Healthcare’s Lightning Strike Cost Problem with Drew Wilkins | Only Healthcare Podcast #23

In this episode of Only Healthcare's Risk Series, hosts Michael Navin and Randy Vogenberg welcome Drew Wilkins, Managing Director at Monitor Deloitte with over 20 years of consulting experience in corporate strategy and innovation. As an expert in access and health with deep expertise in life sciences, Drew reveals how cell and gene therapies are fundamentally breaking America's employer-sponsored healthcare system—not through gradual cost increases, but through unpredictable "lightning strike" events that can cost $3-5 million per patient.

Drawing from his extensive work with biopharmaceutical companies and self-insured employers, Drew exposes the fundamental mismatch between a healthcare system designed to amortize costs over a plan year and breakthrough therapies that deliver potentially curative results in a single treatment. With the average drug development cost reaching $2.6 billion over 12 years with only a 10% success rate, he explains why these therapies command million-dollar price tags while proposing innovative risk-pooling solutions that could revolutionize healthcare financing.

Key Topics Discussed:

• The Healthcare System's Lightning Strike Problem - How America's post-WWII employer healthcare model designed to spread predictable annual costs is fundamentally incompatible with one-time curative therapies costing $3-5 million, creating unpredictable "lightning strike" financial events that smaller self-insured employers cannot absorb, while traditional stop-loss insurance becomes prohibitively expensive as thresholds approach treatment costs

• The Plan Year Trap and Long-Term Investment Dilemma - Why healthcare's annual budgeting cycle prevents employers from making rational long-term investments like GLP-1 coverage for weight loss, since cardiovascular and diabetes benefits accrue over 5-10 years but employee tenure averages 12-24 months, creating perverse incentives to defer preventative care and push costs to future employers

• Revolutionary Risk Pool Innovation for Ultra-High-Cost Therapies - Drew's novel approach to carve out cell and gene therapies from traditional employer benefits into consolidated risk pools that spread costs across multiple employers on a per-member-per-month basis, creating predictability for budgeting while maintaining coverage, similar to reinsurance but bringing risk management closer to self-insured employers

The episode reveals how rebate models designed for tr

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Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.