iiinova — where your digital self keeps evolving

David Silverstein @www.brokenhealthcare.com · 30/09/2026

Most employers don't realize their stop-loss doesn't have to come from the same company that processes their claims. Same for your TPA and PBM. Bundling was sold as convenience. Vertically integrated plans are a choice, and it's why most employers can't explain where their healthcare dollars go.

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David Silverstein @www.brokenhealthcare.com · 26/08/2026

I recently joined David Meltzer's podcast Office Hours to talk about my new book, The Lean Health Plan. I explain how American businesses can fix our healthcare system by applying the Lean methodology, the discipline that originated with Toyota's production system. lnkd.in/gHBxdY2r

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David Silverstein @www.brokenhealthcare.com · 13/08/2026

What do you call the company managing your health plan? They are administrators at best. In my new book, The Lean Health Plan, I call them tollbooths. If you're serious about controlling your healthcare costs, this book gives you the roadmap. www.brokenhealthcare.com/p/my-books

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David Silverstein @www.brokenhealthcare.com · 13/08/2026

For years, understanding your own claims data required specialized software and data scientists you didn't have, so you paid someone who did. An unbounded AI model now reads your claims data and answers in plain English, in minutes. I wrote about what that means for anyone managing a health plan.

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David Silverstein @www.brokenhealthcare.com · 05/08/2026

Everything I've written about excluding high-cost drugs raises an obvious question. What do you do when an employee legitimately needs the brand-name drug you've excluded? The answer is more straightforward than the industry wants you to believe. www.brokenhealthcare.com/p/formulary-...

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David Silverstein @www.brokenhealthcare.com · 03/08/2026

If a specialty drug is excluded but an employee can still get it through a medical review, how is formulary management any different from prior authorization? It comes down to who is making the decision. Prior auth hands that decision to a middleman. Active formulary management keeps it with you.

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David Silverstein @www.brokenhealthcare.com · 13/07/2026

If you are an employer who wants to understand what healthcare AI is going to do to your health plan, my latest Substack explains why medicine will advance but without structural reform AI-powered healthcare will bankrupt us all. brokenhealthcare.com/p/artificial-intelligence-will-revolutionize

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David Silverstein @www.brokenhealthcare.com · 02/07/2026

I spent years fighting for the rules that forced hospitals and insurers to disclose their prices. However, transparency alone isn't enough, not as long as a traditional carrier runs the plan. That's why I wrote The Lean Health Plan — the first book to apply Lean directly to the employer health plan.

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David Silverstein @www.brokenhealthcare.com · 26/06/2026

Most of the conversation around ICHRAs is about year one. Almost nobody talks about year four. By the time an employer wants to come back to a real plan, and many of them will, the things that made a real plan possible are gone. Before you sign, look at what you'd be tearing down.

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David Silverstein @www.brokenhealthcare.com · 10/06/2026

If you have a health benefits renewal meeting scheduled soon, there is a good chance an ICHRA is going to come up. Healthcare costs are crushing employers, and the ICHRA pitch is the first thing in years that sounds like real relief. Before you say yes, there are six things worth knowing.

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David Silverstein @www.brokenhealthcare.com · 02/06/2026

ICHRAs sound like the answer benefits leaders have been waiting for, but an ICHRA does not lower the cost of healthcare. This week I wrote about why the ICHRA pitch is everywhere right now, who benefits when an employer says yes, and the six specific ways it falls apart for the employers who do.

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David Silverstein @www.brokenhealthcare.com · 21/05/2026

American health insurance is a hot potato. When insurance costs more than it's worth, people opt out. When they need coverage, they find it. When they no longer need the job that came with it, they move on. But insurance and risk pools only work if healthy people pay in before they need it.

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David Silverstein @www.brokenhealthcare.com · 19/05/2026

My latest Substack tells the story of a father who looked at $20,000 in annual premiums, steep deductibles, and a healthy family — and decided going uninsured was the smarter call. And honestly? He may not have been wrong. That's how broken this system is. www.brokenhealthcare.com/p/one-story-...

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David Silverstein @www.brokenhealthcare.com · 14/05/2026

If your an employer in the Denver area, I'd love to see to you at this event. Register here: rmtra.starchapter.com/meetinginfo....

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David Silverstein @www.brokenhealthcare.com · 14/05/2026

Hantavirus is having a moment. I wanted to share a link to an article my team at Amaze Health put out today about Hantavirus. It's a complete look at what's happening - all in one place. They do a great job of separating the facts from the frenzy. amazehealth.com/hantavirus-i...

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David Silverstein @www.brokenhealthcare.com · 12/05/2026

Employers, think about how you run your business, now think about your health plan. When you purchase a bundled ASO plan, you are signing a contract to pay fees to a BUCA tollbooth. You negotiate everything else inyour business, so why does your second-largest operational expense get a pass?

