How to Run Healthcare Like a Business

Benefit leaders are under increasing pressure to implement healthcare strategies that not only improve employee wellbeing but also deliver on cost savings and ROI. To push through their preferred programs, it's essential for benefit leaders to approach healthcare like a business initiative—with a clear plan, alignment with key stakeholders, and a strong focus on return on investment (ROI).?

That was the message from Sword Health’s recent Executive Circle gathering in New York City. Brian Marcotte , former president and CEO of Business Group on Health, held a roundtable discussion with leaders from top companies.

They explored strategies for getting buy-in for healthcare initiatives, especially when working with CFOs and finance teams.?Here are the biggest takeaways from their discussion:

One of the first questions you need to answer is: Who makes the final decision on healthcare strategy and purchases in your company? Depending on your organization, this might be an individual or a committee, and understanding this dynamic is critical.

• C-suite influence: In some organizations, decisions are top-down, with the CEO having the final say. If that’s the case, you’ll need to understand who the CEO listens to in the C-suite. For instance, they might turn to the CFO, CHRO (Chief Human Resources Officer), or even the chief legal officer for guidance. If you can influence these key individuals, you’re more likely to get your initiatives approved.
• Committee-driven decisions: In other companies, decision-making is more distributed across a benefits consulting group or a committee. In these cases, consensus may be required, which means you’ll need to build support among several stakeholders before you even reach the decision table.

The key is understanding your company’s decision-making structure and identifying who you need to influence at each stage.

The bigger the financial investment, the more stakeholders you’ll need on board, and the higher up the chain the decision will likely go.

Every company has a unique culture that will shape how decisions are made—especially when it comes to spending. For some organizations, cost is king. They have a performance-driven, financially focused culture where everything comes down to the numbers. In these cases, your healthcare strategy must show a clear ROI and deliver measurable savings and/or health outcomes.? It’s important to “speak the c-suites language” by aligning your proposal to the financial goals of the organization.? Ask yourself how does your CFO present financial information?? Displaying your health care financials in a financial format that your CEO and CFO are familiar with can enhance credibility, demonstrates business acumen and go a long way to influencing the outcome.?

For other companies, the focus might be more on employee relations and long-term retention. These organizations might be more willing to invest in healthcare solutions that improve employee wellbeing over the long term, even if the financial returns aren’t immediate.?

Moreover, consider the market position of your company. Are you in a high-growth mode and competing aggressively for talent? Or are you in a more conservative, cost-saving phase? Tailor your strategy to fit the company's current priorities.? Understanding the cultural context, aligning your goals with the goals of the c-suite and speaking the c-suite’s language are all critical when you craft your pitch.

In today’s inflationary environment, ROI is more important than ever. Companies are under pressure to justify every dollar spent, and healthcare is no exception. For example, the procurement team will be looking closely at the ROI of any new solution—both from the perspective of company-wide financials and their own department's P&L.

For benefit leaders, this means you must present a compelling financial case. Be prepared to answer questions like:

• How will this program reduce overall healthcare spend?
• Where will the bulk of savings come from?
• Can it prevent costly medical interventions, such as unnecessary surgeries?

It's important to have concrete data to back up your claims. For example, a program like Sword Health can reduce MSK surgery by 50%, which directly impacts healthcare costs. Additionally, Sword’s outcomes show that 62% of members report being pain-free after completing the program, resulting in fewer medical claims and higher employee productivity—clear metrics that resonate with CFOs and finance teams.

Finance teams are not just gatekeepers—they can be allies if you position your proposal strategically. Many benefit leaders may hesitate to involve finance early in the process, but aligning with them is one of the most effective ways to strengthen your case for a new health plan.

Here's how to get ahead of finance team questions:

• “De-risk” your program by showing cost neutrality: In some cases, you may not be able to add a new program unless it’s cost-neutral. This means you need to show where the savings will come from to fund the new initiative and procure performance guarantees that at a minimum ensures cost neutrality. For example, if you're implementing a new MSK solution, outline how it will reduce long-term medical claims, healthcare utilization or lower absenteeism to offset the upfront cost and tie program fee reimbursement to demonstrable outcomes.
• Prove long-term ROI: Remember, finance teams are often focused on long-term returns, not just immediate savings. Position your healthcare program as an investment that will yield savings over time, and provide data to support those projections. Highlight any risk mitigation your program offers—whether it’s reducing the likelihood of expensive surgeries or preventing chronic conditions from worsening.

By demonstrating that you've thought through the financials in detail, you're more likely to win the support of the CFO and finance teams.

One of the challenges in gaining approval for healthcare programs is that, often, companies don’t have the budget to simply add new initiatives. You may need to find creative ways to offset costs elsewhere.

For example, if you're proposing a new MSK care program, look at the current medical claims related to chronic pain or musculoskeletal issues. By implementing a digital solution like Sword Health, you could potentially reduce claims related to unnecessary surgeries or long-term physical therapy. Use this projected savings to make the case that the new program will pay for itself over time.

This approach not only shows fiscal responsibility but also demonstrates that you’ve done your homework, making it easier for decision-makers to green-light your proposal.

Finally, be prepared for delays. In today’s uncertain economic environment, many companies are deferring decisions until they can prove the ROI of new initiatives. Even if your solution partner is willing to de-risk the investment, proving the ROI must have credibility.? This can be frustrating, but it also presents an opportunity to gather more data and build a stronger case.??

If you’re facing a delayed decision, continue tracking relevant data—such as current healthcare costs, absenteeism rates, or employee satisfaction scores—so you can reinforce your argument when the decision-making window opens again.? Push your solution partner to provide externally validated studies on ROI and outcomes.??

Running healthcare like a business means approaching your role with a strategic mindset. Know your decision-makers, align with your company’s culture, and be ready to make a strong financial case.

By showing clear ROI, working closely with your finance team, and finding creative ways to offset costs, you can secure buy-in for the healthcare plans that will drive both employee well-being and company performance. Remember, healthcare spend is an investment and an integral part of your workforce strategy.? When positioned correctly, it’s one that delivers lasting returns for both the company and its employees.

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