free) or “surveillance” (subject to deductible).
Nobody outside of claims processing understands these rules. Not your employees. Often not even their doctors. But the consequences are real: researchers estimate $75M–$219M in preventive care costs have been inappropriately shifted to commercial plan members.
We wrote about what “benefit abrasion” means for your preventive care strategy—and why fixing it requires more than a memo to your TPA.
Benefit abrasion is quietly undermining your preventive care strategy
The claims payment infrastructure of modern health plans has created a hidden economic penalty for the employees with the highest clinical risk—the exact people your preventive care investment is designed to help. Understanding the mechanics of “benefit abrasion” reveals why traditional plan designs can’t fully deliver on the promise of free prevention.
The CFO case for prevention: how one metric tells the whole story
Medical trend—the year-over-year change in per-employee healthcare costs—is the single metric that determines whether your benefits program is becoming more or less expensive over time. For a CFO, it’s a cost trajectory strategy that reshapes the conversation about preventive care.
Are you overlooking a costly patient experience problem in your primary care benefits?
With primary care practices receiving an average NPS of -1.2, employers have good reason to believe their people are having poor experiences with their PCPs—and that could be costing employers millions.
Get EHE’s expert insights in your inbox
Sign up for the Prevention Perspective newsletter and get our exclusive research and reports, plus early access to roundtable discussions, industry studies, and EHE Health news.
How to prove your preventive care program is actually working
Most employers can’t answer the most important question about their preventive benefits: “Is this actually lowering our costs?” The Triple Aim framework is a defensible method for measuring the impact of preventive care—and making the case to the CFO.
Beyond the “worried well”: how preventive care engages your highest-risk employees
For benefits leaders evaluating prevention engagement ROI, the question isn’t whether healthy employees will sign up. It’s whether the program can engage the 40-year-old male with borderline hypertension who hasn’t seen a doctor in three years. The evidence says yes.
Your doctor needs 26 hours a day: why primary care can’t deliver prevention on its own
Primary care physicians are structurally unable deliver adequate preventive care—not because they lack skill or intent, but because the economic model and patient volume demands leave no room for it. Understanding this reality is essential for deciding how to invest in workforce healthcare.
Get ahead of your workforce health risks
Give your employees and your business the strategic advantage of engaged prevention. Meet with an EHE benefits advisor to get a custom ROI analysis.