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David Silverstein @www.brokenhealthcare.com · 06/05/2026

Your broker pitches wellness apps while your hospital bills $4,000 for an MRI available down the street for $400. The contract they sold you prevents you from doing anything about it. You have options that will move the needle. Full story on my Substack: www.brokenhealthcare.com/p/the-cavalr...

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David Silverstein @www.brokenhealthcare.com · 05/05/2026

I've watched employers place their faith in a sequence of rescuers for decades. Employers need to understand: The cavalry is not coming. If no one is coming to fix this, then the only question worth asking is what you are going to do about it. brokenhealthcare.com/p/the-cavalry-isnt-coming

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David Silverstein @www.brokenhealthcare.com · 01/05/2026

Bloomberg reported this week that healthy workers are leaving employer plans for healthcare share plans or no coverage at all. I just published a two-part series on Broken Healthcare covering what share plans are, who wins, who bears the risk, and what it all reveals. Links below.

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David Silverstein @www.brokenhealthcare.com · 28/04/2026

Millions of Americans have walked away from traditional health insurance. Share plans are filling that gap, and they're growing fast. If you're considering one, there are 7 things you need to understand before you sign anything. brokenhealthcare.com/p/thinking-about-joining-a-share-plan

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David Silverstein @www.brokenhealthcare.com · 27/04/2026

The ACA was built to expand coverage, so why are millions of Americans fleeing to unregulated alternatives to afford basic care? We need to acknowledge that the system, which is supposed to protect consumers has priced them out and pushed them toward something with no consumer protection at all.

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David Silverstein @www.brokenhealthcare.com · 24/04/2026

Healthcare share plans work well for healthy people. They offer lower costs, fewer rules, and real savings. But if you get sick? You need to know that the plan has no contractual obligation to pay your claim, and there is no appeals process. brokenhealthcare.com/p/the-rise-of-share-plans

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David Silverstein @www.brokenhealthcare.com · 22/04/2026

Millions of Americans are abandoning regulated health insurance because they can't afford it. Enter healthcare share plans. Learn what they are, who they help, who they hurt, and what their growth reveals about the failure of the system we've built. brokenhealthcare.com/p/the-rise-of-share-plans

Graphic showing a person approaching a fork in the road. On one side they can choose an ACA plan and on the other is a healthcare share plan.

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David Silverstein @www.brokenhealthcare.com · 16/04/2026

If you're self-funded, the logo on the health insurance card your employees carry isn't your insurance company. You are. 50 years ago, American business leaders figured that out and took control of their health plans. Then legacy carriers invented the ASO contract, and employers handed it all back.

A quote graphic that has an image of a hand holding the key to health insurance. The quote reads, "The move to self-funding was a fight for control. It was an effort by employers to assume their own risk, bypassing traditional insurance apparatus, and becoming the fiduciary masters of their own healthcare destiny. Then they handed it right back.

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David Silverstein @www.brokenhealthcare.com · 14/04/2026

Fifty years ago, employers broke free from the BUCAs. Then they handed control right back through ASO contracts. It seemed reasonable to employers to outsource the administration of their health plans. Find out why it wasn't and what you need to do about it. www.brokenhealthcare.com/p/you-are-th...

Graphic depicting a self funded employer looking in the mirror and realizing that they are the health insurance company for their workers.

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David Silverstein @www.brokenhealthcare.com · 02/04/2026

Healthcare costs can't keep rising 2-3x faster than wages. If we haven't already, we are reaching a tipping point. Either employers will stop offering coverage, triggering a crisis, or the government will impose price controls, triggering shortages and rationing. Neither path is acceptable.

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David Silverstein @www.brokenhealthcare.com · 18/03/2026

Every American deserves a trusted, independent health and medical partner. Alongside that, we need a local transactional system that handles what it does best, like imaging and procedures. Two distinct models, working together the way they were always meant to. open.spotify.com/episode/1r3L...

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David Silverstein @www.brokenhealthcare.com · 12/03/2026

I spent years fighting for healthcare price transparency. Hospital CEOs and insurance executives told me privately they supported it. But publicly, they stayed silent to protect their jobs while the organizations they worked for actively fought it. Your employee benefits broker may also be trapped.

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David Silverstein @www.brokenhealthcare.com · 09/03/2026

Provider burnout isn't just about long hours, it's about being trapped in a system that won't let you do the work you trained for. Hear more on my recent appearance on Expressions of Leadership on Spotify open.spotify.com/episode/1r3L... or Apple Podcasts podcasts.apple.com/us/podcast/c....

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David Silverstein @www.brokenhealthcare.com · 27/02/2026

Value-based care is the red herring of healthcare reform. While we've been chasing it, bureaucracies have grown, consultants have thrived, and patients have waited longer to access care. Worse, there's no credible evidence it works at scale. Enough with VBC. www.brokenhealthcare.com/p/enough-wit...

Image a red herring in the midst of blue herrings to indicate the value-based care is the red herring of healthcare reform.

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