It’s 11:15 PM on a Tuesday. Your employee’s six-year-old daughter has a 101-degree fever, a sore throat, and has been sobbing uncontrollably for the last two hours after originally going to bed at 7:30 PM. At the moment, the parent doesn’t remember the 24/7 virtual care benefit included in your plan. They don’t think about telemedicine. They just know their pediatrician’s office is closed, the urgent care is closed, and their child is in pain. So, they do what feels safest: drive to the emergency room.

Four hours and $3,800 later, the diagnosis is strep throat. A virtual visit with a physician would have cost the employee $0 and taken 15 minutes, and it would have cost the plan $49.

Multiply that scenario across your workforce. That’s the healthcare illiteracy tax you’re paying every single day.

Unnecessary ER visits cost the healthcare industry $47 billion annually, according to Accenture. The primary driver? Patients with low health system literacy who don’t understand where to go for care.

But here’s what makes this particularly frustrating: you’re already paying for the alternatives. Telemedicine. Virtual primary care. Decision support tools. Navigation services. Your employees just don’t know they exist, don’t understand how to use them, or don’t trust them enough to try.

Healthcare illiteracy isn’t just costing you money. It’s costing your employees health outcomes, time, and financial stress. And it’s completely preventable.

What Healthcare Illiteracy Actually Costs

Not limited to unnecessary ER usage alone, low health literacy is estimated to cost the U.S. economy up to $236 billion annually through medical errors, increased illness and disability, lost wages, and compromised public health.

But those are macro numbers. What does it look like at your organization?

Research shows that employees with limited health literacy report fewer doctor office visits, greater ER use, more hospitalizations, and higher rates of potentially preventable hospital admissions. They’re making decisions that cost more and deliver worse outcomes.

The most common manifestations of healthcare illiteracy:

• Wrong site of care. Employees go to the ER for conditions that could be handled through telemedicine ($49), virtual primary care ($75), urgent care ($150), or a primary care visit ($125). Every avoided ER visit saves between $309 and $1,500.

• Brand medications when generics are equivalent. Employees don’t understand that generic and brand-name drugs contain the same active ingredients. When generic fill rates increase from 70% to 85%, the savings are immediate and calculable.

• Out-of-network usage. Employees don’t check whether their provider is in-network, then face surprise bills that strain their finances and drive up plan costs. This is especially true when a narrow network strategy is being used.

• Delayed or avoided preventive care. Employees skip annual physicals, cancer screenings, and chronic disease management because they don’t understand that preventive services are covered at 100%. Later, you pay for emergency interventions that could have been prevented.

• lack access to prior. Without guidance, employees agree to expensive MRIs when X-rays would be clinically appropriate, or undergo duplicate testing because providers don’t have access to previous results.

Between 13% and 37% of ER visits could be safely referred to primary care, urgent care, or retail clinic settings, according to the Agency for Healthcare Research and Quality. For a 500-employee company with average healthcare utilization, that translates to hundreds of thousands of dollars in avoidable costs every year.

Why Traditional Education Fails

Most employers assume they’re already doing benefits education. After all, you send out open enrollment packets, hold benefits fairs, and post information on your intranet.

The problem isn’t that you’re not communicating. The problem is that your education strategy is fundamentally broken.

• The timing is wrong. You dump information on employees in October for a January effective date. Then, when they need care in March, they have no memory of what you told them four months ago and no idea where to find the information.

• The channel is wrong. You’re sending PDFs and emails to a workforce that consumes information through video, text messages, and mobile apps. You’re using the tools you prefer, not the ones your employees actually use.

• The content is wrong. You explain deductibles, coinsurance, and out-of-pocket maximums using insurance industry language. Your employees nod along, then make decisions that prove they didn’t understand a word.

• The approach is wrong. You treat benefits education as an annual event instead of an ongoing support system. Healthcare decisions don’t happen once a year. They happen at 11 PM on a Tuesday when a child spikes a fever.

The result? Employees who are confused, overwhelmed, and defaulting to the most familiar option: the emergency room.

What Good Education Actually Looks Like

Effective healthcare education isn’t about better brochures. It’s about meeting employees where they are, when they need help, with information they can actually use.

• Year-round, not just open enrollment. The best programs provide ongoing touchpoints: monthly emails on specific topics, quarterly webinars, text message reminders, and always-available resources. Education becomes a relationship, not an event.

• Just-in-time, not six months early. Employees need information when they’re making decisions, not months before. When someone’s navigating a new diagnosis, that’s when they need guidance on finding specialists, understanding treatment options, and comparing costs.

• Multi-channel, not just email. Video tutorials for visual learners. Text-based support for mobile users. Phone-based concierge or navigational services for those who prefer human interaction. Decision support tools for price-conscious shoppers. The medium matters as much as the message.

• Actionable, not informational. Instead of explaining how your plan works, show employees exactly what to do: “If you need care tonight, here’s the number to call.” “Before you schedule that MRI, here’s how to check if your provider is in-network.” “Here’s how to confirm your generic prescription costs $10 instead of $75.”

• Personalized, not generic. Not everyone needs the same information. New parents need guidance on pediatric care access. Employees with chronic conditions need help managing specialty medications. Your education should match their actual needs, not just broadcast generic content.

Fortunately for HUB clients, we have an internal Communications & Design team to develop year-round communication strategies that actually work. These aren’t traditional benefits materials. They’re designed using consumer marketing principles: clear messaging, compelling visuals, and calls to action that drive behavior change. If you’re a HUB client reading this and you feel like you’re not getting these resources, please let me know.

How to Measure What’s Working

If you can’t measure it, you can’t manage it. The good news is that healthcare education generates measurable outcomes.

• Utilization pattern shifts. Track ER visits per 1,000 employees over time. Monitor telemedicine adoption rates. Watch urgent care utilization. If your education is working, you’ll see employees shifting toward lower-cost, appropriate sites of care.

• Generic fill rates. Calculate the percentage of prescriptions filled with generic medications. A well-educated workforce should have generic fill rates above 85%. Every percentage point percentage-point increase translates directly into.

• Preventive care completion. Measure annual physical completion rates, cancer screening compliance, and chronic disease management engagement. These are leading indicators that predict future cost avoidance.

• Engagement metrics. Track who’s attending webinars, watching videos, calling concierge services, and using decision support tools. High engagement predicts lower total cost of care.

• Cost per engaged vs. non-engaged member. Segment your population by education engagement. Members who actively participate in benefits education consistently show 8-12% lower total healthcare costs than those who don’t.

Here’s a simple calculation to understand your potential savings:

1. Calculate your current inappropriate ER usage. If you have 500 employees and 10% made at least one non-emergent ER visit last year, that’s 50 inappropriate ER visits.

2. Estimate the cost difference. Average non-emergent ER visit costs $1,200. Telemedicine or virtual care costs $49-$75. The difference is roughly $1,100 per visit.

3. Calculate potential savings. 50 visits x $1,100 = $55,000 in avoidable costs from ER diversion alone.

4. Factor in other cost categories. Generic fill rate improvements, preventive care increases, and in-network utilization add another 5-8% in total cost savings.

5. Compare to education program cost. A comprehensive year-round education program might cost $5,000-$15,000 annually for a 500-employee group. Your ROI is 3:1 to 6:1, and that’s before accounting for improved employee satisfaction and reduced financial stress.

As you think about your benefits communication strategy, three questions should guide your approach:

1. When your employees need healthcare at 10 PM, do they know what to do?

2. Can you identify which employees are making expensive decisions due to lack of information?

3. Are you measuring whether your education efforts are changing behavior?

Healthcare illiteracy isn’t an employee problem. It’s a strategy problem.

You’ve invested in comprehensive benefits. You’ve negotiated strong provider networks. You’ve added telemedicine, decision support tools, and cost transparency resources.

But if your employees don’t know those benefits exist, don’t understand how to use them, or don’t trust them enough to try, you’re paying for solutions that never get used.

The most effective cost containment strategy isn’t negotiating harder with carriers. It’s helping your employees make better decisions with the benefits they already have.

That starts with education. Real education. Not annual packets and generic emails, but year-round support that meets employees where they are, when they need help, with information they can use.

The question is whether you’re ready to make the effort, and whether you have the right partner to help.

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Sources:

• Accenture, “Unnecessary ER Visits Cost Healthcare Industry” (2021)

• AHRQ, “Agency for Healthcare Research and Quality: Health Literacy Impact”

• Journal of Medical Internet Research, “Health Literacy and Healthcare Costs”

• National Institutes of Health, “Health Literacy Impact on National Healthcare Utilization”

• HealthLeaders Media, “Cost Savings for Telemedicine Estimated at $19-$121 per Visit”

News You Can Use

1. Will You Be Attending SHRM26 in Orlando from June 16-19th? If so, please consider attending HUB’s hospitality event. It will be held on Wednesday, June 17th, from 6:00-9:00 PM at Kavas Tacos + Tequilla. Send me a quick note so I can ensure you are personally greeted by an associate, and click here to RSVP.

2. April is Financial Literacy Month. To help promote literacy, we’re offering clients a free opportunity to experience FinPath, HUB’s proprietary financial coaching and education platform. You and your employees can benefit from a free, interactive education course through Choosewell, plus a chance to win $50. Visit FinPath Wellness to register and take the course.

Navigating Medicare can be hard. In the “worth sharing” segment below, I share a few details on helping my parents navigate senior living. Whether for your parents, yourself, your employees, or your own education, it’s important to understand how Medicare decisions carry more financial weight than most retirees realize. I encourage you to review a recent presentation hosted by HUB’s Private Wealth Management team. Check it out here.

Worth Sharing

I mentioned in the March Issue of The Advisor’s Edge that my dad had taken a fall. Having had a stroke that caused partial paralysis, paramedics were called as he was unable to get up. They determined he needed to go to the Emergency Room.

I was literally on-stage at a DisruptHR NOCO event on March 4th when I received the call. I had to reach down into my pants pocket to silence the phone notification.

From the ER, he was admitted. After about five days in the hospital, he was transferred to a rehab hospital in Fort Collins. Fortunately, he has now returned home, but he was hospitalized for an entire month.

There were some days of uncertainty when we did not know whether returning would be an option. For a while, it looked like we might have to admit him to assisted living.

Fortunately, our family had already started some very necessary conversations. About a year ago, my parents provided access to their financial position - for the very first time. We also began the conversations about possibly moving them out of their home and into an independent living facility.

Since then, we have toured multiple locations, made a decision, enrolled in the waitlist, and made the necessary deposit to hold their spot. We’re hoping that in the next 6-8 months, they will be able to transition into a new beginning, surrounded by community, connection, and care.

Those plans, however, never anticipated a fall. They never anticipated a month-long hospitalization, and they never anticipated a possible escalated need for assisted living.

I thought we were ready, until we were not.

If you’re reading this, and your parents are still alive, begin these conversations now.

It’s uncomfortable. It may be unwelcome. You may meet some resistance. Stand strong in your insistence and use our situation as an example.

You never know when an untimely call may come. Don’t wait for that phone to ring to begin planning.

As a HUB employee, we have access to a program called Homethrive. It may be something for your company to consider offering to your employees.

If I can be of assistance, please let me know.

This past January was different.

The 2026 renewal cycle was the most brutal I’ve experienced in my career. Not just because of the size of the increases — though double-digit renewals were routine across our book of business — but because of how many clients had done everything right and still got hammered.

After two decades in this industry, I’ve come to an uncomfortable conclusion: the traditional insurance market isn’t broken. It’s working exactly as designed. Just not in your favor.

Family premiums rose 111% between 2010 and 2020. Worker earnings grew 27%. The largest health insurance carriers have dramatically outperformed the S&P 500 since the Affordable Care Act took effect. The Medical Loss Ratio — designed to limit insurer profits — actually codified them. When profit is calculated as a percentage of premium, higher claims drive higher premiums, and higher premiums drive higher profit. Low claims year? The carrier keeps the surplus. High claims year? You pay for it at renewal. The insurer wins either way.

There is a better way. Most midsize employers have never heard of it.

What Is a Health Insurance Captive?

Most employers think of health insurance as binary — you’re either fully insured or you’re not. The reality is a spectrum:

Fully Insured → Level-Funded → Bundled Level-Funded → Group Captive → Self-Funded

A group captive sits in the middle of that spectrum. It’s a formalized risk-sharing arrangement among a community of like-minded, well-managed employers. Instead of paying premium to a carrier and never seeing it again, member employers pool their risk — and when the pool performs well, the financial benefit flows back to the members. In most captives, you don’t just share in the pool’s performance. You become an owner in the captive organization itself.

The funding structure has three layers. Your individual corridor, where you retain a defined level of risk protected by specific stop-loss coverage. The captive layer, where claims above your corridor flow into the shared community pool. And aggregate stop-loss coverage above the captive layer for catastrophic protection. When the captive layer performs well, the surplus belongs to the members — not to a carrier’s shareholders.

That’s a fundamentally different financial relationship than traditional insurance.

Three Questions to Evaluate Any Captive

Not all captives are created equal. Before any employer considers one, three questions should drive the evaluation.

1. How large is the membership? Risk-sharing only works when there’s enough risk to share. A captive with a handful of members concentrates exposure. What you’re looking for is scale — thousands of employers, hundreds of thousands of covered lives. Think of it like a mutual fund: a portfolio with five stocks isn’t diversified.

2. What stop-loss terms protect members when large claims hit? The frequency of catastrophic claims exceeding $2 million has increased 14.5 times for midsize businesses over the past three years. Under traditional insurance, a large claim triggers a laser at renewal — a higher individual deductible assigned to that specific claimant, plus a premium increase. You get hit twice. Look for captives offering rate caps, guaranteed no-new-laser protections, and multi-year rate stability.

3. Does the captive demand cost containment across all members? This is the question most employers never think to ask — and the most important one. A captive that allows members to opt in or out of cost containment is only as strong as its least-engaged members. The best captives require participation in vetted cost containment programs across the entire membership. When every employer in the pool is actively managing utilization, the whole community benefits. Your neighbors’ health management directly protects your renewal.

Is Your Organization a Candidate?

Strong captive candidates generally share a few characteristics: relatively clean claims history, a stable workforce, genuine investment in employee wellbeing, and leadership willing to think in years rather than months. As explored in The Wellness Abandonment Tax, healthy populations cost less — and that’s not just a wellness talking point, it’s the actuarial basis for captive participation.

The ideal window to begin the conversation is 9 to 12 months before your renewal date. A feasibility analysis requires three years of claims data, a current employee census, and your existing stop-loss terms.

The employers who will win the next five years of renewal cycles aren’t the ones who negotiated hardest at renewal time. They’re the ones who changed the game entirely.

Read the full article — including how the three-layer structure works, why catastrophic claims are reshaping the market, and what to ask your advisor → The Game Is Rigged. Here’s How to Change It.

If you’d like to explore whether a captive is the right fit for your organization, reach out directly. A feasibility conversation is the logical first step — and it starts simply.

News You Can Use

1. RPW Webinar: Navigating Medicare: Financial Planning for your Health & Wealth

Medicare decisions are more than just healthcare choices—they’re strategic financial decisions that impact your retirement income, tax planning and long-term wealth preservation. Whether you’re years away from Medicare eligibility or approaching enrollment, understanding how Medicare integrates into your comprehensive financial and estate plan is essential for protecting your assets and ensuring a secure retirement.

