Tom Emerick, Author at Insurance Thought Leadership



Tom Emerick

Tom Emerick

Tom Emerick is president of Emerick Consulting and cofounder of EdisonHealth and Thera Advisors.  Emerick’s years with Wal-Mart Stores, Burger King, British Petroleum and American Fidelity Assurance have provided him with an excellent blend of experience and contacts.

His experience and expertise include: designing and managing both global and U.S. benefit programs for large corporations, including multinationals, small to medium-size companies and associations; implementing Six Sigma initiatives in a variety of corporate functions; developing and advocating national health policy solutions; implementing leading-edge, strategic and cost-effective health plan designs; developing long-range health plan strategies; applying evidence-based medicine in employer health plan design; and understanding healthcare economics.

He has served on a variety of employer coalitions and associations, including being on the board of the influential National Business Group on Health and the U. S. Chamber of Commerce Benefit Committee.

Frequently in demand as a speaker for benefits and healthcare conferences, such as the internationally known World Health Care Congress, his topics include strategic health plan design, global health care challenges, healthcare economics and evidence-based medicine.

Recent Articles by Tom Emerick

Ethics of Workplace Wellness Industry

Wellness is back in the news these days. The National Bureau of Economic Research’s controlled trial invalidating a Harvard study that has been used to claim major benefits from wellness programs and the surprise decision in the AARP v. EEOC case disallowing large financial inducements for “voluntary” programs both received national attention. Further, WillisTowersWatson’s quiet […]

What Caused the ACA Rate Surge?

Here is the answer, in 100 words or less: ACA permits people to sign up even if they are already sick. Real insurance cannot work that way. Imagine an Accountable Fire Insurance Act that required insurers to sell you fire insurance after your home had burned. Homeowner insurance rates would skyrocket. Anyone who carefully read the ACA would have seen […]

Walmart Shows Way on Health Benefits

Walmart, a true leader in benefit innovation, is taking the next right step, expanding its popular and successful Centers of Excellence. When Walmart workers, called associates, use Centers of Excellence, deductibles and co-pays are waived. All travel expenses are paid for the patient and a companion. Starting next year, if covered folks at Walmart have spine […]

There May Be a Cure for Wellness

During my tenure at both British Petroleum and Walmart, I tried various forms of wellness, but to no avail. There were never any savings, participation was low, employees didn’t like it, and administration was complex. I’ve continued to follow the wellness industry but could never see any genuine success stories. The gratifying news is that […]

Healthcare: When a Win-Win Is Lose-Lose

“Workplace Wellness Programs Are a Sham“ is a good article in Slate by L.V. Anderson. This is a must read for people who remain true believers that workplace wellness will improve worker health. “The idea behind wellness programs sounds like a win-win,” Anderson writes. Alas, history is full of “win-win” ideas that were destructive, costly or […]

New, Troubling Healthcare Model

As physicians and hospitals compete for the “under 65” patient — whose payments are generally 150%-plus higher than for a Medicare patient — they have to determine their pricing model. The traditional choice is to offer a low price per service based on a higher volume, or a high price per service based on a lower […]

Healthcare: Time for Independence

Forbes carried a good article by Dave Chase, a leader in trying to reform healthcare in the right way. Chase writes, “Employer frustration over the devastating collateral damage from a severely under-performing healthcare system is boiling over.” Click here to read the full article. High health costs are driving U.S. jobs to Mexico and other countries. GE and scores of other […]

Is Transparency the Answer in Healthcare?

During the ‘90s, a new medical plan, called consumer-directed healthcare, was introduced. It was based on the premise that through a high deductible coupled with a funded account, employees would have incentives to become better consumers of healthcare. To maximize the account dollars, employees received access to a transparency portal, either through their carrier or […]

Obamacare: Where Do We Stand Today?

The healthcare industry is changing – same old headline. Since we’ve been in the industry, the “unsustainable” cost increases have been the talk every year, yet somehow we have not reached a tipping point. So what’s different now? How has ACA affected the healthcare industry, and more specifically the insurance companies? The drafters of ACA […]

Healthcare Quality: How to Define It

In a previous article, we mentioned the Centers for Medicare and Medicaid Services’ (CMS’s) new provider reimbursement model, Medicare Access and CHIP Reauthorization (MACRA), which replaces the current reimbursement formula. MACRA will include an incentive component that will replace those in plans today; performance criteria will roll out in 2019. From the providers’ lens, they […]

Are Your Health Cost Savings an Illusion?

