Blog

GLP-1s have become the $100B headline in healthcare. Employers are struggling with paths to sustain and control the costs of covering them, pharmacy costs are spiking, and debates over ROI dominate boardrooms. But here’s the inconvenient truth: without finding the 1 in 4 employees with silent, Stage B heart failure or the millions with early chronic kidney disease - those GLP-1 and SGLT2i dollars are only a small part of the story. We’re medicating the visible problems - weight and diabetes - while ignoring the hidden precursors that drive $30,000–$50,000 heart failure hospitalizations, $90,000+ per year dialysis costs, and billions in lost productivity.<h3>The Hidden Threat Employers Miss</h3>Heart failure doesn’t start in the ICU. It starts quietly, with structural heart changes that most employees and even physicians never see. The AHA calls this Stage B HF (Pre-HF): asymptomatic but measurable disease often shown as Left Atrial Enlargement (LAE), Left Ventricular Hypertrophy (LVH) and increased cardiac filling pressures. These are often linked to obesity, hypertension, or type 2 diabetes and CKD. Additionally, CKD often evolves in parallel, progressing silently until late-stage decline forces dialysis or transplant<ul><li>A 2024 Report of CDC’s National Center on Health Statistics showed that nearly half of U.S. adults (47.7%) have hypertension, yet only 20.7% achieve adequate control despite treatment</li><li>Approximately 1 in 4 high-risk adults screened show Stage B HF changes</li><li>Up to 40% of adults with diabetes have CKD, many undiagnosed until late stages</li><li>60% of CKD patients have at least one structural/functional cardiac abnormality (LVH or diastolic dysfunction), even when asymptomatic</li><li>Hospitalizations cost $30–50k each for HF, while dialysis costs can exceed $90k annually</li><li>Progression is predictable: up to half of Stage B patients develop symptomatic HF within five years; CKD follows similar trajectories</li></ul> You can only manage what you have measured, yet early detection is abysmal. Primary care misses 50–70% of early HF and CKD cases due to lack of systematic screening. Earlier this year, I nominated “Echocardiography Screening to Prevent Heart Failure” to the USPSTF. Their January 2025 response? Decline. Not because the evidence is weak, but because their agenda is full. Translation: no Medicare, Medicare Advantage, or ACA-mandated coverage, no zero cost-sharing, and no systemic push to act early.<figure id="figure-dyn6h9ei5hmip1gp9d"><img id="dyn6h9ei5hmip1gp9d" src="https://cdn.durable.co/blocks/23c4KzbRcXKuR7mxfvXAFEBt9aJQ4QHMmn4Xcakm5anntDxjcCKSZDzO3cK3uyE6.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 1/1; object-position: center center;" data-corners="no-rounded" data-aspect="1:1" data-caption="USPSTF HF Screening Denial" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/23c4KzbRcXKuR7mxfvXAFEBt9aJQ4QHMmn4Xcakm5anntDxjcCKSZDzO3cK3uyE6.png" data-mce-style="aspect-ratio: 1/1; object-position: center center;"><figcaption class="body-normal text-gray-500 mt-2">USPSTF HF Screening Denial</figcaption></figure>Employers don’t have to wait. Fully insured groups (40–50% of the U.S. commercial market) have the flexibility to cover tests, integrate protocols into wellness programs, and pull prevention forward.<h3>Don’t Over-Index on a Single Lab</h3>BNP and NT-proBNP are valuable signals but poor stand-alone decision makers. Cut-offs vary, results fall into “grey zones,” and clinical response is inconsistent and too often random acts of kindness (also known as variability in care).