In this session, you will learn:

• The basics of Medicare, including key enrollment timelines, coverage options,

• and strategic decisions that affect your financial outcomes

• How to integrate Medicare planning into your overall wealth management strategy and retirement income plan

• Special considerations for high-net-worth individuals, including IRMAA surcharges, tax implications, and advanced planning strategies

Register for our webinar on March 31st at 12:00 PM CT

2. Webinar replay: 2026 Compliance & Benefits Update

The benefits and regulatory environment has never been more complex. In this webinar, HUB compliance experts break down the most important developments shaping 2026 — from AI and GLP-1 cost pressures to pharmacy trends, tariffs, and new legislation like the One Big, Beautiful Bill Act — and what employers should be doing now to stay compliant, competitive and proactive.

3. Your Pharmacy Rebate Check Is About to Get Smaller

If your plan has historically relied on pharmacy rebates to offset costs, 2026 is the year that math starts to change — and not in your favor.

HUB’s Pharmacy Consulting Practice has released a client briefing on expected changes to pharmacy rebate yield, and the headline is straightforward: rebate checks received in 2026 and 2027 will likely come in below historical levels and possibly below what your PBM projected.

Three forces are converging. First, the Inflation Reduction Act’s Maximum Fair Prices took effect January 1, 2026, covering ten high-cost drugs including Eliquis, Jardiance, Farxiga, and Stelara. Several have already seen list price reductions of 37–75% — and since rebates are typically calculated as a percentage of list price, lower list prices mean lower rebates. Second, accelerating biosimilar adoption for Humira and Stelara is shifting utilization away from the high-rebate brand products that have anchored PBM underwriting for years. Third, direct-to-consumer pricing programs — including Lilly Direct, Novo Care, and the recently launched TrumpRx program — are adding downward pressure across a broader range of products.

One thing worth watching closely: PBMs are increasingly applying “rebate credits” — the calculated difference between brand and biosimilar costs — in ways that lack transparency. If you’re not sure how your PBM agreement handles this, now is a good time to review.

The shift isn’t all bad news. Lower list prices and biosimilar adoption can reduce your members’ out-of-pocket costs. But the net impact on your plan will depend on your specific utilization of affected products and how your PBM contract is structured.

If you’d like to discuss how these changes may affect your plan specifically, reach out and we can walk through it together.

Worth Sharing

A couple of months ago, I sat down with a representative of University of Colorado Health System (UC Health). During our lunch, she shared that UC Health would be building (yet) another hospital in the Broomfield area.

If you’ve been paying attention along the front range, UC Health has built a lot of hospitals over the past 10 year. I point blank asked her why, and suggested that their continual expansion was a contributor to our cost crisis.

She responded by saying “We need the capacity. Our hospitals are full.”

If true, that’s very disappointing. It’s a leading indicator of how poor our collective health has become.

A week ago, my dad, who is partially paralyzed after a stroke in 2019, took a fall. Bleeding profusely and unable to get himself off the ground, he was taken to the ER at the Medical Center of the Rockies (MCR) by ambulance.

Ultimately, they decided to admit him for further observation. As it would turn out, the hospital was full. We had to wait at the ER until the ambulance activity decreased and a unit could be made available to transfer him to Poudre Valley Hospital in Fort Collins.

The hospital was full. Let that sink in. The UC Health rep was speaking truth.

We have a problem that goes beyond premium management. We have a people problem.

I’m working on an in-person event in late May or early June for us to tackle this problem head on. Stay tuned for more details.

I’m also working with a couple of vendor partners to create an affordable program that helps people create insights into their personal health before they need a hospital bed. I hope to roll out additional detail on that soon, also.

In the meantime, if you’d like to have a conversation about some ways we can mutually build a better, more proactive health and performance program, please reach out.

I recently heard a saying, “Bigger isn’t better. Better is better.”

We, collectively, have to do better.

Thank you for reading.

Jim Sampson Employee Benefits Advisor | HUB International theebadvisor.com

Throughout the 24 years that I’ve been advising on employee benefits, I’ve sat across the table from hundreds of employers during renewal season, delivered difficult numbers, and helped navigate some genuinely tough conversations.

This past January was different.

The 2026 renewal cycle was the most brutal I’ve experienced in my career. Not just because of the size of the increases — though double-digit renewals were routine across our book of business — but because of how many clients had done everything right and still got hammered. They’d managed their populations. They’d invested in wellness. They’d tightened their plan designs. And still, the increase came.

Much of this has been driven by our own collective lifestyle decisions. It doesn’t take robust investigative skills to quickly discern that we, as a collective society, are not in great shape.

But that doesn’t fully account for the mess we just experienced. I found myself asking a question I ask every difficult renewal season, but with more urgency this time: why are we still playing a game that was never designed for us to win?

The answer, as I’ve come to understand it over two decades in this industry, is structural. The traditional insurance market isn’t broken. It’s working exactly as designed — just not in your favor.

There is a better way. It’s been available to midsize employers for years. Most have never heard of it. And the advisors who should be recommending it often don’t, for reasons we’ll get to.

It’s called a health insurance captive. And if you’re a midsize employer between 50 and 500 employees, this may be the most important conversation you’re not having.

The Math Doesn’t Lie

Let’s start with some uncomfortable arithmetic.

Between 2010 and 2020, family health insurance premiums increased 111%. Worker earnings grew 27%. Overall inflation rose 19%. Deductibles climbed even faster than premiums — up 111% in the same period, according to the Kaiser Family Foundation.

Meanwhile, the stock prices of America’s largest health insurance carriers — what the industry calls the BUCAs — have dramatically outperformed the S&P 500 since the Affordable Care Act took effect.

Think about that for a moment. The law designed to make healthcare more affordable has coincided with an era of extraordinary profitability for the carriers managing your plan.

This isn’t an accident. It’s the Medical Loss Ratio at work.

The ACA capped insurer profits by requiring that a minimum percentage of premium revenue go toward actual claims — 80% for small groups, 85% for large groups. The intent was to limit excess profit. The reality was something different.

When your profit is calculated as a percentage of premium, the equation becomes simple: higher claims drive higher premiums, and higher premiums drive higher profit. The MLR didn’t eliminate the incentive to let costs rise. It codified it.

The result? Carriers with the resources and data to engineer a different cost trajectory have little financial incentive to do so. As we explored in Healthcare Cost Drivers Secretly Killing Your Success, this structural conflict is one of the most underappreciated forces driving your renewal — and it’s hiding in plain sight.

Low claims year? The carrier keeps the surplus. High claims year? You pay for it at renewal.

The insurer profits either way. You don’t.

BUCA Stock Prices Since the Passage of the ACA

There Is a Spectrum

Most employers think of health insurance as a binary choice: you’re either fully insured or you’re not. That’s not accurate — and that misunderstanding is costing midsize employers real money.

The reality is a spectrum:

Fully Insured → Level-Funded → Bundled Level-Funded → Group Captive → Self-Funded

Each step along that spectrum represents more transparency, more control, and more opportunity to benefit when your workforce is well-managed. Each step also requires more engagement, more data, and more financial participation.

Most employers in the 50 to 500 employee range are stuck at the left end of that spectrum — fully insured — even when their claims experience, workforce stability, and financial position would make them strong candidates for something further right.

A group captive sits in the middle of that spectrum. It gives you the transparency and data access that comes with more control over your plan, combined with the risk protection of a shared community. It’s not a leap off a cliff. It’s a deliberate step toward a structure that rewards you for managing your population well.

How a Group Captive Actually Works

A group captive is a formalized risk-sharing arrangement among a community of like-minded, well-managed employers. Instead of paying premium to a carrier and never seeing it again, member employers pool their risk together — and when the pool performs well, the financial benefit flows back to the members.

In most captives, this goes one meaningful step further: you don’t just share in the pool’s performance. You become an owner in the captive organization itself. That ownership stake changes the entire relationship. You have a seat at the table, a voice in how the captive is managed, and a direct financial interest in the health of every other member organization.

The funding structure has three layers:

Layer 1 — Your Individual Corridor Each employer retains a defined level of individual claim risk, protected by specific stop-loss coverage. Claims below this threshold are your responsibility. This is where your own data and population health management has the most direct financial impact.

Layer 2 — The Captive Layer Claims above your individual threshold, up to a defined ceiling, flow into the captive. This is the shared risk layer — where the community absorbs the volatility that would otherwise devastate a single employer. A bad year for one member is buffered by the good years of many others.

Layer 3 — Aggregate Stop-Loss Catastrophic exposure above the captive layer is covered by aggregate stop-loss insurance. This is your protection against the tail risk — the claims no employer can predict or absorb alone.

When the captive layer performs well — meaning total claims come in below the pooled funding — the surplus belongs to the members. Not to a carrier’s shareholders. To you, as an owner.

That’s a fundamentally different financial relationship than traditional insurance.

Why Catastrophic Claims Change Everything

Here is a data point that should stop you cold.

The frequency of catastrophic claims exceeding $2 million has increased 14.5 times for midsize businesses over the past three years alone, according to the HCC Annual Report 2024.

To put that in context: gene therapy now runs approximately $3 million per intervention. Advanced cancer treatment can reach $1 million. Organ transplants approach $750,000. Dialysis runs $600,000 annually.

These are no longer rare edge cases. They are increasingly routine events — and a single one can reshape your entire cost trajectory for years.

Here’s why that matters so much under traditional insurance: when a high-cost claimant surfaces in your plan, the carrier responds at renewal with two potential punishments. First, they will increase your premium based on your experience. Second, they (depending on your funding scenario) could apply what’s called a laser, a higher individual deductible assigned specifically to that claimant, meaning you absorb more of their costs in the next plan year. You get hit twice.

Under a well-structured group captive, that dynamic changes. The catastrophic risk is absorbed by the community, protected by stop-loss terms that don’t allow the carrier to laser your worst claimant year after year. The cost curve flattens. The double hit disappears.

As we discussed in the December 2025 edition of The Advisor’s Edge, catastrophic claims are no longer a planning edge case. They belong at the center of your benefits strategy.

Three Questions to Evaluate Any Captive

Not all captives are created equal. The structure matters less than the community you’re joining and the terms protecting that community. Before any employer considers a captive, three questions should drive the evaluation.

1. How large is the membership?

Risk-sharing only works when there’s enough risk to share. A captive with a handful of members concentrates exposure — one bad year for two or three employers can destabilize the entire pool.

What you’re looking for is scale. Thousands of employers, not dozens. Hundreds of thousands of covered lives, not tens or hundreds. That level of scale creates the actuarial cushion that enables year-over-year predictability, and it delivers negotiating leverage that no individual midsize employer can replicate on its own.

Think of it like a mutual fund. A portfolio with five stocks isn’t diversified. A portfolio with thousands of positions weathers volatility differently. The same principle applies to the pool of employers sharing your captive’s risk.

2. What stop-loss terms protect members when large claims hit?

This is where the fine print separates good captives from great ones.

Look for three specific protections: a cap on annual rate increases, guaranteed protection against new lasers for existing members, and multi-year rate stability that doesn’t evaporate after a single large claim.

Without these protections, you’ve traded one volatile structure for another. With them, you gain the ability to plan — not just for the current year, but for the three to five years ahead.

Employers who evaluate captives based on year-one pricing alone are making the same mistake they make in traditional insurance. The real value is in the trajectory, not the starting point. Captive members who commit to the structure and work the program consistently report savings that compound meaningfully over time.

3. Does the captive demand cost containment across all members — or is it every employer for themselves?

This is the question most employers never think to ask. It is also the most important one.

A captive that allows members to opt in or out of cost containment strategies is only as strong as its least-engaged members. If your neighbors in the pool are mismanaging their populations — high-cost claimants going unmanaged, behavioral health issues unaddressed, pharmacy spend unchecked — you share in the consequences even if your own population is well-run.

The best captives address this by requiring participation in vetted cost-containment programs across the entire membership. Not as a suggestion. As a condition of membership.

When every employer in the pool actively manages utilization, controls pharmacy spend, addresses behavioral health early, and invests in workforce wellbeing, the whole community benefits. Your population’s health management protects your renewal. So does everyone else’s.

This is the flywheel that traditional insurance structurally cannot offer. As we explored in The Silent Claims Accelerant, behavioral health conditions alone account for 56.5% of total plan costs for the individuals carrying those diagnoses. That is a community problem. A well-run captive treats it as one.

This Problem Is Bigger Than Your Budget

Before we discuss whether a captive might be right for your organization, it’s worth stepping back from the spreadsheet for a moment.

Healthcare costs are not just a CFO problem. They are a workforce problem.

According to the Allstate Health Solutions Benefit Survey, 62% of employees at midsize employers believe their healthcare contributions are too high. Healthcare is the leading cause of personal bankruptcy in America. And 78% of employees say they would leave their current employer for better benefits.

The renewal shock you just survived is not abstract to your workforce. Every time you raise deductibles, increase employee contributions, or narrow the network to control costs, it lands personally on the people doing the work. It affects their financial security, their decisions about seeking care, and ultimately their decision about whether to stay.

The employers winning the benefits conversation — in both cost and talent — are the ones who’ve stopped treating health insurance as an annual line item and started treating it as a long-term strategic investment.

That shift in thinking is exactly what a well-designed captive makes possible.

Is Your Organization a Candidate?

A group captive is not the right fit for every employer. But many more midsize employers qualify than realize it. Here is what the profile of a strong captive candidate looks like.

Your claims history is relatively clean. You don’t need a perfect record — a few difficult years won’t automatically disqualify you — but underwriters are looking for employers who demonstrate intention around population health management. Three years of claims data is the starting point for any serious feasibility conversation.

Your workforce is reasonably stable. High turnover creates unpredictability in population health data, which makes it harder to price risk accurately. Employers with stable, engaged workforces are the foundation of every strong captive.

You’re already investing in employee wellbeing — or you’re ready to. As explored in The Wellness Abandonment Tax, healthy populations cost less. That’s not just a wellness talking point — it’s the actuarial basis for captive participation. Employers who proactively manage their workforce’s health bring better risk to the pool, and that translates directly to financial performance.

Your leadership is ready to think in years, not months. The fully insured model conditions employers to think in 12-month increments. Captive participation rewards a longer view. The financial benefits compound over time — employers who commit to the structure and manage their population consistently see meaningful savings grow year over year.

Your financial position supports participation. Captives require more upfront financial engagement than fully insured plans. The tradeoff is access to surplus dollars when you perform well. If cash flow is a primary constraint, a feasibility conversation will help clarify whether the timing is right.

The ideal window to begin that conversation is 9 to 12 months before your renewal date. A feasibility analysis typically requires three years of claims data, a current employee census, and your existing stop-loss terms. The process is not burdensome — but it does require intention.

What to Ask Your Advisor

Here is an honest observation after 24 years in this business: not every advisor is equipped to have this conversation.

Placing a group in a captive requires a different skill set than renewing a fully insured plan. It requires relationships with captive managers, familiarity with stop-loss markets, and the analytical capability to evaluate whether a specific captive’s structure, membership, and terms actually deliver what they promise.

Complacent advisors don’t recommend captives. Not because they aren’t right for their clients — but because the work is harder, the learning curve is steeper, and the path of least resistance is to renew what’s already in place. We addressed this pattern directly in Healthcare Cost Drivers Secretly Killing Your Success — broker complacency is one of the most expensive forces in your benefits program, and most employers never see it.

If your advisor has never placed a group in a captive, it doesn’t automatically disqualify them. But it should prompt a direct conversation about whether they have the relationships and expertise to guide you through the process — or whether a second opinion is warranted.

