Essays on health strategy, employee benefits, metabolic health, and the ideas worth thinking about.
The United States spends over $5 trillion annually on healthcare — yet we lack a consistent, longitudinal way to measure the metabolic health of our populations. We measure spending. We measure utilization. But we don't measure health.
For decades, Americans have joked about Mondays. We dread them. We complain about them. What if Monday wasn't something to endure — but the day we intentionally began again?
North Carolina's State Health Plan saw GLP-1 use rise from 2,795 members in 2021 to 23,215 members in 2023, while officials warned that long-term costs could exceed $1 billion. It is not an isolated case — it is a signal.
For America's largest employers, GLP-1 medications are no longer a pharmacy issue. They are a billion-dollar budget issue — and the conversation is moving from HR to the boardroom.
Behind the 9%, 14%, and 20% renewal increases showing up across the country is a pharmaceutical cost wave rapidly reshaping employer-sponsored health insurance — and many brokers are still presenting it as 'general medical trend.'
Most employers can identify how much they spent last year. Yet many cannot answer a more fundamental question: how much future healthcare risk exists within their workforce today?
Employers receive more health plan data today than at any point in history — yet most still cannot answer the most important question in healthcare management: is the covered population becoming healthier over time?
Across the country, public-sector employers are discovering that GLP-1 drug spending is no longer a future problem — it is already showing up in renewals, reserve projections, and budget discussions.
Association Health Plans have long delivered competitive benefits through collective purchasing power. But as GLP-1 costs rise and adverse selection grows, many are finding that the financial assumptions on which these programs were built are under serious pressure.
Most renewal meetings explain what healthcare cost last year. They rarely answer the more important question: is your covered population becoming healthier — or sicker?
GLP-1 spending is growing at a pace few employers anticipated. In some organizations, annual spending on GLP-1 medications has already exceeded what the employer spends on dental benefits for the entire covered population.
Nearly two-thirds of patients stop taking GLP-1 medications before they reach the minimum threshold for meaningful clinical results. For employer health plans, that number should change the conversation entirely.
Employers are scrambling to manage GLP-1 drug costs, but the real question is why metabolic disease has become so prevalent in the workforce — and what to do about it.
There's a smarter way to offer metabolic health support to employees — one that doesn't expose the medical plan to open-ended liability.
Weight is a proxy. The Metabolic Health Index was built to track the indicators that actually predict long-term health outcomes.
The Fresh Monday framework isn't about perfection. It's about using the natural reset that Monday provides to build habits that actually stick.