<figure id="figure-l7jpvymiymip1nksw" class=""><img id="l7jpvymiymip1nksw" src="https://cdn.durable.co/blocks/106Cc3uDRfiwNvFXJN5tgRYMTqDXwT5QYqZqWs1IlT3VADHfpeLPip0rX6mDjBN3.png" alt="" title="" class="object-cover bg-gray-100 " style="aspect-ratio: 16/9; object-position: undefined undefined;" data-corners="no-rounded" data-aspect="16:9" data-caption="Variable BNP and NT-proBNP targets may not be consistently adopted in clinical management across disciplines. Additionally LAVI thresholds for defining at least Stage B HF in 2022 ACC/AHA Guidelines differ from historic values published by ASE." data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/106Cc3uDRfiwNvFXJN5tgRYMTqDXwT5QYqZqWs1IlT3VADHfpeLPip0rX6mDjBN3.png" data-mce-style="aspect-ratio: 16/9; object-position: undefined undefined;"><figcaption class="body-normal text-gray-500 mt-2">Variable BNP and NT-proBNP targets may not be consistently adopted in clinical management across disciplines. Additionally LAVI thresholds for defining at least Stage B HF in 2022 ACC/AHA Guidelines differ from historic values published by ASE.</figcaption></figure>In the end, the ROI isn’t in ordering one test. It’s in structured pathways:<ul><li>Biomarkers: NT-proBNP for HF stress, UACR/eGFR for CKD</li><li>Handheld screening echocardiography: to confirm structural disease.</li><li>Risk scores: layering diabetes, obesity, hypertension, family history.</li><li>Treatment initiation protocols: tying GLP-1/SGLT2i access directly to risk documentation, bypassing prior-auth bottlenecks.</li></ul>Employers shouldn’t just subsidize tests. They should subsidize consistency protocolized approaches that turn a low cost urine test (UACR) and a biomarker and and screening echo into a multimillion dollar savings play.<h3>Inverting the Utilization Management Question</h3>GLP-1s and SGLT2is aren’t just diabetes or weight-loss drugs. They are cardio-renal prevention tools. The evidence:<ul><li>SGLT2i's cut HF progression and hospitalizations by 20–30% (Class I guideline support)</li><li>GLP-1's in obesity reduce CV events and HF symptoms (SELECT trial)</li><li>Combination therapy may slash HF risk 40–50%.</li><li>...And this does not contemplate the additional benefits by GLP-1's to reduce Metabolic-Associated Fatty Liver Disease (MAFLD)...an independent predictive risk factor for both heart failure and death</li></ul>Yet only 10–15% of eligible patients receive them. Why? Sticker shock ($500–$1,300/month), prior auths, and narrow coverage. Employers can flip the script by tying access to early detection. Should we invert the question to say "if a patient has evidence of Stage B HF, why aren't they on an SGLT2i and if obese, has diabetes or evidence of MAFLD, also a GLP-1?"<h3>Why Employers Are the Pivotal Players</h3>Fully insured groups face 7–8% premium hikes and pharmacy spend consuming 25–30% of budgets. GLP-1s already account for 10.5% of claims in 2024, up from 6.9% in 2022. Coverage is expanding, but uneven: 36% of employers cover GLP-1s for both diabetes and obesity; only 20% cover weight management broadly.Here’s the lever: don’t just say yes or no to GLP-1/SGLT2i coverage. Say "YES" when cardio-renal disease or Stage B HF is detected, diagnosed and a care plan for intervention is defined.Employer strategies:<ul><li>Wellness Integration: Pair NT-proBNP or handheld echo with HRAs; auto-approve GLP-1/SGLT2i for positive screens</li><li>Value-Based PBM Contracts: Demand rebates tied to fewer HF admissions</li><li>Targeted Pilots: Focus on T2DM, CKD, obesity, and hypertension cohorts where Stage B HF prevalence is highest</li><li>Equity Lens: Use telehealth and subsidies to close gaps for underserved employees, where utilization lags 20–40%</li></ul><h2>A Call to Action </h2>Employers are pouring millions into GLP-1 coverage. The smarter play? Spend $250 or less in diagnostics to find the hidden pre-heart failure and heart failure cases to unlock the real ROI of GLP-1s and SGLT2is.This is prevention that pays: lower claims, healthier employees, and long-term cost curve bending. USPSTF may lag, but employers don’t have to. The choice is clear—make prevention the default.Question to readers: If you’re covering GLP-1's and SGLT2i's today and struggling with paths to control cost, what’s stopping you from tying access to Stage B detection? That’s where the real ROI lies.#HealthcareEconomics #HeartFailure #GLP1 #SGLT2 #EmployerBenefits #ValueBasedCare #CKD #Hypertension #Diabetes #PreventiveCare #ValueBasedCare