The right advisor asks the three questions above before recommending any captive. They evaluate pool size, stop-loss terms, and cost containment requirements with the same rigor they’d apply to any plan design decision. And they’re transparent about their own experience and limitations.

The Game Can Change

The traditional insurance market is not going to fix itself. The incentives running the system benefit carriers, not employers. Premium revenue is the engine. Your cost increases are the fuel.

But midsize employers in the 50 to 500 employee range are not without options. They are not too small to demand transparency. They are not too small to share risk intelligently. They are not too small to benefit when their workforce is healthy and their population is well-managed.

A group captive is not a silver bullet. It is a structure that rewards employers who are willing to engage — with their data, with their population, with their long-term strategy.

The employers who will win the next five years of renewal cycles are not the ones who negotiated hardest at renewal time. They are the ones who changed the game entirely.

You have more control than you think. The question is whether you’re ready to use it.

If you’d like to explore whether a captive is the right fit for your organization, I’d welcome the conversation. A feasibility analysis is a logical first step — and it starts simply. Reach out to me directly at jim.sampson@hubinternational.com and let’s find out together.

Sources:

• Kaiser Family Foundation, Employer Health Benefits Survey 2020

• HCC Annual Report 2024

• Allstate Health Solutions Benefit Survey 2024

• Milliman (independent review of captive member savings data)

Under final rules issued in 2024, any HIPAA Notices of Privacy Practices (NPP) need to be updated by February 16, 2026. HUB previously wrote about these rules here.

When our article was originally published, HHS had not yet updated the model notices; however, these have now been updated. The updated notices can be found at the link below.

https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/model-notices-privacy-practices/index.html

HUB clients, please note, our annual notice kit includes the Notice of Availability not the full NPP. The Notice of Availability lets employees know they can request the full NPP.

What the #@!! Just Happened? Understanding the 2026 Healthcare Cost Crisis

If you feel like you were just hit by a truck, you’re not imagining things.

The 2026 renewal cycle has been one of the most brutal in recent memory. Employers across the country are staring at double-digit increases, asking the same question: “What the hell happened?”

The answer isn’t simple. But it’s findable.

After 24 years in this business, I’ve seen plenty of challenging renewal seasons. This one stands out. Not just because of the size of the increases, but because of how many forces converged at once. Specialty drugs exploded. Mental health costs embedded themselves across every care pathway. GLP-1s went from niche diabetes treatments to mainstream metabolic therapy. And the post-pandemic catch-up care wave is still surging.

The data from Springbuk’s 2026 Employee Health Trends report makes it clear: this isn’t a temporary spike. These are structural shifts that will shape your benefits strategy for years to come.

Here’s what you need to understand about what’s driving your costs right now.

GLP-1s: From Disruption to Foundation

About 30% of current non-specialty brand-name drug spend is for GLP-1s used in diabetes treatment. Another 10% is for obesity treatment. While most employer plans exclude weight loss treatment options, we’re seeing some leakage.

GLP-1s have gone from niche to mainstream faster than almost any drug category in history. And demand shows no signs of slowing. Potentially lower price points, introduction of oral GLP-1s for obesity, greater use for cardiovascular risk reduction, and potential new indications like chronic kidney disease are all on the near-term horizon.

The increasing spend isn’t primarily from higher prices per prescription. It’s from more members taking these drugs. And that number will continue growing.

What’s critical to understand is that GLP-1s are becoming foundational metabolic therapies with cost implications that extend far beyond obesity. These drugs impact cardiovascular health, kidney function, and long-term diabetes management. The question isn’t whether to cover them. The question is how to structure coverage in a way that’s clinically appropriate and financially sustainable.

As of now, only 42% of users remain on their medications for more than 90 days. Until those compliance rates increase, the costs incurred make it difficult to justify additional investments.

Mental Health: Embedded Across Everything

Mental health costs are not episodic. They are embedded across care pathways.

Depression is the #1 driver, bigger than any behavioral health condition. Mental health condition group spend climbed from $8 PMPM in 2022 to $10.19 PMPM in 2025 for depression alone. Behavioral health overall went from $16 PMPM to $20.58 PMPM.

Therapeutic services, evaluation, and management are carrying most of the spending growth. Interestingly, telehealth did not drive growth, contrary to what many assumed. And the age group seeing the fastest rise in therapy utilization is 35-49, not younger employees.

What this tells us is that mental health isn’t a standalone benefit category. It’s woven into chronic disease management, musculoskeletal issues, gastrointestinal conditions, and productivity across your entire workforce.

The Visibility Problem

Here’s the underlying issue that makes all of this harder to manage: employers not only have a cost problem but they also have a visibility and prioritization problem.

Every missed opportunity adds up, driving costs 10-15% higher and leaving millions on the table. When you don’t have clear data on where your costs are clustering, you can’t design targeted interventions. You’re left making generic plan design changes that shift costs to employees without addressing root causes.

When you can see these patterns in your own population, you can act with precision. Self-funded employers have a significant advantage here. You have access to your data. You can see exactly where your costs are concentrated and design programs that address your specific population’s needs.

Five Strategic Trends to Watch in 2026

Beyond the cost drivers themselves, five broader trends are reshaping how employers need to think about benefits strategy:

1. Pharmacy strategy becomes central to overall affordability

Pharmacy is no longer a separate silo. It’s driving overall benefit plan affordability and patient experience. Integrated pharmacy strategies that address both medical and Rx channels, manage specialty drug utilization, and create clear coverage policies for GLP-1s will be table stakes in 2026.

2. Benefits as a talent lever intensifies

Benefits continue to be a key differentiator in hiring and retention, especially as employee expectations shift toward more flexible, personalized, and purpose-driven offerings. The organizations that treat benefits as a strategic talent investment will outperform those that treat it purely as a cost center.

3. Consumer experience expectations accelerate

Employee expectations for the healthcare experience will continue to accelerate, driving investment in AI-powered personalization, digital navigation tools, and integrated care experiences that deliver simplicity, clarity, and proactive support. Employees want healthcare to feel as seamless as every other consumer experience in their lives.

4. Advanced analytics become non-negotiable

As healthcare costs continue to grow more complex, advanced analytics, forecasting, and consumer-centric strategies will play a larger role in helping employers stabilize budgets and reduce year-over-year volatility. The organizations that invest in data infrastructure and analytical capabilities now will have a decisive advantage.

5. Health and Performance regain prominence

With these types of increases rocking employers, we have to revisit conversations about keeping your people well. If you haven’t made effort to remove barriers to care and explored incentives for primary care partnerships, it’s time to consider those. As well, “Know Your Numbers” campaigns that were once commonplace in the early 2000’s must be revisited. Trends indicate people are ignoring the blocking and tackling now that could prevent crisis conditions later.

Three Questions for 2026

As you process these trends and turn to your own data, three questions should guide your strategy:

1. Where are my costs really coming from?

2. Who in my population is being left behind?

3. Am I set up to adapt or just to react?

These questions don’t have easy answers. But they have findable answers when you have the right tools and the right approach to your data.

The 2026 renewal cycle was brutal. But it also created clarity. You now know exactly how much it costs to operate without visibility, without targeted interventions, without data-driven prioritization.

The question is what you do with that knowledge.

---

Sources:

- Springbuk + Truven Health Analytics, Employee Health Trends 2026 Report

- Cigna 2026 Health Care Trends report

- Mercer 2025 National Survey of Employer-Sponsored Health Plans

News You Can Use

1. Understanding Benefit Use Gaps

HUB recently released our 2025 Workforce Vitality Gap Index report. One of the key topics address is why employees are not using your benefits and what to do about it. Check out the report here.

2. 2026 Compliance and Benefits Update

We’ll be hosting our 2026 Compliance and Benefits webinar on February 25th. Learn more and register here.

3. DisruptHR Northern Colorado on March 3rd

DisruptHR isn’t just an event, it’s a reset, and DHR Northern Colorado 6.0 is raising the bar even higher.

Yes, you’ll get fast-paced, thought-provoking presentations and a room full of people who love challenging the status quo, but what really sets the Northern Colorado event apart is the experience. During the event, we come together as a group to participate in a live fundraiser for a local cause, turning the energy in the room into real impact for our community.

Add in interactive games, meaningful networking, food and beverages, and the chance to win some seriously fun door prizes, and you’ve got an event that’s engaging from start to finish with multiple chances to get up and stretch your legs!

Past Door Prizes Have Included:

⌚ Apple Watch

📱 iPads

🧊 YETI Coolers

🍷 Wine Sampler Baskets

💳 Gift Cards

✈️ Grand Prize: $500 Southwest Airlines Gift Card

Stick around until the end. You might leave inspired and planning a getaway.

When? March 4th at 1 PM

Where? The Candlelight Dinner Theatre - 4747 Marketplace Dr, Johnstown, CO 80534

What to Bring? Just your disruptive self! Drinks and light food will be provided.

Click Here to get your tickets (only $25)

Worth Sharing

In the feature article above, I addressed revisiting “know your numbers” campaigns. The benefits of doing so are front and center for me, as my wife and I just signed up for Function Health.

While a number of testing companies are emerging, this one offered a nice mix of affordability and comprehensiveness.

Function’s website says, “A fulfilling life depends on health, and health depends on awareness. You are the source of your truth and we are here to enrich you with the deepest awareness of what is happening within you.”

Said another way, “A healthy person thinks about a lot of things. An unhealthy person mostly thinks about a single thing.”

If you’d like to know your own numbers, I’d be honored if you did so using my referral code. Function Health charges $365 for two tests a year that will exam over 160 biomarkers.

To your health,

Jim Sampson

The Wellness Abandonment Tax

Did we forgo one of our most effective tools?

This time of year always feels deeply contemplative. Invariably, I carve out a few hours to complete a process of reflection before I begin to set goals and targets for the year ahead.

These aren’t resolutions. Resolutions feel like hope. This is a process of asking what worked, what didn’t work, and who do I want to become in work, community, relationships, physically, and spiritually.

While I’m largely ignorant as to whether this practice of reflection is commonplace, I assume you also do something similar - if the number of ads for planners, coaching, and other related tools that appear in my various feeds are any evidence.

More likely than not, you may still be reeling from one of the most difficult renewal seasons ever. You are likely asking yourself, “how do we prevent this from happening again next year?”

I assure you, I too am asking that question.

Most employers responded by raising deductibles, tightening formularies, looking at alternatives like unbundling and captives, and, as always, negotiating harder with carriers. These tactics matter. But they're addressing symptoms, not causes.

What gets left out of these strategies arguably might be the most effective answer. The best way to keep healthcare costs affordable is, and always has been, to use less healthcare.

And right now, companies that ignore employee wellbeing aren’t just missing an opportunity. They’re paying a hidden tax that compounds every renewal cycle.

What You’re Already Paying

When employees are stressed, burned out, and struggling with their health, it doesn’t show up as a single line item. Instead, numerous studies suggest it bleeds across your entire budget:

• Presenteeism (employees present but unproductive): up to $12,000 per employee annually

• Burnout: $4,000-$20,000 per employee, depending on role

• Turnover: 50-200% of salary to replace each departed employee

• Absenteeism: $4,080 per employee annually

For a 500-employee company with moderate burnout levels, that’s $2-6 million in annual hidden costs.

And every single one of these costs feeds directly into your healthcare trend. Burned-out employees get sick more often. They delay care until problems become expensive. They develop chronic conditions that require ongoing treatment.

The Business Case

The ROI for health and performance programs ranges from $3 to $6 for every dollar invested. Johnson & Johnson saved $250 million over six years through wellness initiatives, generating $2.71 for every dollar spent.

Companies with comprehensive wellness programs experience:

• 14-19% lower absenteeism rates

• 25% less employee turnover

• One-third less voluntary turnover overall

Mental health support specifically returns $1.50 to $4.00 for every dollar invested.

Here’s what connects directly to your renewal challenge: lower utilization drives lower trend, which creates more manageable renewals. When your workforce is healthier, they need less healthcare.

What Actually Works

Effective health and performance programs are holistic, addressing physical health, mental health, financial wellbeing, and work-life integration. They’re not token gestures. They’re strategic investments in your workforce’s capacity to perform.

For self-funded employers, you have a significant advantage: data access. You can see exactly where costs are concentrated and implement targeted interventions. If musculoskeletal issues are generating claims, focus on direct-contract programs, ergonomics, and preventive care. If mental health medications drive your pharmacy spend, examine your wellbeing resources and promote activities that create community and connection.

The Choice You’re Making

You’re not choosing whether to spend money on employee wellbeing. Your employees’ health status is driving costs whether you’re investing in it proactively or not.

What you’re actually choosing is how to spend that money:

Option A: Invest $500 per employee proactively in wellness programs. Get $3-$6 back through reduced costs and higher productivity.

Option B: Pay $4,000-$12,000 per employee reactively through presenteeism, burnout, and turnover. Then face another brutal renewal next year.

The wellness abandonment tax comes due every payroll period. And it shows up again at renewal when your carrier tallies up another year of claims.

When your people feel better, they do better. They use less healthcare. Your renewals stabilize.

It’s not complicated. It’s profitable. And it’s the most sustainable strategy for the challenge you just survived.

Want to dive deeper into the data behind the wellness abandonment tax? Read the full article The Wellness Abandonment Tax.

HUB Can Help

Did you know that your partnership with HUB includes access to our Health and Performance Team? HUB’s Health and Performance team offers comprehensive strategic guidance across a broad spectrum of wellbeing areas to help organizations and their employees thrive. In addition to our strategic vertical consulting work, we provide tactical support through a variety of service verticals, such as biometric screenings, health fairs, and other wellness initiatives that engage employees and
provide actionable insights.

Please let me know is you’d like to discuss this topic further.

News You Can Use

1. Partnership Article: Why the traditional fully insured model wasn’t built for the modern healthcare environment: Read it here.

2. HUB recently released our Outlook 2026

   HUB 2026 Outlook highlights insights and expertise across employee benefits, specialty industries, retirement, private client and personal insurance. This year’s theme, "From Reactive to Ready: How Risk Management Maturity Leads to Resilience and Profitability," reflects the growing need for smarter, enterprise-wide risk management. As risks become more complex, costly, and interconnected, organizations that invest in risk maturity are better positioned to protect profitability, strengthen resilience, and support workforce vitality. Check out the full report here: HUB Outlook 2026.

3. The December Issue of HUB’s In Compliance Newsletter was released on December 22, and includes the following topics:

   1. Newly released federal guidance shines some helpful light on the handling of HSAs with telehealth and DPC arrangements.

   2. Another dismissal handed down on the initial and largest case alleging breach of fiduciary duty for a health and welfare plan.

   3. A review of the loss of government health plan subsidies and when that triggers a qualifying event.

   4. In the final installment in a series about DCAPs, we review the most common reasons, and resolutions, for when a plan fails discrimination testing.

   5. Our annual article summarizing to-do items for benefit plans in 2026.

Worth Sharing

1. As a veteran of the U.S. Army Reserves, I was pleased to learn that HUB has received recognition as a Military Times Best for Vets Employer. We join USAA, Zurich North America, Travelers, The Cigna Group, Liberty Mutual, Blue Cross Blue Shield of South Carolina, Progressive, and Armed Forces Mutual as one of nine insurance industry companies to make this list. The 2025 ranking is now LIVE and available at: bestforvets.militarytimes.com/employers.