The New England Journal of Medicine carried an excellent article by David Casarette, MD, on the topic of healthcare illusions and medical appropriateness. Click here to read the full article. Casarette observes that humans have a tendency to see success in what they do, even if there is none. Casarette writes, “Psychologists call this phenomenon, […]

Flogging the Data Until It Confesses

Did you ever hear the joke where the boss says floggings will continue until morale improves? In healthcare, flogging the data until results improve or the data confesses is not uncommon. Too bad. Over the course of my career, I’ve worked with companies with more than a hundred thousand covered lives, the claim costs of which could swing widely from […]

6 Limitations of Big Data in Healthcare

Claims data captures the services provided to a patient. This information can be grouped into different cohorts—those getting preventive exams, those seeing specific physicians or hospitals for conditions, etc. The data can be grouped by diagnosis. However, all claims data is just a collection of medical bills. Medical bills do not contain a complete look […]

Why Healthcare Costs Soar (Part 6)

In most healthcare discussions today, “the exchange” is usually described as a solution to address employers’ health and cost challenges. The exchange model is now being offered by carriers, by consulting firms and by independent companies. Accenture says the enrollment in private exchanges exceeded 6 million in 2015, and it’s projected to be 40 million […]

Why Healthcare Costs Soar (Part 5)

Readers of Cracking Health Costs know that healthcare is both complex and consuming, and an ever-greater share of GDP in the U.S., while our health outcomes are falling behind our peer countries. According to the 2015 Health Care Services Acquisition Report, the deal volume for businesses in the healthcare services sector rose 18%, with 752 […]

Why Healthcare Costs Soar (Part 4)

The first three articles in this series by David Toomey and me are here, here and here. Over the last few years, the buzz in the healthcare industry has been about accountable care organizations (ACOs), and the next wave will be the promotion of “value-based contracting.” These are similar approaches, different words. Generally, an ACO […]

What Loneliness Does to Your Health

One of the myriad reasons workplace wellness is not performing well is that all humans have about 100 risk factors, of which obesity, high blood sugar, high blood pressure and high cholesterol are only four. If those four are in pretty good shape but the other 96 are out of whack, don’t expect good health results. […]

Why Healthcare Costs Soar (Part 3)

In Part 1 and Part 2 of this series, David Toomey and I described a wildly successful collaboration with Virginia Mason Medical Center (VM) and a few Seattle employers. During the the time of the VM collaboration, we invited major physician groups to meet with the employers. One of the most memorable meetings was with the CEO and chief medical […]

Why Healthcare Costs Soar (Part 2)

This is the second of a two-part series, by David Toomey and me, on why healthcare cost growth has historically been much higher that general inflation.  In the last blog post, we outlined the complexity of the network negotiation process and the challenging dynamics among the insurance companies, the providers and the employers. The majority […]

Why Healthcare Costs Rise So Fast

This is the first of a two-part series, by David Toomey and me, on why healthcare cost growth has historically been much higher that general inflation.  If you want to truly understand why corporate healthcare costs have risen faster than nearly anything else over the past 40 years, read this article. In 2001, David was […]

Walmart’s Approach to Health Insurance

My most recent post generated many questions, mainly about my definition of “value” in healthcare purchasing. My definition of value is the highest quality of care provided in the most efficient manner, i.e. not too much care, not too little care, delivered in a “lean” way and paid for in a mutually satisfying way. Walmart’s Centers […]

Payments to Providers Must Be Reformed

Sally Welborn wrote a good blog post in The Health Care Learning & Action Network calling on self-insured employers to take the lead in reforming healthcare purchasing. She is senior vice president of benefits at Walmart Stores and is responsible for the design and administration of benefits. She writes, “Fixing the payment system can actually result in limiting […]

The Destructive Search for an Elixir of Life

For 3,500 or more years, mankind has been searching for the mythological elixir of life, the Fountain of Youth, the philosopher’s stone, pool of nectar, etc. that will defeat aging and extend life, if not achieve immortality. According to Wiki, “The elixir of life, also known as the elixir of immortality and sometimes equated with […]