Want ROI on GLP-1's and SGLT2i's? Start with Finding the 1 in 4 Employees with Stage B Heart Failure

<h3>The Risks of False Evidence Appearing Real (FEAR) and the subtle, but real costs of speed, trust, and credibility</h3>If your organization is struggling with concerns and risks mitigation on how to govern video meeting recordings, AI transcriptions, and evolving productivity tools, then this is worth a hard look as the pressure mounts to integrate AI across business functions.In today’s fast-moving market, one of the greatest risks may be the disconnect between what is SAID and what the organization actually DOES. Many companies brand themselves as AI-forward, tech-enabled, and cloud-ready. They ask customers to trust their platforms, governance models, and ability to manage high-stakes data. But is that same posture demonstrated internally? Too often, the answer is no.Fear often drives these decisions. Fear of loss of control, liability risks, data exposure, and even concerns for IP leakage. These are valid concerns, but when considered in isolation, they frequently result in sweeping restrictions on tools that could make teams faster, more aligned, and more effective that may even lead to market acceleration and growth. This often includes meeting recordings, AI-generated transcriptions, and intelligent assistants spanning a number of uses such as asynchronous team work, knowledge transfers, training, project management and more.Unfortunately, this is not just an operational policy, but rather may be a cultural signal. One that reflects caution over confidence, reinforcing risk of cultural learned helplessness over ownership, and may lead a disconnect between brand promise and employee experience.<h3>So what is your FEAR response? </h3><blockquote>Forget Everything And Run? OR….. Face Everything And Rise?</blockquote>You have likely heard the common justifications, but many fall short under broader scrutiny:<h3>How does this align with industry standards?&nbsp;</h3>Many innovative organizations are exploring ways to enable these tools using retention limits, access controls, and audit trails and unfortunately struggle to understand paths to governance, but sometimes land in blanket bans that create drag rather than progress.<h3>Sensitive information may be at stake&nbsp;</h3>That is exactly why governance matters. Blocking documentation does not eliminate risk. It reduces transparency, visibility, and continuity. Compliance obligations remain regardless. More importantly, policies like these often ignore the tools that are already in play but outside of control. Employees, customers, and partners are increasingly using AI assistants, recording tools, and transcription apps on personal phones, desktops, or meeting platforms that are not governed by your internal IT policies.By banning secure, auditable internal tools, you may simply drive usage underground. This increases risk, not reduces it. Shadow AI, consumer-grade apps, and third-party meeting platforms already transcribe and potentially retain data by default. Pretending this doesn’t exist creates a false sense of security. Real governance requires acknowledging the full tool environment, then enabling safer, approved options.<h3>The scale of usage and storage cost are significant</h3>Those concerns reflect utility to the internal teams, not just volume. Leaders should understand why, what, and how tools are used, then implement smarter retention and access policies.<h3>Privacy and protection are essential</h3>Yes; but you must also weigh the risk of inaction. Slower decision-making, fragmented communication, and reduced execution speed are real risks in a marketplace that is not waiting. If you cannot responsibly govern your own internal tools, how will you credibly govern high-stakes customer data? No governance model is perfect, but the absence of as structured path is worse. Building operational muscle is part of the maturity journey.<h3>Perhaps one of the most important questions is how does your AI Governance Policy align with your company’s core values?&nbsp;</h3>If your company values innovation, trust, and transparency, internal policies should reinforce those values, not contradict them.This challenge is not anecdotal. The data backs it up:<ul><li>74% percent of companies struggle to scale AI value beyond pilot phases (<a data-mce-href="https://www.bcg.com/press/24october2024-ai-adoption-in-2024-74-of-companies-struggle-to-achieve-and-scale-value" href="https://www.bcg.com/press/24october2024-ai-adoption-in-2024-74-of-companies-struggle-to-achieve-and-scale-value">BCG: AI Adoption in 2024</a>)</li><li>Over 75% of executives say AI improves decision-making, morale, and collaboration (<a data-mce-href="https://www.bcg.com/press/12november2024-organizational-learning-and-ai-specific-learning-managing-uncertainty" href="https://www.bcg.com/press/12november2024-organizational-learning-and-ai-specific-learning-managing-uncertainty">BCG / MIT Sloan: Global Executives Using AI</a>)</li></ul>This is not about pushing tools blindly. It is about enabling teams to deliver effectively while governing with clarity and intent. The path forward is not restriction. It is governed enablement where consider practical steps may be worth consideration such as:<ul><li>Time-limited storage, for example auto-delete after 7 to 30 days</li><li>Role-based access with auditability, differentiated for internal use versus external communications</li><li>Whitelisted tools with embedded safeguards and policy compliance</li></ul>In the <a data-mce-href="https://hbr.org/2025/07/speed-is-a-leadership-decision" href="https://hbr.org/2025/07/speed-is-a-leadership-decision">July 2025 issue of Harvard Business Review, Andy Jassy - CEO of Amazon</a>, said it plainly… <blockquote>Speed is a leadership decision!</blockquote>As you assess all forms of risk, not just those most visible, keep these in mind:<ul><li>"In a world that is changing really quickly, the only strategy that is guaranteed to fail is not taking risks." — Mark Zuckerberg</li><li>"The greatest risk is not taking one." — Jack Welch</li></ul> Do not confuse protection with progress. Fear-based decisions often create scenarios of False Evidence Appearing Real where what seems like "safety" may in fact lead to missed opportunity, organizational drag, and a loss of relevance.<h3>The goal is not zero risk, it is responsible enablement with the goal of building maturity, not walls.</h3>