   

2. Some of you know that I’m a big fan Peter Atia’s book, Outlive: The Science and Art of Longevity. As we think more about the “wellness abandonment tax” and set our own health and wellbeing goals, I want to share a resource that may be worth examining. My wife and I will be joining Fuction in 2026.

   While it’s too early to provide any sort of endorsement or personal testimony, I’ve had a few clients ask how they could incorporate ideas from Outlive into their own lives. This seems to be a promising possibility.

   Function facilitates access to over 160 health screening tests, and enables members to monitor early indicators of 1000s of diseases and health conditions.

We are in the season when people begin to think about resolutions. How will they make next year better? What could they do differently? Who can they become.

We are also in the season where business owners and CFOs finalie their budgets and plan for their investments in the coming year.

Many are still trying to process what the hell happened to their health insurance plan? Companies are still reeling from some of the largest increases the industry has ever seen. Specialty drug costs have exploded. Post-pandemic catch-up care isstill surging. And million-dollar claims have increasingly become normal.

You’ve already raised deductibles. Tightened the formulary. Negotiated harder with the carrier. But as you finalize that budge and you stare at those numbers, you know it means smaller bonuses, delayed hiring, and another difficult conversations in the months to come.

The unavoidable question is, “How do we prevent this from happening again next year?”

Most employers respond to this question by doubling down on plan design changes, pharmacy benefit management strategies, and stop-loss shopping. These tactics matter. But they’re addressing symptoms, not causes.

There’s a more fundamental lever that most organizations are missing entirely.

The best way to manage healthcare costs is to need less healthcare.

And right now, companies that ignore employee wellbeing aren’t just missing an opportunity. They’re paying a hidden tax that compounds every renewal cycle. I call it the wellness abandonment tax, and it’s costing employers millions in ways they never see coming.

The Hidden Invoice

Let’s talk about what you’re already paying.

When employees are stressed, burned out, and struggling with their health, it doesn’t show up as a single line item on your budget. Instead, it bleeds across dozens of categories, making the true cost nearly impossible to track.

Here’s what the research shows:

Presenteeism (employees who show up but aren’t really there) costs up to $12,000 per employee per year. That’s seven times more expensive than absenteeism. These are people sitting at their desks, attending meetings, responding to emails, but operating at 50% capacity because they’re exhausted, anxious, or unwell.[1]

Burnout costs between $4,000 and $20,000 per employee annually, depending on their role. For executives, that number climbs above $20,000. And here’s what makes it particularly insidious: 89.5% of these costs come from presenteeism, which means most employers have no idea they’re paying it.[2]

Turnover driven by burnout and poor well-being costs between 50% and 200% of an employee’s annual salary to replace them. That includes recruitment, training, lost productivity during the transition, and the knowledge that walks out the door.[3]

Absenteeism costs $4,080 per employee annually in the U.S., adding up to $600 billion across the economy each year.[4]

Do the math for a 500-employee company. If even half your workforce is experiencing moderate levels of burnout and disengagement, you’re looking at $2 to $6 million in annual hidden costs. These aren’t projections. This is what’s happening right now.

And every single one of these costs feeds directly into your healthcare trend. Burned-out employees get sick more often. They delay care until problems become expensive. They’re more likely to end up in the ER instead of urgent care. They develop chronic conditions that require ongoing treatment.

The wellness abandonment tax isn’t a future risk. It’s a current expense you’re already paying.

The Visible vs. Invisible Cost Trap

After a brutal renewal season, budgets are tight. Leadership is looking for places to cut. And wellness programs can look like an easy target.

After all, the wellness program has a clear price tag: maybe $150 to $1,200 per employee per year, depending on what you’re offering. That’s $75,000 to $600,000 for a 500-person company. It’s right there in black and white.

The costs of NOT investing in wellness? Those are spread across your entire P&L. They show up as:

• Overtime pay covering for absent employees

• Temporary staffing fees

• Recruitment and onboarding expenses

• Training costs for new hires

• Lost productivity that never gets measured

• Healthcare claims that seem disconnected from wellbeing

• Disability claims

• Workers’ compensation costs

CFOs see the program cost crystal clear. But they miss the abandonment tax entirely because it’s distributed across so many categories that no single line item screams “this is a wellbeing problem.”

The short-term logic seems sound: “We’ll save $500,000 by cutting the wellness program.”

The reality: You’ll pay $2 to $3 million in hidden costs instead. And when renewal season comes around again, you’ll be right back where you started, except now your workforce is in worse shape and your healthcare trend is even steeper.

What the Data Actually Shows

Let’s look at what happens when companies actually invest in employee wellbeing.

The ROI on wellness programs ranges from $3 to $6 for every dollar invested. Johnson & Johnson, one of the most studied examples, saved $250 million over six years through their wellness initiatives, generating $2.71 for every dollar spent.[5]

Seventy-two percent of companies see reduced healthcare costs after implementing wellness programs. Ninety-five percent of companies that actually measure their wellness program ROI report positive returns.[6]

But the benefits extend far beyond direct healthcare savings.

Companies with comprehensive wellness programs experience 14% to 19% lower absenteeism rates. They see 25% less employee turnover compared to organizations without wellness initiatives. And companies with high employee wellbeing have one-third less voluntary turnover across their entire workforce.[7]

The connection between wellbeing and performance isn’t abstract. Healthier employees are more focused, more creative, and more productive. They make fewer errors. They collaborate more effectively. They bring their best thinking to the problems that matter most to your business.

Mental health support specifically returns $1.50 to $4.00 for every dollar invested, primarily through reduced absenteeism and healthcare costs.[8]

Here’s the piece that connects directly back to your renewal challenge: lower utilization drives lower trend, which creates more manageable renewals. When your workforce is healthier, they need less healthcare. It really is that straightforward.

Wellness isn’t a perk. It’s the most sustainable cost containment strategy you have.

Beyond the Gym Membership

The wellness programs that actually work aren’t the token gestures most people picture. They’re not about offering a gym discount and calling it a day.

Modern, effective wellness programs are holistic. They address the full spectrum of what impacts employee health and performance:

Physical health: Preventive care, activity programs, chronic condition management, biometric screenings that catch issues early, and disease-specific support for diabetes, hypertension, and other common conditions.

Mental health: Employee Assistance Programs, counseling services, stress management resources, and genuine organizational commitment to psychological safety.

Financial wellbeing: Education on benefits decisions, retirement planning, debt management, and the financial literacy that reduces one of the biggest sources of stress in people’s lives.

Work-life integration: Flexibility in how and when work gets done, clear boundaries around after-hours expectations, and a culture that doesn’t glorify burnout.

The engagement factor matters enormously. A wellness program only delivers ROI if employees actually use it. Participation rates are the difference between a program that pays for itself and one that’s just an expense.

Leadership modeling makes the difference here. When executives talk openly about using mental health resources, when managers take their PTO without apology, when senior leaders participate in wellness challenges, it signals that these programs are legitimate, not just HR theater.

Evidence-based programs consistently outperform ad-hoc initiatives. One study showed 38% fewer hospitalizations among participants in structured wellness programs compared to non-participants.[9] When programs follow established models with proven effectiveness, the results speak for themselves.

For self-funded employers, you have a significant advantage: data access. You can see exactly where your costs are concentrated. If GLP-1 medications for diabetes are driving pharmacy spend, you can implement targeted weight management programs. If musculoskeletal issues are generating claims, you can focus on ergonomics and preventive physical therapy. If mental health is the pressure point, you can expand counseling access and stress management resources.

This isn’t guesswork. It’s using your own data to address your specific population’s needs.

From Cost Center to Competitive Advantage

The strategic question isn’t whether wellness programs cost money. Of course they do. The strategic question is whether you’re going to pay proactively or reactively.

And right now, the wellness abandonment tax is growing every single year.

Burnout rates are at record highs. Mental health claims continue climbing. And here’s what should concern you most: younger workers (Gen Z and Millennials) are experiencing burnout at significantly higher rates than older generations. Sixty-eight percent of Gen Z and 61% of Millennials report experiencing burnout, compared to 47% of Gen X and 30% of Boomers.[10]

This isn’t a problem that’s going to solve itself as your workforce ages. It’s getting worse.

Organizations that invest in wellbeing now position themselves for sustainable success across multiple dimensions:

They reduce future healthcare trend over a three-to-five-year horizon. They improve retention in labor markets where top talent has options. They build cultures where people actually want to work, which matters when 87% of workers consider health and wellness offerings when choosing employers.[11]

And they prevent the renewal shock you just survived from becoming an annual ritual.

Wellness investment is renewal insurance. It’s risk management. It’s workforce strategy. And it’s one of the few levers you can pull that improves both the human experience and the financial outcomes simultaneously.

The Choice You’re Actually Making

Let’s return to our CFO, sitting with those budget projections, asking how to prevent this from happening again.

The answer isn’t more aggressive pharmacy benefit management, though that helps. It’s not higher deductibles, though sometimes that’s necessary. It’s not shopping carriers every year, though competition keeps everyone honest.

The answer is addressing the root cause: the health and wellbeing of your people.

You’re not choosing whether to spend money on employee wellbeing. That choice has already been made for you. Your employees’ health status is driving costs whether you’re investing in it proactively or not.

What you’re actually choosing is how to spend that money.

Option A: Invest $500 per employee proactively in comprehensive wellness programs. Get $3 to $6 back through reduced healthcare costs, lower turnover, less absenteeism, and higher productivity. Build a healthier workforce that needs less expensive care.

Option B: Pay $4,000 to $12,000 per employee reactively through presenteeism, burnout, turnover, and absenteeism. Watch these hidden costs bleed across your entire organization. Then face another brutal renewal next year because your workforce’s health hasn’t improved.

The wellness abandonment tax comes due every single payroll period. It shows up in reduced output, in vacant positions that take months to fill, in overtime that never quite catches up, in good people who leave for opportunities at companies that seem to care more about their wellbeing.

And then it shows up again at renewal, when your carrier or actuary tallies up another year of claims and delivers projections that make you wonder how much longer this is sustainable.

When your people feel better, they do better. They show up with energy. They solve problems instead of creating them. They stay instead of leaving. And they use less healthcare.

It’s not complicated. It’s profitable. And it’s the most sustainable strategy for the challenge you just survived.

References

[1] Life Guides. “The True Cost of Employee Disengagement and Presenteeism...and How To Fix It.”

https://www.cdc.gov

(CDC research shows presenteeism costs up to $12,000 per employee annually, 7x absenteeism costs)

[2] Martinez, M.F., et al. “The Health and Economic Burden of Employee Burnout to U.S. Employers.” American Journal of Preventive Medicine, Volume 68, Issue 1, 2025. https://www.sciencedirect.com/science/article/abs/pii/S0749379725000236

[3] Enrich Financial Wellness. “The Cost of Replacing an Employee and the Role of Financial Wellness.” (Replacing employees costs 50-200% of annual salary)

[4] Employee Benefit Research Institute. “Unplanned absenteeism costs U.S. businesses approximately $600 billion annually, or $4,080 per employee.” 2024.

[5] Holisticare. “Corporate Wellness Programs: Real ROI Data for 2025.” November 2025. https://holisticare.io/blog/corporate-wellness-programs/

[6] SFM Mutual Insurance. “Measuring workplace wellness program ROI and VOI.” March 2024. https://www.sfmic.com/roi-and-voi-a-strong-wellness-program-measures-both/

[7] Infeedo. “Why Corporate Wellness Programs Are Worth Every Penny in 2025.” July 2025. https://www.infeedo.ai/blog/corporate-wellness-programs-worth-every-penny-2025

[8] Enthea. “How Much Does Mental Health Cost Employers?” April 2025. https://www.enthea.com/resources/how-much-does-mental-health-cost-employers

[9] SurveyConnect. “ROI Of Employee Wellness Programs & Assessments.” December 2025. https://surveyconnect.com/news/the-roi-of-employee-wellness-programs-and-assessments/

[10] Wellhub. “Employee Burnout in the US: Symptoms, Impact, Prevention, Stats.” November 2025. https://wellhub.com/en-us/blog/wellness-and-benefits-programs/burnout/

[11] Workhuman. “20 Impactful Workplace Wellness Statistics in 2025.” October 2025. https://www.workhuman.com/blog/workplace-wellness-statistics/

Is your renewal giving you sticker shock? You’re not alone.

This has been one of the most difficult renewal seasons I’ve experienced in my 23 years as an employee benefits advisor.

The numbers tell the story: employers are seeing health insurance cost increases ranging from 10% to 30% for 2026—the steepest jump in over a decade. Even some of our captive programs are calling for increases in their stop-loss rates of 15-20%, despite being specifically designed to manage costs more effectively.

What’s driving these unprecedented increases? Three major trends are converging all at once.

The Specialty Medication Surge

Specialty medications have become the dominant cost driver in pharmacy spend. These high-cost drugs, including GLP-1s for diabetes, advanced cancer therapies, autoimmune treatments, biosimilars, and gene therapies, now account for more than half of total pharmacy spending despite serving fewer than 2% of employees.

GLP-1 medications offer a telling example. Initially developed for diabetes management, utilization has exploded as these drugs prove effective for both blood sugar control and weight management. Prescription drug spending among large employers rose 9.4% in 2025, driven mainly by specialty drugs like GLP-1s.

But GLP-1s are just one piece of a larger puzzle. Advanced therapies for cancer, autoimmune conditions, and rare diseases are reshaping pharmacy budgets. In some health plans, a single specialty drug category can represent 10% or more of annual prescription spend—and the pipeline shows no signs of slowing.

The challenge: these medications often deliver real clinical value for employees who need them. The question employers face isn’t whether to cover them, but how to manage their impact sustainably.

Post-Pandemic Catch-Up Care

Employees delayed care during the pandemic. Now they’re back—often with more advanced conditions requiring more intensive treatment.

Outpatient visits, surgeries, and chronic condition management are all rising. This “catch-up wave” is driving a 5% to 10% increase in utilization compared to pre-pandemic levels, and it’s expected to continue through 2026.

Catastrophic Claims Are the New Normal

Million-dollar claims have tripled over the past decade. What used to be rare events are now routine, driven by complex surgeries, specialty drugs, and advanced therapies.

Stop-loss carriers are responding with tighter terms and higher premiums, adding another layer of cost pressure for self-funded employers.

What This Means for You

These aren’t temporary blips. The underlying cost drivers (specialty pharmacy, provider consolidation, deferred care, and utilization increases) aren’t going away.

The challenge isn’t just managing costs. It’s doing so while maintaining coverage that employees value and can actually afford to use.

Traditional employer responses, including raising deductibles and out-of-pocket maximums, and increasing employee contributions, remain viable ways to address these challenges.

However, we’re seeing expanded conversations around high-performance networks, unbundled health plan structures, stop-loss captives, transparent Pharmacy Benefit Managers, reference-based pricing, and enhanced access to behavioral health, urgent care, and primary care through direct primary care (DPC) and virtual primary care (VPC) models.

That’s where strategy meets sustainability.

If your renewal caught you off guard this year, you’re not alone. But understanding what’s driving the increases is the first step toward building a more resilient benefits program for the years ahead.

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News You Can Use

HUB Outlook 2026 Now Available

HUB International has released our annual thought leadership campaign, HUB Outlook 2026. This year’s collection includes the comprehensive 2026 North America Report alongside 13 focused industry and product reports covering key insights for both U.S. and Canadian markets.

Whether you’re looking at industry-specific trends or diving deep into particular risk areas, the Outlook series provides strategic perspective for the year ahead. Access all reports here.

