Rewriting the Rules of Healthcare: The American healthcare system is a $5 trillion problem—bloated, inefficient, and intentionally complex. Prices climb without logic, transparency is a joke, and trust has been shattered. For decades, we’ve been told that fixing it is impossible—”too big, too messy, too ingrained.” But that’s the narrative the system’s intermediaries rely on to maintain the status quo.
Here’s the truth: healthcare in America isn’t complicated by accident—it’s been designed this way. Layers of administration, middlemen, and convoluted pricing structures aren’t there to improve care; they exist to protect profits.
We hear it all the time: “the system is broken.” But what does that actually mean? It’s not just about rising premiums or indecipherable hospital bills. It’s about employers pouring millions into healthcare without a clear understanding of where that money actually goes. It’s about insurers deciding which treatments are “necessary”—not based on patient needs, but on financial incentives. It’s about a system built to confuse and control, rather than liberate and care.
For businesses, healthcare is one of the biggest expenses, yet most have no real insight into how their dollars are being spent. Meanwhile, patients are hit with hidden fees, surprise bills, and an utter lack of price transparency. This confusion isn’t a flaw—it’s the feature that keeps the system profitable. And unless we challenge it, nothing will change.
The Business Side of Healthcare
Healthcare has two sides: the delivery of care and the business of care. The delivery side includes critical services—surgeries, doctor visits, and emergency care. The business side? That’s where things get messy. It encompasses insurance claims, deductibles, collections, and a web of administrative complexities that drive up costs and take focus away from patient health.
Take insurance reimbursement, for example. Healthcare providers spend an enormous amount of time navigating these processes, delaying payments and adding administrative burdens that pull resources from actual care. Self-insured employers and patients bear the brunt of this inefficiency, paying inflated costs to cover a system designed with more middlemen than necessary.
The numbers speak for themselves. Administrative costs in the U.S. are significantly higher than in other countries with comparable levels of care. Eliminating inefficiencies in the business side of healthcare could free up billions annually—money that could be used to reduce costs for employers, providers, and, most importantly, patients.
Rethinking Traditional Insurance Models
For decades, traditional insurance models have dominated healthcare, prioritizing profits over patient well-being. They’ve built a system designed for bureaucracy, not care—layering in administrative processes that inflate costs and make access needlessly complicated. Instead of making healthcare more efficient, these models have created a maze of paperwork, middlemen, and confusion that serves insurers more than patients or employers.
A real solution is emerging: direct access and direct payment models, like those led by Nomi Health, that cut through the financial and logistical mess of healthcare. By eliminating unnecessary middlemen, these models ensure providers get paid directly and in full—no delays, no red tape—while also giving patients and employers direct access to care without bureaucratic barriers.
For employers and patients, this means transparency and control. Employers finally see where their healthcare dollars are going, while patients get the care they need without navigating a tangle of referrals, surprise bills, and hidden fees. It’s a straightforward, no-nonsense approach that brings clarity to an industry built on confusion and inefficiency.
Providers win, too. Instead of waiting on slow, complicated reimbursement cycles, they get paid quickly and in full—freeing them from the revenue cycle headaches that have plagued healthcare for years. The bottom line? A system that actually delivers value for the people who matter most—employers, providers, and, ultimately, patients.
Case Study: Michigan’s Direct Provider Network
Michigan has become a proven leader in reshaping healthcare—demonstrating that employers can take control of costs and access without sacrificing quality. With its diverse mix of urban and rural communities and a market long dominated by only a few logos, the demand for a better approach is undeniable. Self-funded employers here aren’t experimenting; they’re leveraging strategies that work. They require three things: full transparency into their healthcare spending, the ability to allocate those dollars efficiently, and direct access to high-quality medical and pharmacy care for their employees and families.
This model has already delivered significant results, linking employers directly with providers to ensure prompt, full payments while reducing administrative waste. By removing unnecessary middlemen, costs stabilize, access improves, and local providers retain control. Treating employers and their partners as strategic decision-makers and empowering them with data-driven solutions isn’t just a smarter approach—it’s a tested and scalable blueprint for sustainable healthcare reform.
A Call for Systemic Change
The inefficiencies in healthcare aren’t just frustrating—they’re costing employers, providers, and patients billions. But they’re not inevitable. We’ve already seen what happens when businesses take control: direct contracting, transparent pricing, and a smarter way to move healthcare dollars. The results? Lower costs, better care, and a system that finally makes sense for the people footing the bill.
The roadmap is clear, and the solutions are already in motion. The real question isn’t whether healthcare can be fixed—it’s whether we’re ready to accelerate the change or stay stuck in a broken, outdated model. The choice is ours.
Editor’s Note: Mark Newman is the co-founder and CEO of Nomi Health. Newman and his team are working to solve the healthcare crisis by removing the waste embedded in the traditional process and cutting healthcare spending costs by up to 30%.