The AI Leadership Credibility Gap: When Fear Poses as Governance

<h3>Healthcare Innnovation's Latest "Wellness Visit" Findings</h3>Healthcare’s innovation pipeline isn’t short on products....it’s short on purpose. Over-spec’d devices, chasing feature and function wars no one asked for, ultimately exposing a growing divide: product thinking vs. solution building.Across too much of the healthcare and medtech industry, spanning devices large and small, technology and inclusive of AI in many forms, we are witnessing a chronic industry condition: technologies engineered for technical achievement rather than clinical relevance, operational simplicity, or measurable value.The diagnosis is clear and pick your poison, as each may apply:<ul><li>Z99.99 — Chronic Feature Fatigue | Endless spec upgrades without solving real clinical or operational problems</li><li>Z00.999 — Encounter for Device with No Clinical Value | Technologies that add workflow burden, not workflow clarity</li><li>T82.89XAX — Malfunction of Innovation, Initial Encounter | Brilliant inventions that stall when they meet the complexity of real-world healthcare</li></ul><h3>Why This Matters Now</h3>Healthcare is not buying devices anymore. It is buying outcomes, workflow efficiency, embedded decision support, elevated patient experience, and measurable system value.Why? Because that’s what the system (and the market) demands.&nbsp; Yet too many companies still pursue strategies rooted in:<ul><li>Technical isolation — Building standalone products with no data liquidity or interoperability.</li><li>Spec sheet escalation — Assuming more features equal commercial appeal… maybe adoption.</li><li>Transactional selling — Pushing individual products rather than enabling care transformation.</li></ul>The result? Devices that don't fit the market need. Workflows that don’t improve. Value propositions that don't resonate….and innovation efforts that burn capital without bending cost—curves in a socially optimal path.<h3>The Solution-Centered Mindset: A Different Path Forward</h3>To thrive, companies must fundamentally reset how they think about innovation, commercialization, and customer engagement strategically beginning with roadmaps and internal process.A Comparison of Mindsets<table style="border-collapse: collapse; width: 100%;" border="1" data-mce-style="border-collapse: collapse; width: 100%;"><tbody><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Dimension</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Product-Centered Approach</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Solution-Centered Approach</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Technology Focus</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Tech performance in isolation</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Enable full care pathways and real-world clinical decisions</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Development Priorities</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">More features, faster specs</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Outcome measurement, interoperability, workflow fit</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Go-To-Market Strategy</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Sell devices based on spec superiority</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Deliver bundled, interoperable solutions focused on outcomes</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Provider Experience</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Manual, fragmented integration</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Embedded decision support, streamlined data flow</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Payer Enablement</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Little evidence, high prior auth friction</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Clear value evidence, outcome-linked ROI pathways</td></tr><tr><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Patient Experience</td><td style="width: 33.3312%;" data-mce-style="width: 33.3312%;">Disjointed, delayed diagnosis and treatment</td><td style="width: 33.3373%;" data-mce-style="width: 33.3373%;">Seemless escalation, faster answers and access, with better engagement</td></tr></tbody></table><h3>It’s Not Enough to Just Build the Solution—Price, Package, and Deliver It Differently</h3>Even the most elegant solution will stall without a commercial model that reflects its value. Solution-centered strategies must be paired with innovative go-to-market and approaches and innovative business models that lower adoption barriers and align incentives across stakeholders.That includes advancing approaches for:<ul><li>Subscription or usage-based models that shift capital expense to operational ROI</li><li>Outcome-based pricing that aligns with value-based care contracts</li><li>Managed service models that bundle devices, software, services, and support into a turnkey care delivery platform</li><li>Risk-sharing structures that allow provider organizations and payers to co-invest in transformation</li></ul> Repackaging solutions through these models doesn't just make adoption easier — it makes value tangible.