Stay Connected with HUB EDGE

Each month, HUB distributes HUB EDGE, our newsletter featuring timely insights on employee benefits, risk management, and insurance trends. If you’d like to receive HUB EDGE or our other communications directly, you can customize your subscriptions at our subscription preference center.

2026 Benefits Cost Trends Report

HUB’s Employee Benefits Actuarial and Financial Consulting Practice published its 2026 Benefits Cost Trends Report in August. The report analyzes the factors driving healthcare cost increases and offers strategic recommendations for employers navigating renewal season.

This data informed much of the feature article in this month’s edition. Read the full report here.

2025 Workforce Vitality Gap Index

If you missed it, HUB recently released the 2025 Workforce Vitality Gap Index, our annual report examining the disconnect between what employers offer and what employees actually value in their benefits programs.

The report identifies key gaps across five generations in the workplace and provides actionable recommendations for closing them. Both the full report and recorded webinar are available at hubinternational.com.

Worth Sharing

My son Grant married his fiancée Colby on the shore of the Sea of Cortez just before sunset on November 24th. I was asked to write a speech for them, and I thought some of the advice I gave them might be helpful to each of us.

Grant has always been most alive when he could serve. Since he was young, he had a gift for leaning in and giving his time, talent, and treasure to others who needed them more. When Colby entered his life, we saw that she shared that desire to serve.

In my toast, I broke down the word SERVE into five pieces of advice:

S is for Struggle. Avoid trying to skip the struggles. That’s where all the lessons live. Everyone wants the result without the process. The success without the failure. The reward without the work. But the struggle isn’t the obstacle. It’s the education.

E is for Experiences. Eleanor Roosevelt once said, “The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experiences.” The experiences you share will always mean more than the stuff you acquire.

R is for Revere. To revere is to respect with a tinge of awe. Brag about each other. Celebrate each other’s wins. Never stop dating. Be curious. Be present. Don’t let the monotony of living life together ever let that life become mundane.

V is for Vulnerable. To be vulnerable is to be authentic. Be truthful, even when that truth may cause disappointment. Most things that upset us probably will not matter much in a month, let alone a year. Work to be good at letting little things go.

E is for Evolve. Life will look different in your 30s than it did in your 20s. And it will undoubtedly look different in your 50s than it did in your 30s. More importantly, you will be different. You have to evolve together. Accept change. Even embrace it.

When you can change together and witness all the seasons, you discover something of unspeakable value. You discover what true love really looks like.

We wish Grant and Colby rewarding struggles, memorable experiences, unending reverence, authentic vulnerability, and mutual evolution.

Thank you for reading,

Jim Sampson

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How Underlying Behavioral Health Issues Destroy Your People and Your Plan

Can you really know what your employees are going through outside of work? Is that a realistic expectation for an employer to have?

We recently began working with a new client called Porchlight Health. Porchlight Health operates recovery and addiction treatment centers across a network of locations in Colorado and New Mexico.

In a recent conversation with Porchlight’s CEO, we discussed how the presence of behavioral health situations can create exponential claims outcomes. After our conversation, he shared a Milliman Research Report conductuted in 2020. Results included:

• Although only 27% (5.7 million) of the 21 million individuals in the study population had a behavioral health diagnosis and/or received behavioral health-specific treatment, those individuals accounted for 56.5% of total health care costs for the entire study population.

• Half of the 5.7 million individuals who received a behavioral health diagnosis and/or treatment received less than $68 each per year in behavioral health treatment.

• Over 95% of health care spending for the entire study population was used for physical treatment; the corresponding spend for behavioral health was just 4.4%.

You can read the full study HERE.

What You Missed ⏮️

1. Bridging the Vitality Gap

   Understanding and addressing the diverse needs of employees has become more complex and more critical. With five generations coexisting in the workplace, employers are challenged to recalibrate their employee benefits and total rewards programs to address a wide array of needs and values.

   The HUB International 2025 Workforce Vitality Gap Index, an annual report addressing employer and employee insights, presents key findings and offers recommendations on how to bridge those gaps by learning what questions to ask and leveraging data in new ways to achieve breakthrough results.

   Learn more HERE.

2. ACA Affordability for 2026:

   The IRS announced that ACA Affordability will increase to 9.96% from the current 9.02%. Employers will welcome the increase, which is quite substantial.

On the Horizon 🔔

Be in the room when one of today’s most inspiring leadership voices takes the stage. With authenticity, purpose, and powerful storytelling, Graci will share how leaders can:

• Lead with authenticity

• Build belonging in the workplace

• Rise through adversity

Her message has been featured in Forbes, NBC News, and Harvard Business Review— and this is your chance to hear it live.

• 2025 HUB Colorado Leadership Summit

• Empower Field - United Club

• Wednesday, October 15 2025 from 9:30AM-4:30 PM MT

Use code EARLYBIRD for 80% off now: REGISTER HERE.

Book on My Desk📚

If you’ve followed my journey, you know I’ve done some extreme fitness challenges. I promised my wife that I would chill out this year. That led me to The Gospel of Fitness by Steve McKinney. This book examines how to make fitness sustainable as we age, focusing on the three W’s - walking, weights, and watching what we eat.

I’ve been following McKinney’s program for about a month now, and highly recommend it. Check it out HERE.

Thank you for reading,

Jim Sampson

There has been no lack of words describing the pitfalls of the American healthcare system. You’ve likely heard all of them.

Recently, my daughter went to urgent care with a suspected case of meningitis. Fortunately, she was ok and learned she was suffering from a "common virus."

However, after doing the right thing by going to urgent care first, she was immediately redirected to the emergency room. Still waiting for the last of the bills to arrive, she has already incurred charges in excess of $10,000.

Perhaps it was just bad luck. Then again, maybe it was all by design.

This is a story that happens to the well-intended far too often.

It has me reflecting on all the ways we encounter expense drivers that simply remain unseen. Until we bring light into that darkness, nothing will change.

Today, we address five healthcare cost drivers receiving too little attention.

In no particular order, these are the special few that we all need to spend a little more time thinking about and considering how we can mitigate or temper their negative influences.

• Insurance Companies

• Healthcare Aggregation

• The Pharmaceutical Quagmire

• Brokers and Insurance Agencies

• Human Nature

Insurance Companies

Innovation hasn’t died, but it has largely been thwarted by the ever-present need to generate profits.

This seems to be especially true when we take a look at America's largest insurance companies.

The Affordable Care Act attempted to temper the profitability of insurance companies by introducing the Medical Loss Ratio (MLR).

This capped how much an insurance company could capture for operational expenses and required a pre-determined ratio to be dedicated to claims payments. (Insurance companies can retain 20% for small groups and 15% for large groups.)

However, the MLR effectively codified insurance companies' profitability. As a result, service, innovation, and cost containment have arguably suffered.

When you are guaranteed revenue on 15% of the premium, how do you grow that revenue?

You have to increase premiums.

MLR has created a fundamental conflict for insurance companies. While they have the resources and ability to create a different cost trajectory for their insureds, doing so is not in the interest of their shareholders.

Most employers could benefit from a pivot towards self-insuring and unbundling, giving you control, financial transparency, and access to data at a level that does not exist under these traditional arrangements.

Healthcare Aggregation

When it comes to dysfunction, one of the under-cited sources of inflation has to do with the number of aggregators and consolidators constantly at play in the healthcare delivery continuum. Whether it’s insurance companies buying pharmacy benefit managers (or other insurance companies), health systems buying medical practices, insurance companies buying physician practices, the proliferation of new hospitals, or health systems and third-party companies popping up stand-alone emergency rooms, there has been a massive expansion of investment dollars into a smaller pool of players — all created to increase market share and increase profits.

In his book Cheated, Alan Wiederhold shares that private entities' annual value of acquired healthcare servicesincreased from $42 billion in 2010 to approximately $120 billion in 2019.

He shares a quote attributed to the Private Equity Healthcare report: "Private equity funds, by design, are focused on short-term revenue generation and consolidation and not on the care and long-term wellbeing of patients. This, in turn, leads to pressure to prioritize revenue over the quality of care, and overburden health care companies.”

The 30,000-foot view suggests that aggregation reduces competition, increases market share, increases profitability, increases internal referral opportunities, and gives health systems more significant clout to negotiate richer contracts while also focusing on quantity over quality.

None of this betters the experience or cost containment.

I suspect this may have been the root cause of my daughter's being redirected to the emergency room. The urgent care she visited was owned by the same company that owned the hospital.

It makes you wonder if the urgent care environment has been intentionally limited in order to create greater revenue for health system.

The Pharmaceutical Quagmire

The number of ways that the pharma industry impacts our healthcare pricing is too long and too complex to capture here fully. And frankly, I’m no expert in this area. However, some primary culprits are the FDA, the manufacturers, and the pharmacy benefit managers.

One of the most helpful resources I recommend to everyone is the book The Price We Pay by Dr. Marty Makary. In the chapterPharmacy Hieroglyphics, he details the destructive financial impacts of pharmacy benefit managers onprescription pricing.

Makary shared the following anecdote in his book:

Cookie Benefit Manager

“Think about how this PBM game might look if it happens to another important commodity: Girl Scout cookies. Let’s say a dad approaches the CEO of a small company and offers to provide discounted Girl Scout cookies services to the company’s 100 employees. The busy CEO has no idea how much the different boxes of Girl Scout cookies normally cost (who does?) but he likes the simplicity of getting all his cookies from one guy. And he’s intrigued by the promise of bulk discounts the dad claims he can pass along to the company. The CEO agrees to make the dad the exclusive Girl Scout manager for his employees.

“A week later, the dad arranges for a few young Girl Scouts to set up a stand at the company office. One employee walks up and asks for a box of Thin Mints — everybody’s favorite. The girl says it will cost him only $2. He pays the $2 “copay” for his box and gobbles them up. The girls go on to a sell a hundred boxes. The CEO is glad to see his employees enjoying the cookies.

“A week later, the dad arranges for a few young Girl Scouts to set up a stand at the company office. One employee walks up and asks for a box of Thin Mints — everybody’s favorite. The girl says it will cost him only $2. He pays the $2 “copay” for his box and gobbles them up. The girls go on to a sell a hundred boxes. The CEO is glad to see his employees enjoying the cookies.

”A month later, the dad bills the company’s CEO a whoping $50 per box, and subtracts the “20% discount” bringing the bill to roughly $40 per box. The busy CEO can’t decipher the bill but pays it anyway, comforted by the 20% discount reflected on the bill.

“The dad then gives the Girl Scouts $1 for each box that they sold, so the girls collect a total of $3 per box (the $2 copay from the employee + $1 from the cookie manager). Their wholesol cost is $2.50, so the girls make 50 cents per box. The dad makes $39 per box, or $3,900 for the day for “managing the employee cookie benefit.”

Dr. Mary Makary, The Price We Pay

In this analogy, the dad is the PBM and the girl scouts are the pharmacies. Today, approximately 80% of Americans get their medications through a PBM. The system is a mess, and we can do better.

Brokers and Insurance Agencies

Both authors referenced above, Wiederhold and Makary, blame contingency or bonus programs provided by insurance companies as the driver of the status quo.

With massive consolidation in the industry, there are fewer payors available for brokers to represent. In some markets, there may be as few as two or three insurance companies available to offer to employer clients.

Every one of those insurance companies incentivizes brokers with both new and renewal bonuses to assure they are maximizing their market position, and those bonuses can add up.

They are not wrong to suggest this may be a driver.

But they are not entirely right, either.

Brokers and insurance agencies are not on this listbecause of the financial mechanics of compensation.

It’s because they are lazy. Complacency is the real contributor.

The reality is that more innovation has been introduced to the marketplace in the last seven to nine years than in the twenty years prior to that. Niche vendors have exploded, and point solutions abound. Each offers a new strategy or methodology to cost containment. Data analytic platforms have proliferated. Third-party Administrators have transformed from check-payers to true advocates. Healthcare navigational resources have become abundant. More resources are available today to help employers manage claims expenses than ever before.

The innovative stuff takes work, is hard to learn, and can be burdensome to quote. Vendor relationship managers change often, making it difficult to stay in touch. It’s also difficult to know which vendors actually do cool stuff instead of just saying cool stuff. It just takes a lot of work.

Instead of doing that work, many brokers take the safe route. They pick one or two insurance companies, put nearly all of their clients with them, and tell their clients that their large blocks of business give them the clout to negotiate better deals.

Human Nature

Maybe it’s you, the individual who’s reading this. Maybe it’s the collective you. Maybe it’s the corporate you.

Maybe it’s all of us.

But we are our own worst enemies. It’s human nature.

A quick Google search of “lifestyle impact on health costs” brought up hundreds of articles. Here are a few of the best headlines:

• Changing lifestyle choices could cut $730B in annual health care spending

• Poor diets linked to $50 billion in U.S. health care costs

• Voluntary Health Risks: Who Should Pay?

• Health and Economic Costs of Chronic Diseases

• Unhealthy choices cost company health care plans billions of dollars

• Modifiable Health Risks Linked to more than $730 Billion in US Health Care Costs

Should we go on?

If we all made a more concerted effort to take care of ourselves, we wouldn’t need to be so egregiously offended by the behaviors of insurance companies, aggregators, pharmaceuticals, and brokers.

Ultimately, you are the problem. I am the problem. We are the problem. The articles above indicated that lifestyle modification could impact up to $730 Billion in annual healthcare spending. Until we get serious about doing everything in our power not to be the problem, I’m not sure any of the rest of it matters.

Not only should we do a better job taking care of our health, but we must turn every stone. You are obligated to yourself, your company, your employees, your customers, and your community to be a part of the solution.

Rest assured, there are solutions. For every bad apple, there are dozens of good apples. It just takes some work to pick through the barrel.

Please let me know if I can help do the picking.

Over the last 24 months, I have witnessed a young man step into a new life as a man of faith. In nearly every measurable way, this has enriched his life and improved his holistic well-being.

Throughout this journey, he's found balance, optimism, and love. He was recently engaged to his girlfriend, whom he met in his Christian community, a community that welcomed him and mentored him on his journey.

It's been pretty cool to see. I'm proud of him, and I'm honored to bear witness to his progress into adulthood.

Recently, however, my wife and I had a conversation with this young man that raised a few concerns. I don't know if these concerns can be attributed to his faith or are instead the byproduct of not yet having a fully formed frontal lobe.

Regardless, there appears to be a nugget of wisdom in our conversations that we all should be reminded of.

Begin with a Vision

He and his fiancé were engaged in late December. He will graduate in May, and she will complete her graduation requirements next December.

They are anxious to begin their lives together and are planning a destination wedding in November as soon as her classes are concluded.

They have identified a location in Mexico where they want to have their ceremony, having spent some time there on one of their many trips together. Although they currently live in different states, much of their connected time has occurred during various travels.

Their enthusiasm is infectious.

Their planning leaves a little bit to be desired.

They have envisioned what that day will look like for them. They can tangibly describe who they want to be there in Mexico with them and how the ocean backdrop will appear in their photos.

They hope for something simple and significant.

We asked them for their budget to create and deliver this experience, and they were largely stumped.

They had not completed any research. They have a friend's vacation home they plan to use but have not spoken to the homeowner. They want to take their wedding party on a celebratory catamaran trip but have not investigated the per-person fees. They hadn't considered how people would get to Mexico or move from place to place once they arrived. They hadn't considered what wedding staples like flowers, food, and drink may cost, even at minimalist levels.

