Practical Reality for Small Employers: Exclusions and Tough Choices

In this episode of Second Opinion, Christina Farr is joined by John Zutter, CEO of Lantern, and Matt Harmon,  a long time benefits executive who's worked at fortune 100 companies to discuss the rising costs of healthcare, focusing on how large employers are addressing the financial impacts of treatments like cell and gene therapies and medications such as GLP-1s while exploring the challenges, strategies, and ethical implications of providing affordable healthcare.

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LINKS: 

Lantern: https://lanterncare.com

Subscribe to Second Opinion Newsletter: https://secondopinion.media/ 

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FOLLOW:

https://www.linkedin.com/in/john-zutter-687000a/

https://www.linkedin.com/in/mattharmon/

https://www.linkedin.com/in/christinafarr/

https://www.linkedin.com/in/lubagreenwood/

https://www.linkedin.com/in/ashzenooz/

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HIGHLIGHTS FROM THE EPISODE:

• Healthcare costs for employers are rising dramatically, with some Fortune 100 companies seeing 18% increases in a single year, amounting to hundreds of millions in additional spending.
• Million-dollar claims, once rare, are now common due to advanced cell and gene therapies (costing up to tens of millions per patient), new expensive medications like GLP-1s, complex surgeries and treatments, and rising rates of cancer and chronic conditions.
• Smaller employers often can't afford high-cost treatments and may exclude coverage while large employers have more resources to implement specialized programs and networks.
• About 60% of Americans get healthcare through employers.
• High employee turnover at some companies (35% annually) makes long-term health investments difficult.
• GLP-1 Medications Emerging Challenges: High member demand driven by marketing and physician recommendations, long-term ROI unclear due to medication newness, employers implementing prior authorization and step therapy requirements, and alternative access through compounding pharmacies and direct programs.