Model Optimal Care, book cover

Published May 2026

End U.S. Healthcare Waste.

A practical, data-driven guide for the self-funded industry: employers, benefits directors, CFOs, TPAs, payers, brokers, and the consultants who advise them.

About the Book

U.S. healthcare waste runs at an estimated 25 to 30 percent of national health expenditure, which reached $5.7 trillion in 2025. A significant share of it sits inside employer-sponsored health plans, hidden behind opaque contracts and vendors with no financial incentive to fix it.

Employers who self-fund their health plans sit at the centre of this problem. They also hold the power to solve it. This book shows how.

What You'll Learn

Find the waste

Locate fraud, waste, abuse, and inefficiency inside claims data you already own.

Read the contract

Understand how vendor agreements are written to keep costs opaque.

Act as a fiduciary

Meet the obligations the Consolidated Appropriations Act created.

Build the plan

Turn findings into a measured, phased cost-containment programme.

Who This Book Is For

Anyone with fiduciary responsibility for an employer-sponsored health plan, or anyone who advises them:

  • Benefits Directors & HR Executives
  • CFOs & Finance Leaders
  • Self-Funded Employers
  • PEOs
  • Stop-Loss Carriers
  • ASOs
  • Third-Party Administrators (TPAs)
  • Benefits Brokers
  • Healthcare Consultants
  • Healthcare Policymakers
  • PBMs & Pharmacy Consultants

A Video Introduction

Model Optimal Care: A Video Introduction

Early Praise

What industry leaders are saying about Model Optimal Care.

"This is a rare healthcare book that respects the reader’s intelligence and time. No vendor pitches. No inflated ROI claims. Just field-tested strategies backed by data and common sense. If you’re a plan sponsor and you are not reading this book, you are leaving money on the table."

Al Lewis CEO, Quizzify; Author, Why Nobody Believes the Numbers and Surviving Workplace Wellness

"Model Optimal Care is the resource our industry needs right now. For professionals new to self-funding, it provides a clear, data-driven foundation. For those of us who have spent decades in this space, it delivers current methods, innovations, and practical arguments that sharpen how we serve the self-funded community."

Ernie Clevenger President & Publisher, MyHealthGuide, LLC; Retired President & Co-Founder, CareHere, LLC; Past Chairman, SIIA

"Transparency alone does not reduce healthcare costs. Employers need the discipline to act on what the data reveals. Model Optimal Care delivers that discipline, with practical strategies that turn information into fiduciary action."

Michael McKenzie, MHA Healthcare Technology Founder and Former Hospital CIO

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