The Worst Doctors From 2015

This list of worst doctors came to me via email, and I thought it was too good not to post. The origin of this is a Medscape article written by Lisa Pevtzow, Deborah Flapan, Fredy Perojo and Darbe Rotach. Please read the Medscape article in full. It’s a gem. The Medscape article shows pictures of […]

How to Calculate Return on Wellness

In the era in which wellness vendors were still claiming a return on investment (ROI_ on wellness (and more and more are not), I asked a number of them how they calculated the ROI. Not one calculated the ROI in a way that a steely-eyed CFO would endorse. Below is a partial list of costs […]

Wising Up on Prostate Tests (Finally)

The number of tests for prostate cancer has dropped, according to an article in the Wall Street Journal by Melinda Beck, but it’s not for the reason that first jumps to mind. The article says, “The declines follow the U.S. Preventive Services Task Force’s recommendations against routine testing for prostate cancer, first for men aged […]

2 Studies of Why Wellness Fails

Henry David Thoreau famously said, “Most men lead lives of quiet desperation…” People who lead desperate lives don’t make good subjects for wellness programs, nor, for that matter, lifestyle advice from doctors. Below are two real life examples of ordinary people I’ve chatted with about matters of personal health. After both of these conversations, I […]

Is It Time to End Annual Physicals?

A good story with the headline, “Do Annual Physicals Do More Harm Than Good?”, was posted recently on CCN, written by Nadia Kounang. Click here to read the full article. This is not a new question about annual physicals. Leading physicians have been asking this question for decades. Yet the public and professional wellness vendors […]

Healthcare Exchanges: Math Doesn’t Work

Employers of all sizes are rushing into healthcare exchanges these days — often after heavy prompting by their consulting firm or broker. Part of the expectation is that employers can cap their future health plan costs while giving active employees more options. Sounds great, doesn’t it? The problem is the math doesn’t work. In addition, […]

Job Misery Is a Slow, Steady Killer

George Carlin once said, “Oh, you hate your job? Why didn’t you say so? There’s a support group for that. It’s called everybody, and they meet at the bar.” All Carlinisms aside, job misery is a leading cause of death. That has been studied and reported in Europe over and over. Consequences are weight gain, […]

The 3 Best Websites on Healthcare

These are three websites I read every day and from which I draw a huge amount of useful information: The Doctor Weighs In, hosted by Dr. Patricia Salber. TDWI is truly mind-expanding. She explores topics from the relationship between morality and religion to detecting post-surgery respiratory problems. Here is a link to The Doctor Weighs […]

3 Surprising Hazards Of Worksite Wellness

In an entirely entertaining Forbes online article, a truly effective healthcare leader, Leah Binder, lists the following three hazards of worksite wellness programs: 1. Dismaying and Alienating Employees. Who today doesn’t already know that smoking is unhealthy? 2. Bad Programs Don’t Save Money. Too many wellness vendors simply fabricate results. 3. Potential Harm to Employee […]

A Radical Shift in Pricing Cancer Drugs?

“Cancer drugs aren’t just really expensive; they’re a bad value.” That stunning headline is from a Washington Post article. The author is Carolyn Johnson. She writes, “With some cancer drug prices soaring past $10,000 a month, doctors have begun to ask one nagging question: Do drug prices correctly reflect the value they bring to patients […]

The iDoctor Will See You Now

“Medicine today is currently set up to be maximally imprecise,” Dr. Eric Topol says. Regular readers of will understand that comment. Topol, one of the world’s foremost cardiologists, has been a bit of a gadfly to Big Pharma and the medical profession. He discusses a coming revolution in how personal health care will be […]

Doubts on Testing for Breast Cancer

The Guardian carried a story by Sarah Boseley about the controversy in Europe and other countries about the effectiveness and safety of mammograms. It seems some of the early studies on the issue were deeply flawed. The article says, “Internationally renowned cancer experts have cast fresh doubt on the benefits of breast cancer screening programs, […]

How to Live Longer? Drink More Coffee

This idea is taken from The Doctor Weighs In post by Dov Michaeli. As the article says, “Coffee drinkers have a reduced risk of dying prematurely from all causes, and consequently live longer.” Coffee is a “vice” that is most worthy, and one to be embraced. Some health attributes of coffee include reduced risks of […]