As these conversations evolved and we discussed some of these important considerations with them, you could see the overwhelm overtake them.

Reverse Engineer our Goals

While visiting with the young couple, he expressed that they could have the whole thing planned and pulled off in less than three months, so there was no reason for them to begin now.

Fortunately, with a concrete goal or vision of what they would like to experience, we had a chance to provide some needed mentoring.

"If one does not know to which port one is sailing, no wind is favorable." -Seneca

Knowing what they want to create provides a foundation for success. In short order, they had Googled a "wedding planning checklist," had made plans to contact the homeowner to secure their location, had made plans to schedule an investigatory trip to their destination, had begun saving and securing a budget, and were well on their way to making this vision a reality.

With a small amount of research, their expectations shifted. They became more realistic, and the young couple walked away with tangible next steps to deliver on their aspirations.

I'm reminded how important it can be to know what we want. What do you want to accomplish this year in your work, relationships, and physical, mental, and emotional well-being? What does each of those areas look like for you?

Have you taken time to reflect? Are your goals posted somewhere you can see and review them daily?

I heard Brendan Buchard say recently that we invest 10 times more of our attention to looking at other people's lives on social media than we do thinking and reviewing what we want to create in our own lives.

If you haven't created that space through a weekly review process or a daily reflection practice, I would like you to begin there.

Once you know the destination, it becomes much more straightforward to begin planning your route.

The Parable of the Talents

We were struck by this young couple's naivety as we progressed through this discussion. They operated on pure emotion and optimism, assuming that everything would unfold for them and that no obstacles would be encountered.

Having circled the sun a few dozen more times than either of them, we quietly choked on our pragmatism.

In a separate conversation, the young man said something like, "We don't need to worry about all of that; tomorrow will worry about itself."

I recognized this as something akin to a Bible verse, so I looked it up and realized he was referring to Matthew 6:25-34, which ends with "Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own."

Unbeknownst to him, he had given me a small opening.

With his fiancé in another state, his rent and expenses minimal, and his free time abundant, we encouraged him to leverage this short season to pour into work, even to get a second job if necessary.

He and I discussed how valuable it can be to a young married couple to be secure in their finances.

He shared his disdain for money and the more essential community connections and service desires he hoped to experience, saying he didn't need to worry himself with the burden of work and being the slave of money.

In response, I purchased him a copy of Ramit Smith's book "I'll Teach You to Be Rich" and I delivered it with a reminder of the Parable of the Talents.

If you're not familiar with the Parable of the Talents, it's a story told by Jesus in Matthew 24 about a master who was leaving his house to travel and, before leaving, entrusted his property to his servants with the request that each of them use their abilities (or talents) to account for and expand his property using their unique gifts.

He is in a season of growth. Time, space, health, and minimal expenses all exist in this season. Yet, he's waiting for life to give him a helping hand.

In waiting, he's missed the nuance of that very help.

He has a job and can expand his hours to learn and earn more. He has time to find other ways to expand his earnings and create a foundation of security upon which his budding marriage can rest. For the time being, he has housing with his parents and no rent, college loans, or debt to repay.

His faith that everything would work out and that tomorrow's worries would worry about themselves caused him to overlook God's work in his life now.

Life Often Requires Audibles

Fortunately, I became goal-oriented at an early age. Looking back, I've met or exceeded many of the goals that I set for myself when I was a young man.

At the same time, the how took many unexpected twists and turns.

I never expected to be a divorcee, but that led to the love, support, and partnership I found in my wife and best friend.

I never expected to make a mid-career change, but it led me to an opportunity with an organization that provided the resources I needed to serve clients as I had always hoped.

I never expected to be diagnosed with skin cancer, but it made me mindful of my health and helped me restructure my routines and habits to serve my well-being.

It's critical that this young man and his fiancé have a vision. Hopefully, they are beginning to recognize that achieving that vision may have some unexpected twists and turns.

And, at times, the helping hand they believe will be provided arrives in the form of a push from behind or a firm kick in the ass.

Moving Forward

Where do you lack vision? Where could your goals and aspirations be firmed up and your commitment stronger?

Where are you missing the silent opening of new doors forward because you are so focused on the one door that closed?

Who in your life could you lend a helping hand? Or who in your life is reaching out to offer you a helping hand, but you're too stubborn or blinded to accept it?

Where are you wasting time by focusing energy on your weaknesses instead of doubling down on your God-given talents?

Good luck on your journey. If I can ever be that helping hand, I hope you won't hesitate to ask for my help.

Be well,

Jim

We often think resilience is the goal, but what if there’s something better—something that allows us to grow stronger through life’s challenges?

My wife and I had always thought it would be fun to learn how to fly fish. In September 2019, we planned a trip to Steamboat Springs, complete with a full-day session with a guide. We were excited to explore a hobby that combined our love of adventure with our passion for the outdoors.

But the day before we were set to leave, everything changed. We learned that my dad had suffered a stroke.

Instead of heading to Steamboat Springs, we headed to the hospital. Over the next three months, we built our lives around daily hospital visits, navigating the demands of family and work, and facing an uncertain future. It was an incredibly challenging time, but it also taught me a profound lesson about resilience and something even more powerful: antifragility.

What Is Antifragility?

In Nassim Nicholas Taleb’s book Antifragile, he shares the idea that the opposite of being fragile isn’t resilience—it’s antifragility. While resilience is the ability to endure challenges and bounce back, antifragility is the capacity to grow stronger through adversity.

So how do you build antifragility? You have to return to your protocols. When unexpected illness, injury, or disappointment occurs, it’s easy to turn to sedation—whether it’s TV, alcohol, social media, or dozens of other ways to block the noise.

But embracing antifragility means leaning into the sustaining habits that allow you to thrive: eating well, sleeping adequately, and staying active. These habits don’t just keep us afloat; they create energy, capacity, certainty, and confidence. By leveraging these positive routines, we can transform adversity into growth, building the strength and clarity needed to navigate life’s challenges.

Lessons for Life and Leadership

This experience reminded me that life’s challenges often force us to pivot, but how we pivot makes all the difference. It’s tempting to seek comfort in distractions or quick fixes, but true antifragility comes from leaning into the sustaining habits that help us thrive.

While my wife and I never rescheduled that fishing trip, seeing the difficulty my dad has endured and continues to endure helped us re-commit to our own health initiatives. It helped us get clear on what matters most.

This lesson is especially relevant for employers and leaders. When stress or disruption arises—challenging financial situations, shifting team dynamics, or personal struggles—returning to positive habits like clear communication, consistent routines, and proactive support can create the energy and confidence needed to navigate adversity.

Just as antifragility helps individuals grow stronger, it can transform workplaces, building trust, resilience, and the capacity to thrive in uncertainty.

Let’s Embrace Antifragility Together

If navigating life’s challenges feels overwhelming, let’s explore how embracing antifragility can transform adversity into opportunity. Whether it’s empowering employees, creating positive habits, or supporting your team through change, we can work together to build the habits and structures that foster growth and confidence—even in uncertain times.

Here are a few prompts to help you evaluate how you have met unexpected adversity.

1. When have you encountered something completely unexpected?

2. How did you respond in the early moments of that adversity?

3. Looking back on that experience, how do you feel you handled the situation?

4. What process or protocol did you follow to re-establish normalcy?

5. What would you do differently should adversity strike again?

Let’s start a conversation about turning setbacks into stepping stones for success. It's critical for both business and personal achievement. Please share an example in the comments of lessons you learned so we can all learn with you.

For the first time in over 20 years, my wife and I found ourselves in a true empty-nester situation. None of our kids were going to be home to celebrate the holidays with us. So, we decided if they weren’t going to be home, we didn’t need to be home either. That’s how we ended up spending the holidays in beautiful Belize.

As we explored the country, we were struck by the contrast between how similar and how different people can be in other parts of the world. But what stood out to us most was the universal kindness we encountered in Belize. Every single person we passed on the streets or sidewalks greeted us warmly with a ‘good morning,’ ‘good afternoon,’ or ‘good night.’

It was heartwarming, and it noticeably contrasted against the head-down, ignore everyone American ethos rooted in the idea of ‘stranger danger.’

That simple kindness left a lasting impression on us. It reminded us of how powerful small gestures can be in creating connection and fostering a sense of belonging. We could all use more of it—both personally and professionally.

A Lesson in Kindness and Connection

This experience reminded us that small acts of kindness can create a profound connection. A simple greeting or moment of acknowledgment can break down barriers, challenge cultural norms, and foster an environment of trust and warmth.

In the workplace, we often focus on complex systems or grand strategies, but the small, consistent actions—like listening, acknowledging, or supporting employees—often make the biggest difference. Just as those warm greetings in Belize made us feel welcome and valued, employees thrive in environments where they feel seen, appreciated, and connected.

Building a culture of care starts with simple, intentional actions. When employers prioritize connection and kindness, it creates a ripple effect of trust and loyalty that benefits everyone.

Bringing This Mindset to the Workplace

If creating meaningful connections in your workplace feels like a challenge, let’s start a conversation. We need to consciously bring this same mindset of kindness, compassion, and clarity to our educational efforts to ensure employees receive the necessary information and the positive intention that drives your investment in them.

Simple, intentional actions—like providing multimodal communication formats that enable employees to access information at the time and place most convenient for them—can significantly improve their perceptions of you as an employer.

Together, we can design employee experiences that foster trust, build connections, and make a lasting impact. While grand strategies are important, it’s the small gestures that truly change how people feel—and ultimately, how they thrive.

Despite numerous industry advancements designed to simplify access to healthcare, it can be incredibly difficult for your employees to know what may or may not be necessary in the moment of diagnosis.

In today’s article, I leverage my health scare to explore how to help your employees become better healthcare consumers.

It’s been a few years now, but in 2017 I was diagnosed with Basal Cell Carcinoma.

This is what they call “good cancer.” I guess it’s called that because it’s unlikely to spread. Personally, however, there was nothing good about it. It was a brutal process, and it resulted in a nasty hole, ghastly stitches and both internal and external scars.

I don’t mean to be dramatic. Several years later, it’s now a nearly forgotten memory. The scars are mostly unnoticeable. And what at the time felt draconian and completely unfair, has largely faded into nothing more than a bad moment in time.

In retrospect, I was lucky.

Furthermore, I look back on the experience with gratitude as it was my first meaningful taste of the difficulty so many of our clients’ employees and family members experience when they too have to seek medical attention.

Concept versus Reality

In 2004, Qualified High-Deductible Health Plans/Health Savings Accounts (HDHP/HSA) plans were introduced, bringing healthcare consumerism to the masses.

The fundamental concept underlying these plans was that because members would now have to pay the upfront costs of their care, they would be more diligent in seeking effective and efficient solutions.

Unfortunately, in 2004, no resources were available to enable that behavior.

Over the last 10-15 years, we've seen a proliferation of resources emerge, each designed to help people navigate through healthcare decisions and compare the value of each option.

Companies like Castlight, Alight, HealthJoy, Amaze, First Stop Health, Nice Healthcare, PeakMedical, Teledoc, Livongo, SimplePay, Cancer Care Plus, Valenz, Progency, Healthcare BlueBook, and dozens of others have stepped into the conversation, each promising to make healthcare decisions more cost-effective and efficient.

All well and good. However, in the moment of a diagnosis, it can be difficult to impossible to know the right thing to do.

As am employer, we have to recognize these challenges and work endlessly to close the gaps.

With that, it feels useful to share some of the lessons I learned in the hope that your employees become better consumers of healthcare.

Lesson 1 – Trust Your Inner Voice (or your spouse’s)

In my case, the eventual diagnosis of cancer began with an unresolved blemish. The blemish, which seemed to be nothing more than an ordinary pimple, made its unwelcome appearance on my right cheek roughly a year and a half before I had it removed.

As so many of us do, I ignored it.

It took me about six months to schedule my first dermatology appointment — partly out of ignorance, partly out of stubbornness. I was in my early 40s, so “I was too young for skin cancer.” My wife was more persistent, and eventually, I conceded to her concerns that this wasn’t normal.

I scheduled my first-ever dermatology appointment. That dermatologist, however, gave me a clean bill of health, so I went on my way.

The blemish persisted. Eventually, I went to a second dermatologist. This one had the good sense to perform a biopsy. Unfortunately, it returned negative, so I was again told I had no concerns.

I later learned that multiple biopsy methods can be done, and this doctor chose the wrong one.

After more time passed, the third dermatologist performed the correct biopsy, resulting in an accurate diagnosis.

It took over 18 months from onset to surgery.

You have to learn to listen to yourself (or at least to the people who love you). Had my wife been less vocal, I likely would have brushed it off as an anomaly after two doctors gave me a clean bill of health – at least until it became so overwhelming and evident that I had no other option but to deal with it.

You know your body better than anyone. When something’s wrong, you must be your loudest and most passionate advocate. Doctors make mistakes, just like the rest of us. If you know, you know. Trust yourself.

We have to permit ourselves to have the final say on our well-being.

Lesson 2 – Understand Your Options

Unfortunately, Basal Cell Carcinoma grows roots. Over time, those roots grow deeper and broader into your skin. What may look superficial from the exterior can be a mess underneath. My doctor used the term “aggressive,” which is an excellent way of saying, “That bastard has been growing for a while.”

Of course, I didn’t understand any of this at the time.

Mohs Surgery is the standard treatment prescribed for Basal Cell Carcinoma (BCC). From a layman’s perspective, this is the equivalent of using a spoon to scoop out the cancer spot. Then, they look at it under a microscope to see if they got all of it, and if not, they come back and get a bigger scoop. They repeat this process until all the edges are clean.

Approximately 85% of BCCs occur on the head and neck, which are the areas most frequently exposed to the sun. Practically, this means that you are likely to end up with a scar visible to the outside world.

Board-certified Mohs surgeons are common. Many excellent dermatologists have this certification, but much fewer have the skills to stitch you up in a way that will minimize your scarring.

Again, I didn’t understand any of this at the time.

In my case, I could have quickly researched to learn that you can locate a board-certified Mohs surgeon who partners with a plastic surgeon.

Had a navigational resource been available, this would have been the perfect time to make a call.

Instead, I trusted my dermatologist. He was, after all, the doctor.

That trust left me with about a four-inch scar that was utterly avoidable.

Whatever your situation, know your options and then act. You’ll feel pressure to act immediately, especially when something foreign is growing in your body.

We must help employees understand they must take the extra step to understand best practices.

Don’t be afraid to demand a full explanation of your options. If they are not forthcoming, consider changing doctors if it assures a more positive outcome.

Some doctors will stonewall you, trying to force you to have surgery in their practice. Surgeries make money.

Hopefully, you will find a doctor who truly prioritizes your needs, but you should approach every conversation with a healthy dose of skepticism.

Lesson 3 — The Emotions Are Real

I was fortunate. People deal with more insidious diagnoses every single day.

Even with such a favorable diagnosis, four inches and 20+ stitches across my cheek left me feeling shattered. At no point did the doctor, his nurses, nor his staff ever indicate this was anything more than a simple procedure.

When I made it to my car, looked in the mirror, and saw the long line of stitches across my jaw, I broke down in tears. I felt like Frankenstein and immediately mourned my unwelcome and unwanted facial modification.

I don’t consider myself a vain person, but I was disfigured. It hurt my soul. I was angry, embarrassed, sad, and deeply disappointed that I had joined a club I never wanted to be a part of. I was convinced no one would ever meet with me again professionally, let alone choose to be my friend. It threw me into a downward spiral unlike anything else I had experienced.

