ROI Case Study

In “Fighting for Coverage,” a patient describes a double war: the physical fight to stay alive and the bureaucratic fight to prove to an insurer that her life is worth the cost. Her account spotlights a core tension in the U.S. system—coverage decisions are increasingly shaped by prior authorizations and desk-based reviewers who…

The sustainability of the healthcare system won’t be secured by another round of cost-cutting or clever benefit design alone, but by a hard cultural pivot toward alignment: payers, providers, employers, and patient advocates pulling on the same rope instead of grading each other on different exams. Right now we’ve built a maze that…

Patients shouldn’t have to become their own case managers just to access a hip replacement, transplant, or any other life-changing procedure; the moment they’re pushed into a paperwork fight, the system has already shifted its burden onto the sick. In a functional healthcare model, clinicians and their teams handle the insurer negotiations behind…