<blockquote>Interoperability is no longer optional. It must go beyond technical checkboxes</blockquote><ul><li>Contractual interoperability may open access</li><li>Technical interoperability may transmit data</li><li>Semantic interoperability may translate meaning</li></ul>But business and clinical interoperability are what unlock system value. They empower organizations to:<ul><li>Support seamless patient journeys</li><li>Empower providers with real-time, actionable data and CDS</li><li>Enable payers to recognize and reward value without excess friction</li><li>Drive continuous evidence generation and outcomes validation</li></ul> Disconnected devices — even powerful ones — don’t create scalable change. Connected systems do. As I have stated previously, solving the “less sexy” problems may in fact be the most attractive solution because that is where monotony, burnout and fragmentation live.<h3>Solution Thinking Across the Care Continuum</h3>Imagine a typical patient journey:<ul><li>Screening Stage: Early risk detection through wearable tech, AI-enhanced screening tools, and predictive analytics</li><li>Diagnostic Stage: Seamless escalation from point-of-care diagnostics (e.g., ultrasound, ECG) to advanced imaging and specialist consultation without fragmentation or friction</li><li>Treatment Planning: Integrated data platforms, AI-enabled decision support, and interdisciplinary care coordination that accelerate time-to-treatment and reduce variability.</li><li>Ongoing Management: Remote patient monitoring, home-based diagnostics, and population health platforms that prevent readmissions and lower the long-term cost of care.</li></ul>Every product, platform, or service should map to (AND ENHANCE) this continuum.If you can’t connect your offering to meaningful improvement across the entire patient and provider journey and to the value chain, you’re not delivering a solution. You’re delivering a widget.<h3>The Future Belongs to Solution Builders</h3>Healthcare should no longer tolerate technological brilliance that doesn’t translate to clinical relevance, operational value, and financial sustainability and to help our patients most, we need to lean in differently.I may be wrong, but I feel strongly that the healthcare and healthtech companies that will lead the next decade will:<ul><li>Design for workflows horizontally across the continuum, not in fragmented silos</li><li>Prove outcomes, not just pitch features</li><li>Build systems of success, not just sell products</li></ul>Anything less isn’t innovation or optimization — it’s inertia. &nbsp;“Chronic feature fatigue is treatable” but only if we stop assuming treatment success equates to specs, features and functions, and instead start delivering microdoses (and maybe macrodoses) of system-focused transformation.&nbsp;--------------------------------------------------------------- Disclaimer: The ICD-10 codes referenced in this article (Z99.99, Z00.999, T82.89XA) are used satirically to illustrate common challenges in the medtech industry. They are not real clinical codes and should not be interpreted as actual medical classifications.#HealthcareInnovation #SolutionSelling #MedTech #ClinicalOutcomes #ValueBasedCare #Interoperability

Healthcare Needs Solutions...Not More Products

Erik Abel

Thought Leader Portfolio (clean hero, blog, and about).

Erik Abel is a healthcare strategist and operator bridging clinical, payer, and MedTech ecosystems to scale AI and digital health solutions that improve access, outcomes, and profitability across fee-for-service, hybrid, and value-based models. With over two decades of leadership translating innovation into reimbursable, market-ready solutions—including a nine-figure acquisition, nationwide diagnostic deployment, and measurable payer adoption—he is recognized for advancing healthcare innovation and commercial growth through research, thought leadership, and advisory work that converts complex care, technology, and policy environments into sustainable value across the healthcare continuum.


Insights & Opportunities

Want ROI on GLP-1's and SGLT2i's? Start with Finding the ...

The AI Leadership Credibility Gap: When Fear Poses as Gov...

Healthcare Needs Solutions...Not More Products