Maybe that sounds dramatic, but my face was jacked up.

The experience helped me understand the gravity of and challenges that arise when the unexpected happens.

If you have an employee or a loved one who experiences a health scare, don’t dismiss what they are going through. It’s real. It’s rough. It’s raw. Please don’t minimize them by telling them it’s a good kind of (insert illness here).

Also, continue to promote behavioral health resources, employee advocacy and concierge programs, nurse lines, or whatever tools you have in your arsenal. Often, we dismiss the value of those programs because of low utilization, but when they are needed, they can be a lifesaver.

Lesson 4 – Promote Self Care

Don’t be as stupid as I was.

You get one body for the entire trip duration, however long it may be. Take good care of it.

I do this well in many ways. I exercise daily, eat well, and try to get good sleep. I consciously try to be a good example and practice what I preach.

But until receiving a cancer diagnosis, I never thought about something as simple as a daily face lotion with SPF. I was a child of the 80s. Not only did we not use sunscreen, we thought it was cool to coat ourselves with the tan accelerator stuff when we were kids.

Maybe for you, it’s also SPF lotion or wearing hats and sun-protection shirts.

But I’m guessing it’s a hundred other micro-failures. You skip that workout. You finished the whole bottle of wine on a Tuesday. You stare at your television or phone long past when you should have just gone to bed. You begin your morning by checking your email. You constantly amplify the cortisol running throughout your body because you haven’t figured out how to quiet your mind.

At some point, we each come to the realization that our everyday choices directly correlate to our everyday outcomes. If you don’t like those outcomes, it’s up to you to change the habits that create those outcomes.

And yes, we now have a magic pill available to help you lose that dad-bod, but that comes with its complications.

We don’t talk about it, and if we do, we likely don’t do it at work.

Why is that? Why is self-care so infrequently a regular topic in professional environments?

We spend the majority of our waking hours each week at work. How you approach and promote self-care becomes a part of who you are as an organization.

Promoting self-care equates to promoting culture.

It’s fundamental to creating a quality employee experience.

It’s a critical part of any effort to help you and your employees become better consumers of healthcare.

Lesson 5 – People Are Both Amazing and Resilient

When the proverbial hits the fan, we put our lives in the hands of others to fix what ails us. It’s crazy when you step back from it, but it’s also awesome.

It’s fantastic that certain men and women have been uniquely created to remove the bad that happens to their fellow humans.

When I pause and think about it, I love that humans care for humans. We are fortunate to live in a time when our medical professionals have the knowledge to solve real problems.

It’s easy to bash the healthcare industry, and it happens everywhere. Whether it’s big pharma, the insurance companies, the lack of access to quality primary care, or a hundred other challenges, we always hear about healthcare’s failings.

But let’s not forget that most people are inherently good, and many of those good people chose healthcare as their calling.

We must continue to work collectively to remove barriers, encourage positive healthcare consumerism, and help our people feel safe and comfortable going to see their healthcare providers. They’re good people, and they exist to help.

Let us also remind our people that they are resilient.

Unfortunately, we don’t recover from every healthcare scare. However, most of the time, the scars and memories fade, and we end up stronger for having overcome that obstacle.

We can use it as a catalyst to become a better version of ourselves.

Sometimes, it’s hard to remember that this, too, shall pass. Help remind your people that they are resilient, too.

Part of creating a quality employee experience exists in those profoundly personal situations. Be there for your people when things get complicated. Remind them of their resiliency.

Final Thoughts

Nothing ever gets fixed by ignoring the issue. Hope is never a strategy.

Whether it’s a health issue, a relationship issue, or a confidence issue – take action. Talk to that person. Start. See the doctor.

Do.

Taking action on life makes life more livable.

And, you and your people deserve to live fully.

This year, I set perhaps the largest BHAG (Big, Hairy, Audacious Goal) I had ever created for myself. I decided to attempt my first ultramarathon, the Run Rabbit Run 50 Miler.

For a small percentage of humans, this is nothing more than a training run. In fact, more than 400 individuals were out on the trail completing the Run Rabbit Run 100 miler while a smaller group of us, around 200, attempted the 50.

People are as beautiful as they are crazy. I am amazed and in awe of athletes that regularly attempt this types of events.

I am not one of them. In fact, I'm not much of a runner at all.

Prior to this event, I had completed a few sprint triathlons, a half-dozen half-marathons, and a single marathon back in 2009. Never competitive in any of them, most of these events were simply used as targets so I wouldn't slack off on my workout schedule.

But then, last November, I turned 50. It feels old. It sounds old. It's supposed to be old. Hell, when you turn 50 there really is no denying you've crested the hill.

That awareness, combined with this impression - real or imagined- that I was supposed to slow down, be more careful, push myself less, just pissed me off.

Signing up for a 50 mile ultramarathon ultimately was my middle-finger to those voices. I'm not dead yet, and I felt the need to prove it - mostly to myself but also to anyone else who doubted me.

I didn't know what to expect. I didn't know if my body could endure it. I certainly didn't know if I could actually complete it.

I just knew I had to try.

I'm thankful I did, and I learned a few things along the way. But first, let me provide a little more information on what the day would entail.

The Challenge

Created in 2012 as a charity run, Run Rabbit Run has evolved into one of the most competitive ultramarathons for top runners across the country.

The 50 began at the base of Steamboat ski resort, ran up to the peak of Mt. Warner, followed single track across mountain ridges, through highland meadows, and along mountain lake shores until you reached Rabbit Ears. After ascending to and literally touching the rock at the top of the pass at just over 10,500 feet, you ran back the way you came. All in all, it included about 9,000 feet of elevation ascension and descension.

The Struggle

The winning runner, who happened to also be 50 years old (super frickin' impressive) completed the 50 in just over 8 1/2 hours.

It took me around 14 1/2 hours.

Despite feeling prepared after nearly 10 months of training, it thoroughly kicked my ass.

I ran into some unexpected obstacles. Three in particular, that made the day particularly challenging.

First, my phone died. I completed an audio book during the first 1/2, but at the turn around realized I had less than 20% battery remaining. I had brought a portable charger, anticipating this may happen, but the back up battery had lost its charge somehow, and I was left ... in silence. By mile 40 or so, my phone had died completely leaving me with no ability to call for help or provide updates to my wife.

Second, I had trained consuming mostly gels and cookies. That seemed to work from an energy standpoint, but I had never trained and eaten these foods exclusively for more than five hours, let alone more than 12.

Turns out eating this stuff for that long has pretty negative ramifications on my stomach. I'll leave out the specifics, but let's just say it made for a long afternoon.

Finally, and unexpectedly, it turns out over the course of a race like this, racers become very spread out.

Left to no external distractions from my dead phone and a seriously pissed off stomach, I found myself trudging mostly uphill for the majority of the second-half of the event with absolutely no other runners in sight for most of the afternoon.

With calf tightness and leg pain becoming more pronounced with each passing mile, I found myself in a mental death match between the devil on one shoulder and the angel on the other.

One voice telling me I couldn't go any further, the other telling me to toughen up and soldier on, the two voices literally argued out loud.

Had any one been around to witness this craziness, they would have been reminded more of the drug-crazed zombies walking the streets of downtown Portland than any version of an athlete they may have expected.

As the sunlight faded over the mountains, the pain and agony and frustration of having to finish in the dark congealed into a slow-burning rage. My reaction to all pain is anger, attestable by anyone who has witness the string of expletives that follow any time I stub my toe on the corner of the couch.

As I stumbled down the six-mile descent at the end with a crappy headlamp that completely failed to illuminate the variety of rocks, ruts, and roots, I pretty much hated myself for attempting something so obviously beyond my skill level.

The Redemption

Fortunately, I had been keeping an eye on my pace. Despite becoming slower and slower as I struggled towards the base of the mountain, I never really had any doubt I would meet the 15-hour cutoff.

With no updates for hours, my wife at the finish line shared no such confidence in me.

About a mile or so from the finish line, people began lining the remaining path towards the finish. With both the 100 mile race and the 50 sharing the last few miles, they awaited their own loved ones to make the final appearance.

Graciously, they shared kind words of encouragement with me and the other stragglers, giving me a much needed boost after hours of self-loathing.

And then I crossed the finish line, and it all disappeared.

The frustrations of being slower than planned, the unbearable leg pain, the doubt and mental abuse by the less-kind of the two voices, the self-loathing.

It all disappeared.

I had made it.

I had done it.

Completely drained, but fully content, I was an ultramarathoner.

The Lessons

A week or so after the event, one of my associates called genuinely interested in hearing about my experience. Towards the end of the call, he asked me what I had learned.

Unprepared for that question, I stumbled through an answer. Apparently he found my answer satisfactory because he asked me to share those lessons with our sales team, and that conversation became the genesis of this article.

Here's what I shared with them, and now share with you.

1. It's Supposed to be Hard

Today more than ever, we are constantly tempted by the "easy life."

With endless dopamine hits from social media, to every TV commercial promoting instant gratification, it's easy to forget that life is supposed to be hard.

The first noble truth of Buddhism is the pervasive presence of suffering in our lives. Christ was crucified before risen. Light always follows darkness.

When we grasp this, this idea of difficulty, we become empowered.

When we expect difficulty, we can train for it.

When we train for difficulty, we become resilient, or even better, antifragile.

Our muscles become stronger when we move heavy things. Our love grows deeper when we go beyond the honeymoon phase, understand that our partners have flaws, and accept them in totality.

When we intentionally embrace, or at least accept, that there will be some hard things, we accelerate the gifts that come from the going through them.

2. Success Happens in the Dark

"Doing hard things" is a habit that must be practiced, or like all habits, it will be lost. - Mark Manson

Knowing that obstacles make us stronger, we must learn to go through the obstacles.

We have to become willing to endure. If you want to run 50 miles, you cannot show up at the starting line without logging some miles in advance. If you want to learn to plan an instrument, you're going to have to accept you'll hit some wrong notes.

And then you have to do it anyways.

Call it commitment, resilience, or discipline, you have got to do the work before you can find competency in anything.

We have to have to be humble enough to embrace the inevitable suck before we find success.

We have to do the work.

Had I not been willing to wake up in the pre-dawn hours, I would never have made it to the finish line. It wasn't easy, but it also wasn't an accident that I finished. I had done the work month-after-month-after-month leading up to the race.

Everything becomes easier with reps, and you have to be willing to do the reps when no one is watching. You have to put in the work.

Want to become a better presenter? Learn a new language? Learn to play an instrument? Become a writer? Become less reactive? Control your temper? Quit an addiction? Earn wealth?

Hope is not a plan. Winning the lottery isn't a strategy.

Commit to doing the work.

3. There's a Formula to Flourishing

I used to believe that the purpose of life was to expand, to grow. I thought if I continued to learn, it would lead to ultimate fulfillment. To be a lifetime learner was the key, I believed.

Over time, I've come to realize the real objective is to flourish. It's to move each day a little closer to realizing our full potential.

Fortunately, this idea has been well studied. Martin Seligman wrote a book called Flourishing, where he introduces the acronym PERMA. The path to flourishing being Positive Emotions, Engagement, Relationships, Meaning, and Achievement.

Brian Johnson with Heroic.us simplified PERMA into a formula. It's:

Work + Relationships + Energy = Flourishing.

Meaningful work, service to others, love and connection, and building healthy habits around sleep, diet, exercise, and inner peace all work together to create fulfillment.

I have come to believe that the energy component exponentially fuels the others.

It's nearly impossible to pour from an empty cup. So, taking care of ourselves becomes the accelerant in our ability to serve and love others.

If you're going to do the work in the dark, start with energy.

4. People are Amazing

Running 50 miles, for me, was truly a Big Hairy Audacious Goal. Attempting it, let alone completing it, gave me an unshakeable sense of accomplishment and confidence. I know something about myself now that I didn't know before.

While I was struggling through my own crucible, another 150 people or so finished the 50 miles along side of me, nearly all of them faster than me.

And while we were having our little stroll, another 300 people ran 100 miles.

Fucking amazing.

People are amazing.

When we allow ourselves to see the beauty in others, we see beauty everywhere.

Whether it's watching Freddie Freeman knock a grand slam over the wall for a walk-off win during the World Series, or seeing a stranger sit down at one of the public pianos scattered around Old Town Fort Collins to play an enchanting melody, there is talent everywhere.

And if you are a people, you're amazing too.

I ran across picturesque mountain landscapes in arguably some of the most beautiful geography in the United States, but that was secondary to all the goodness happening on that terra firma.

It wasn't just the athletes, but the volunteers at the aid stations tirelessly ringing the cowbells we could hear miles ahead, encouraging us to keep moving towards the sound.

It was the person who took my backpack and graciously refilled my water bladder so I could rest and eat a banana.

It was my wife waiting at the finish life to give me one of the most welcomed hugs I have ever received.

It's easy to get seduced by negativity. It's everywhere, if that's what you want to see.

But, please be reminded that you have a choice.

So, embrace the hard, do the work, take care of yourselves, and be kind to others.

You too have the ability to flourish.

One of the greatest injustices served annually to CFOs and HR directors nationwide is the idea that they provide health “insurance” to their employees. We stopped “insuring” health risks years ago. Therefore, employers must assess whether they have incorporated the seven attributes of a well-designed benefits program.

Thank you for checking out this humble endeavor.

This project has been born out of my relationships and related conversations with countless clients and their employees.

Nearly every day, I encounter a thought, a question, an idea, or a conversation that requires me to expand my understanding.

Over the 20-plus years I've worked with a wide variety of employers, I've experienced two unique and unexpected outcomes.

First, no two organizations approach employee benefits—or the entire conversation of employee compensation, attraction, and retention—the same way. As a result, every engagement forces me to learn and adapt how I support them in achieving their unique goals.

Second, we are only beginning to work on "health" insurance. For most of my career, this has been "illness or injury" insurance.

There's no doubt that the unexpected happens. Life can be brutally unfair and too many people get dealt a level of adversity that makes no sense at all.

But there is another reality. Sometimes, we do it to ourselves.

We need to talk about that, too.

I read somewhere that we are each perfectly designed to mentor someone who now sits where we used to be.

This is the place where I can share the lessons I have learned as they have been gifted to me through all the wonderful people I have met through my career as an employee benefits advisor.

Because this publication has been named The Employee Benefits Advisor, I will primarily focus on conversations and feedback about the ever-evolving continuum of solutions available to employers to improve their employees' experience as we move forward.

However, I'm also passionate about personal wellbeing. Specifically, I enjoy learning about growth mindset, and how we as individuals move closer each day to realize the most genuine, unique, and best version of ourselves.

In the past, I had a separate blog addressing these more personal topics. Ultimately, however, I have come to believe they are interrelated.

To achieve the best outcomes within our health plans, we also have to help people attain the best outcomes in their own lives.

For better or worse, the two are intricately connected.

For that reason, I have unified those topics under this publication.

Membership is free. Once you subscribe and become a member, I have opened comments so we can have conversations. You can challenge me, argue with me, and provide your own reflections. I hope this will be a place of community where we can learn and grow together.

Regardless, please know that I am humbled. I promise to be thoughtful and useful, and I hope you find great value in the conversations to come.

Lastly, I have opened up a "supporter" tier. As a supporter, you have a larger voice. With your commitment to this work, I will invite you into the conversation, share updates to readers about the good work you are doing, and in time, build a community of people who care about the interconnectivity of corporate and personal and wellbeing.

