Why Employer Healthcare Rewards Spending, Not Outcomes

Employers don’t actually buy healthcare. They buy a system that processes spending.

And that distinction explains almost everything that feels broken.

In this episode, Dr. Andrew White breaks down why healthcare costs keep rising—even when employers invest in better benefits, wellness programs, and vendor solutions—and introduces a simple filter you can use to evaluate whether a benefit is designed to reduce risk or simply process claims.

If you advise on benefits or make benefits decisions, this episode will change how you see the system.

In This Episode, You’ll Learn:

• Why employer healthcare rewards utilization instead of outcomes
• What employers think they’re buying vs. what they’re actually purchasing
• How access, administration, and risk transfer shape behavior
• Why outcomes are discussed rhetorically, but spending is rewarded mechanically
• How incentives work across carriers, PBMs, brokers, and providers
• Why prevention struggles inside a system built to price risk, not eliminate it
• How to stop buying benefits that sound right but can’t actually work

Key Takeaways:

• You can’t invoice for a surgery that never happened—but you can bill for every step once a claim begins
• Healthcare isn’t broken; it’s working exactly as designed for the incentives it follows
• Most players in the system are paid to manage utilization, not prevent it
• Employers are often asked to own outcomes without owning the system’s incentives

The One Question to Ask Before Buying Any Benefit:

Who gets paid when utilization goes up—and who loses money if it goes down?

If a solution doesn’t make money by preventing problems, it won’t prevent them for long.

Why This Episode Matters:

This episode reframes healthcare benefits as risk management, not perks or programs—and explains why meaningful change requires incentive redesign, not more vendors.

Healthy Business Matters is a podcast for employers, brokers, CFOs, and operators who want clarity—not hype—about healthcare, benefits, and risk.

Questions, feedback, or guest suggestions:

hello@alignco.life

American employers are spending more on healthcare than any other country in the world, and outcomes continue to get worse.

That disconnect is why Healthy Business Matters exists.

In this introductory episode, host Dr. Andrew White, founder and CEO of AlignWell, explains the purpose of the podcast and the problem it’s designed to tackle: a healthcare system that rewards spending instead of results, and benefit strategies that look good on paper but fail in real-world execution.

This is not a podcast about vendor demos or polite conversations. It’s about how employee benefits actually work, and how they fail, in real employer environments.

Who this show is for

• Insurance brokers working with self-funded, captive, or level-funded plans
• HR leaders, CFOs, founders, and executives responsible for benefit decisions
• TPAs, PBMs, and point solutions operating in the employer health ecosystem
• Anyone accountable for benefit design, budget, and outcomes

What you’ll hear on this podcast

• Real-world benefit design and execution conversations
• Why many benefit strategies fail despite good intentions
• The difference between education, behavior change, and outcomes
• Mental models for designing benefits that actually move the needle
• Conversations with operators, brokers, TPAs, PBMs, and industry leaders who are in the trenches

Key ideas from this episode

• The healthcare system rewards spending, not results
• Employers are the largest funders of U.S. healthcare — and the biggest lever for change
• Real reform comes from how employers buy, not from legislation
• Most benefit strategies fail because they start with compliance instead of intent
• Knowledge alone doesn’t change health; systems and accountability do

Listener promise

If you don’t leave each episode with an idea or perspective that improves your decision-making, the episode failed.

New episodes release every Tuesday, with occasional bonus conversations.

Get in touch

Have a topic you want covered?

Know a guest who should be on the show?

Want to share feedback or learn more about AlignWell?

hello@alignco.life