Total Control Health Plans recently hosted the second annual Health Insurance 4.0 summit for Michigan employers, highlighting industry trends and areas of opportunity to reinvent this critical employee benefit. The event consisted of presentations and panel discussions from industry leaders, including a featured keynote from New York Times Bestselling Author Gardiner Harris.
We’re excited to share some of the insights and key takeaways from this year’s event in our latest blog. Be sure to also check out our video recap of the event below.
Hospital System Panel – Tackling Unsustainable Costs
We kicked off the event with a discussion with leaders from several area hospital systems. Leaders from Holland Hospital, Michigan Medicine, and Trinity Health shared how they’re working to help solve the problem of unsustainable healthcare costs through direct healthcare networks like Nomi Health.
Throughout the discussion, David Blackmon, Alex Roehling, and Travis Souza addressed the importance of collaboration between provider partners to deliver new therapies and medical advancement opportunities to the members of our local communities.
“We need fundamental change, and that requires creative thinking and involvement from the employer, health systems, and perhaps a benefit advisor, to try something different,” said Roehling.
Understanding Physician Quality with Data
Garner Health’s research shows that the individual physician a patient sees is the biggest factor in maximizing healthcare value – more than hospital systems, health groups, or plans.
Tom Goldhardt highlighted Garner’s powerful platform that helps individuals identify high-quality care with real data about patient outcomes by physician. The tool operates as a health plan addition that allows employers to provide their teams with transparent physician data, showing the highest-performing doctors who provide care at the lowest cost. Additionally, employees who see the highest rated physicians typically see 80% lower out-of-pocket costs, often being reimbursed for seeing the top doctors in their network.
“No More Tears”
In the event’s keynote presentation, New York Times Bestselling Author Gardiner Harris highlighted some of the takeaways from his book, “No More Tears: The Dark Secrets of Johnson & Johnson.” As he outlines in the book, Harris discussed some of the misleading, potentially dishonest relationships that exist between pharmaceutical manufacturers and physicians and hospital systems.
Harris also applauded event attendees and employers for navigating such a complicated healthcare landscape to support their staff. “It’s near impossible to figure out this system, and I view each of you as heroes for the role you play in ensuring your employees receive quality coverage,” said Harris.
Statewide Insurance Report Findings
The Health Insurance 4.0 event marked the unveiling of the 2025 MI Employer’s Health Insurance Report. This annual survey is run by Total Control Health Plans to collect data from business leaders across the state of Michigan about the challenges they face when it comes to health insurance benefits.
The 2025 MI Employer’s Health Insurance Report can be downloaded in full here.
Pharmacy Trends to Watch in 2026
Rebekah Gregg, COO of the Pharmaceutical Strategies Group (PSG), highlighted several pharmacy trends that employers can expect to see as we approach 2026.
Just as we saw in several lawsuits over the last few years, fiduciary responsibility will stay top of mind, as more employees seek legal action against their employers for inflating prices for select drugs in comparison to typical out-of-pocket costs. As we’ve seen historically, these lawsuits will be complex due to the difficulty in determining the actual cost of a drug. In light of this trend, Gregg notes that plan design, procurement, contracts, documentation, and monitoring will be more important than ever.
Gregg also highlighted findings from PSG’s 2025 PBM Customer Satisfaction Report, which showed that PBM satisfaction is the lowest it’s been in over a decade. With this significant decline, she says we may see an increase in the adoption of emerging PBMs outside of the “big three” organizations.
Is Your TPA a Fiduciary?
Perrin Rynders from Varnum LLP spoke about a recent case where a local company sued their plan administrator for not acting as a fiduciary for their employees. The company argued that the plan administrator did not uphold their responsibilities to act in the best interests of the company, and instead, overcharged on some claims and profited from the overpayments.
Rynders highlighted lessons from this specific case, and shared that these situations may be difficult to audit due to competing views over who owns claims data – the third-party administrator or the employer. He encouraged employers that they are entitled to their claims data and reminded them to ask for access to the information.
Employer Panel – Successfully Moving to Self-Funded Plans
To close out the event, TCHP Account Manager Jens Milobinski interviewed several local business leaders to hear about how they successfully transitioned their company’s health plan from a fully insured model to a self-funded plan.
Jayne Macomber, CFO of Outdoor Discovery Center, shared that her team made the switch after seeing a roughly 33% increase from their previous carrier. She encouraged employers to run the numbers and see the difference a self-funded plan can make. Kim Miller, VP of Human Resources at Big Dutchman, and Jessica VandenBosch, HR Lead at Dykhuis Farms, credited strong relationships with trusted partners as making the difference in a smooth transition to a self-funded plan.
A huge thank you to all who participated in and attended this year’s Health Insurance 4.0 event! We look forward to seeing you all again at our 2026 event next fall.