With deep gratitude,

Jim Sampson

Do you ever feel yourself being sucked into the vortex of another person’s energy, knowing the whole time that this probably isn’t the best decision?

Do you hear the virtuous little voice on your shoulder telling you it would be far more beneficial to go to bed? Or do you only hear the naughty little voice telling you “it might be fun?”

A couple of weeks ago, I got to watch this play out — both in myself and others — while attending a three-day work offsite planning event.

Fortunately, I work with a great group of people and we genuinely enjoy each other. We don’t have a chance to come together often, so when we do, it’s often difficult to know when to call it a day.

But the joy available in those connections can also ruin your energy.

Energy, of course, is not only the foundation of the Big 3 Keys to Flourishing, but the accelerator. It alone has the ability to create exponential outcomes in our work.

So that naughty little voice is not your friend.

FOMO, or Fear of Missing Out, is it’s siren song.

As the night wore on, I could feel the lure of that naughty voice becoming more insistent, but my virtuous voice was not giving up.

While that virtuous voice eventually won, and I avoided the dreaded land of regret, many of my associates were not so fortunate.

While FOMO could push you to experience something new and exciting, too often its true nature is rooted in something far more insidious.

FOPO.

Admittedly, FOPO has only recently been added to my vocabulary. I learned about it from Michael Gervais after his appearance on The Reinvention Project podcast with host Jim Rome.

FOPO stand for Fear of Other People’s Opinions.

It likes to masquerade itself as FOMO, but it’s much darker, deceptive, and destructive.

FOPO empowers others to throw us off our game. It’s when we make unaligned decisions because of extrinsic pressure. It may be the need to please, avoidance of disappointing, or the curse of J. Alfred Prufrock, who famously asked himself “do I dare disturb the universe?”

FOPO so often causes us to wonder — do I speak up? Can I skip this event? Will their feelings be hurt if I say no? What do I wear? Why was I not invited? Will I be judged…?

FOPO destroys your soul.

It robs you of authenticity.

It deprives you of freedom.

It smothers your divine uniqueness.

It makes you fragile.

FOPO mars your days, your weeks, your months, until you realize all of your dreams are FUBAR.

Fucked Up Beyond All Recognition.

So what are you to do?

When you come to that realization that your Dr. Jeckyll FOMO is actually Mr. Hyde FOPO? What the hell are you to do?

Brian Johnson with Heroic (check out heroic.us for some pure excellence) would tell you to become antifragile.

The Secret to Becoming Antifragile

People often make the mistake of believing that the opposite of fragility is resiliency. Brian argues (effectively) that the opposite of fragility is actually antifragility.

Fragility means you keep getting punched in the face until you eventually say fuck it and go hide under the bed, effectively ruining any chance you could have had to flourish.

Fragility causes you to simply give up.

The next time you are afraid of some supposedly disastrous outcome, remember that if you don’t control your impulses, if you lose your self-control, you may e the very sour of the disaster you so fear. — Ryan Holiday in the Daily Stoic.

The next level is resiliency. Resiliency is admirable. If you can attain no level higher than being resilient, than you are likely still doing very well. You are living a good life, and putting in a good fight.

But resiliency is not the end all be all. Resiliency is like Rocky Balboa. No matter how many blows to the face you absorb, you just keep trudging forward. You don’t give up, but you never really learn to bob or weave either. Unfortunately, even the most resilient will eventually tire to the never ending beat down.

You can be fragile and break easily. You can be resilient and withstand more stress before breaking down (and then bouncing back a little than most.) Or, You can be the opposite of fragile. — Brian Johnson in Areté

To truly become the creator of your best self, you have to learn about and embrace the path of anti fragility.

Antifragility means growth. It means you may still get punched, but each jab and body blow teaches you to become a more powerful fighter.

Antifragility is born in the knowledge that obstacles make us stronger.

That strong wind will extinguish a candle, but it will fuel a fire — Nassar Taleb in Antifragile

Ultimately, the path to Antifragility is found in the development of self confidence. Confidence comes from the Latin words con and fidere. It literally means “with intense trust.”

It’s the opposite of FOPO. It generates in the knowing that you were divinely created. That God made no accidents.

We need to cultivate an intense trust in ourselves such that it doesn’t matter what happens [or what other people think] because we know that we are the type of people who can do what needs to get done whether we feel like it or not. We need to intensely trust ourselves, such that we can not only handle whatever life throws at us but we can get stronger as a result. — Brian Johnson in Areté

To find that trust, that Antifragility, the simple path is to always follow your protocol. What is the one thing you have the most control over?

Is it when you will wake each morning? Is it getting in a walk or a workout? Is it reading the Bible or a good book? Where do you find your energy?

The antifragile keep returning to that well, especially in the moments when they feel least like doing it.

They know that when they find their energy, and they drink from that well, they will show up in work and love.

So what is that thing for you? What is that daily habit that you know will help you feel great about yourself, but you just don’t consistently give that gift to yourself?

What would life look life if you just started doing that one thing?

Start there.

I know a lot of people with FOMO also embrace YOLO.

But if you truly believe You Only Live Once, do it your way. Life an extraordinary life by beating to your own life.

If you haven’t been consistent, if you’ve lacked intense trust, it’s never too late to start.

Do that one thing today.

Tune out the noise.

Trust yourself.

And make it happen.

Not tomorrow, but…

TODAY.

You cannot begin to thrive in work and relationships if you attempt to thrive in your own personal wellbeing.

In Outlive by Dr. Peter Attia he shares “In the late 1970s, the average American male weighed 173 pounds. Now the average American man tips the scale at nearly 200 pounds. In the 1970s, a 200-pound mand would have been considered very overweight; today he is merely average.”

Average is just another word for mediocre.

The acceptance and tolerance of the dad bod is literally killing us.

But the issue goes deeper and wider than just our collective, increasing waistlines. It’s a conversation about what we tolerate. It’s a conversation about standards. It’s a conversation about being producers, great husbands, loving and engaged fathers, leaders and living useful lives.

It’s a conversation about being better.

The fact that a term like dad-bod exists frankly disgusts me. Not only is it literally killing us, but it’s robbing us of our manly essence. It’s robbing us of our identity.

And it’s no one’s fault but our own.

Mediocrity Is a Choice

The definition of mediocre is “of only ordinary or moderate quality, neither good nor bad, barely adequate.” Other words for mediocre include undistinguished, commonplace, pedestrian, everyday, run-of-the-mill.

Mediocrity is being the best of the worst and the worst of the best.

Do you see the commonality in all those words?

They all have an opposite. The opposite of mediocrity is excellence.

In fact, if you dig deeper, the Latin root word of mediocre is mediocris, or “in a middle state” or literally “at middle height,” equivalent to medi(us) “center, middle” + ocris “rugged mountain.”

This is good news. It means that you weren’t born mediocre, and you don’t have to stay mediocre. You descended to mediocrity, and with a little intention and attention, you can ascend away from it.

It’s taken me some time to realize this fact. And the ascension, while well underway, is not easy. Nor, have I perfected it.

But I’ve learned a few things along the journey. In fact, I believe I have stumbled onto a formula that, when leveraged, will accelerate your own ascent.

Nearly everything I share here stems from lessons learned from mentors. Part of my process of learning is distilling those lessons into my own words and my own meaning, hopefully to your benefit.

I first learned the path up the next mountain from Garret J. White at Wake Up Warrior. Garrett and his team were excellent mentors to me for over four and a half years, and he helped me first see, and later believe, that it was possible to have it all in body, being, balance, and business. If you’ve not heard of Wake Up Warrior, I encourage you to check it out. Garrett can be a bit spicy. He will inspire some and disturb others, but I can assure you he’s dedicated in totality to helping you find your divine beauty as a man.

About a year ago, I was introduced to the work of Brian Johnson at Heroic. Brian’s program takes a very different approach, and he intentionally appeals to all people, regardless of your gender.

Brian compresses the knowledge of hundreds of philosophers, researchers, psychologists, and the wisdom of historical leaders into actionable processes we can each use to get better every day.

Through Heroic, I learned about the work of Dr. Martin Seligman. Seligman is credited as being the father of positive psychology, and he’s the author of Flourish.

Flourish suggests that there are five components necessary for each of us to excel.

• Positive emotions

• Engagement

• Relationships

• Meaning

• Achievement.

Brian Johnson condensed this into three areas — Energy, Work and Love.

These three areas serve as the foundation of any flourishing man.

However, through trial and error, I’ve come to realize that Energy is the accelerant.

So, the formula looks like this: (W+L)E.

Simple, not easy.

To maximize our outcomes in work (engagement, meaning, and achievement) and improve the quality of love (relationships, meaning, engagement, positive emotions), we most importantly must manage and improve our energy (positive emotions, engagement, meaning, achievement).

You cannot pour from an empty cup.

Through these fireside talks, we will explore this. We will delve into the what, the how, and the why.

Hopefully, you will find value.

Hopefully, you will find here a path to accelerate your ascent up your next mountain.

And stop settling for a life so much less than what you were created to enjoy.

There seems to be about exactly three practical ways to tackle the year ahead. The classic path of resolutions, the emerging practice of choosing a word of the year, or just saying fuck it, and doing what you’ve always done.

The later strategy is effectively no strategy at all.

And the practice of New Year Resolutions has largely failed us, if it ever worked at all.

According to some research done in 2016, only 9% of Americans who make New Year’s resolutions feel they were successful in keeping them. Said another way, of those who actually set a resolution, 91% fail to keep them.

It’s no wonder resolutions fail. The root word is resolve, or re-solve. We’re literally making a resolution to attempt again that which has already eluded us. It’s only a minor improvement on the fuck it strategy.

The emerging alternative is to declare an intention through a single, powerful, representative word. Words like abundance, joy, peace, calm, stewardship, Areté, love, hope, service, presence, or connection.

All good words, and setting an intention, for me at least, and having a theme to what I want to experience for the new year, has had some power behind it.

Last year, my word was Areté. For those unfamiliar with the word, it generally means to pursue the best version of yourself.

Under that guidance, I committed to self improvement. It resulted in my best year ever in body, being, balance, and business.

But this year, instead of single word, I’m choosing a phrase. And my phrase is Do Dope Shit.

Do Dope Shit

In late November, and incredible life was tragically cut short after a tragic accident while on vacation. His name was A.J. Goldsmith. We didn’t know each other well, but we were both affiliated with a local non-profit. A.J.’s left behind a beautiful wife, and an immense amount of impact and potential.

After learning of his passing, I went down a rabbit hole learning about him. AJ had a life motto, which was Do Dope Shit. It was more than focal phrase for the year ahead. He embodied those words in every aspect of living, and by every account, he did it very well. He was one of those human experiences you felt long after the moment of meeting him had passed.

Eleanor Rosevelt once said “the purpose of life is to live it. To taste experience to the utmost. To reach eagerly and without fear for new and richer experiences.”

A.J.’s “Do Dope Shit” says the exact same thing, just much more succinctly.

Do Dope Shit is fundamentally about the pursuit of prosperity.

Let’s pause and look at that word.

Did you know the word prosperity literally means to go forward with hope. ”Therefore, prosperity, “is not so much a condition in life as it is an attitude towards life,” author Eric Butterworth.

So what would Doing Dope Shit look like for you?

So many have this internal resistance to the pursuit of abundance or prosperity. Some internal barrier that says we are not worthy. Ask yourself, in this moment, do you allow yourself to go forward with hope?

Or are you first littered with excuses? Too busy. Not enough money. Not realistic. Too much kid stuff. To much work stuff.

What experiences have been left untackled. What appreciations have been left unsaid. What dreams have gone unrealized. What adventures have been left unthread…. — 2023 5 Martini Ode

Are you willing to give yourself permission?

If prosperity is to go forward with hope, and the desire for prosperity is not so much a condition of life but a an attitude towards life, then let me ask you, what the heck is holding you back. Why will you not give yourself permission?

To even begin to Do Dope Shit, it must begin with permission. Permission to purse a better version of you.

For some that may be truly reaching for new and richer experiences. For others, it may be simply leaning into the daily habits needed to position yourself to experience those new and richer experiences at a future date.

Maybe it’s not possible now because your body isn’t where it needs to be do to Do Dope Shit. Maybe you believe you lack the financial foundation to Do Dope Shit. Maybe you simply don’t believe you deserve to be prosperous.

If any of those apply, start there. Meet those obstacles head on, and remember that OMMS — Obstacles Make Me Stronger.

Your outcomes are a lagging measure of your habits. Your net worth is a lagging measure of your financial habits. your weight is a lagging measure of your eating habits. Your knowledge is a lagging measure of your learning habits. Your clutter is a lagging measure of your cleaning habits. You get what you repeat. — James Clear, author of Atomic Habits

I too once felt that Doing Dope Shit was beyond my ability. I had too many obligations, and too much work to be done. I didn’t have the necessary sense of self-worth.

But then I started chipping away at it. I began waking a little earlier and waking regardless of how well I slept. I started reading books that lifted me up and taught me new ways to think. I hired a coach, who became a mentor. I joined a group of men who shared that passion for self improvement. I started working out every day, even if it was just simply going for a walk (where everyone should start, by the way). I started taking my wife on dates, then on trips, consistently. I began reading the Bible, connecting with the Source. I hired a trainer and nutritionist and lost 40 lbs.

I transformed my body, and my mindset. I turned things around.

It wasn’t a fast process. It’s been five years of consistently deciding that I was worthy, and then doing the daily work to fulfill that belief.

Maybe that’s where you need to start. Maybe Doing Dope Shit is just getting your ass out of bed and taking action on you.

Or maybe it’s something more. Maybe it’s permission to take some time off work and go do that thing… whatever it is. Travel. Experience. Love. Live. Connect.

It’s up to you, but if you take nothing else away from this conversation, then listen closely. You are worthy. You are capable of experiencing prosperity. All you have do is begin. Today. Accept yourself. Do the best you can and do fully what you can. Not someday. Today.

Here’s a few ideas of what Doing Dope Shit Looks Like for Me.

Last year was a massive year of transformation for me. It was the year when everything just worked. Doing dope shit begins with me demonstrating to myself this is in my control. I will commit to and live with the body I love.

Doing Dope Shit means a big fat hairy stretch goal. I turned 50 in November, but I’ve started running again and I’ve set my sights on running the Run Rabbit Run 50 Mile Ultra in September.

Doing Dope Shit means finally figuring out how to build the writing habit into my daily habits, so that I can create and give something to the world.

Doing Dope Shit means means living by the mantra that if it’s not a hell yes, it’s a no.

It means going new places and seeing new things with my wife. Spain in February. Concerts. The mountains. Hikes. Time with our kids. Belize for Christmas. We’re calling it Belize Navidad.

It means tasting experience to the utmost. Enjoying phone free connections. Friends. Love. Laughter.

It means showing up every fucking day and doing all that I can to be the best version of myself in energy, work and love.

What I know, and A.J.’s passing taught me, is that life is short. There are no guarantees. If if it’s going to be, it’s up to me.

So stop with the resolutions. Tap into something bigger. Give your self a chance to experience prosperity so that your life has a chance to become prosperous.

Do Dope Shit. There’s no time to waste a day. If you can’t do dope shit for yourself, do it for A.J.

Before closing, I would be remiss if I didn’t share with you a chance to support represent AJ’s Do Dope Shit, while also supporting his wife.

His friends and family set up a site where you can purchase Do Dope Shit gear. Check it out at causeteam.com.

Now, get after it.

Happy 2024.

Thanks for reading,

Jim