Tips on Evaluating a Wellness Program

This is news you can use. If you want to evaluate the cost/benefit ratio of a wellness program, the following is a list of costs that are almost always overlooked in wellness evaluations. These are not the only things that need to be evaluated, just the ones most commonly overlooked. When the items in the […]

Want to Live Longer? It’s Not That Hard

Dov Michael wrote an informative article on the relationship between optimism and longevity. (Hats off to The Doctor Weighs In.) Optimism provides a mortality advantage. Optimists live longer than pessimists, it seems. Michael writes, “There is real scientific evidence, accruing at an accelerating rate, that optimistic disposition leads to better health; the converse is true […]

Urgency of Rising Medicare Fraud

Ho-hum: The FBI arrested 46 doctors and nurses…largest Medicare fraud bust ever. That is from a headline in a recent CNN story. Seems the thieving doctors and nurses got away with $712 million before getting busted. Per the story, “In total, 243 people were arrested in 17 cities for allegedly billing Medicare for $712 million […]

What Makes Us Get Sick? Look Upstream

The headline comes from a TED conference speech by Rishi Manchanda, who has worked as a doctor in South Central Los Angeles. After about 10 years, he realized, “His job isn’t just about treating a patient’s symptoms, but about getting to the root cause of what is making them ill-the ‘upstream’ factors like a poor […]

A Surprising Health Risk: Loneliness

Loneliness is both sad and a major health risk. More and more people are professing loneliness in their lives, and more and more evidence is piling up that loneliness, like dissatisfaction in life, is a killer. Here are some personal observations: Why do many people have so few friends as they age? Maintaining long-term friendships takes […]

Why Wellness Scams Cost Employers and Harm Employees

This is a headline in an LA Times article: “Why ‘Wellness’ Program Scams Cost Employers and Harm Employees.” The article, written by Michael Hiltzik, is yet another major mainstream media hit on corporate-sponsored wellness. Hiltzik writes, “Perhaps the most popular fad at large today in the employee health benefit world is the ‘wellness’ program.” Doubts […]

Scandal of Unneeded Knee Replacements

HR and benefits managers need to wake up: As a Reuters report by Will Boggs says in the headline, “One-third of knee replacements in the U.S. may be inappropriate.” Ouch. But, by today’s surgery standards, the story should come as a surprise to no one. The article says, “Judging by the symptoms of people with knee arthritis, one-third of knee […]

Wellness Boosts Productivity? Hold on

An article in Business Insurance( describes how a speaker at a conference said productive gains justify company-sponsored wellness. He was quoted as saying, “Many employers have implemented disease management programs to try to control health care costs, but the big savings are elsewhere.”   His “elsewhere” is  productivty gains. Whenever I hear someone make a claim […]

Healthcare Education: The Enduring Myth

Since about 1980, healthcare “experts” have been getting a tremendous amount of attention with claims that patients need to be better educated about their health and more “engaged.” Let’s review a little history and see how that plan has worked. Around 1975, healthcare spending and insurance premiums started surging about 12% 15% per year. Those spending increases spurred […]

The Real Fiscal Cliff – Not the Puny One in the News Today

Medicare and Social Security are in deep trouble — deep trouble. The nominal national debt is puny compared to the unfunded liabilities in Medicare and Social Security. How does $16T — yes “T” as in trillion — compare to $86T? There is a good article in the Wall Street Journal written by Chris Cox and […]

What's Next – Emerging Trends In Managing Population Health

New promising trends in managing population health are emerging. Our 20-year experiment with modern day corporate sponsored health and wellness has not saved money.* While some people have been helped by it … no doubt … in the end it has not been effective in controlling health costs. The facts on this have been known […]

The Human Resources View Of Health Care Benefits Needs To Change

The Human Resources notional view of health care benefits needs to change and do so quickly. At one time the view of health benefits was one of satisfying/motivating employees, closely coupled with a notion that health benefits were a great way to attract and retain top talent. Truthfully, that was never really the correct notion […]

It's 2012 – Let's Recap

Let’s hit a few highlights of 2011. In the past, I’ve described certain scary trends in health care in the United States: US spending on health care is lapping our peer countries while our life expectancy is declining comparatively. This is a major drain on our economy and is costing us jobs. We have a […]

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