Jill Ambrose, MBA, BSN, RN, had a plan. Move to Colorado, work three 12 hour shifts a week as a pediatric registered nurse, and spend the rest of her time on the ski slopes. It did not go quite that way.
The detour that followed led through the Children’s Hospital of Philadelphia, Nemours A.I. DuPont, working in medical and surgical trauma, before branching into patient safety, regulatory work, clinical trials and completing an MBA with a healthcare focus. Eventually, improbably, it brought Ambrose to the center of one of America’s most pressing challenges: the rising cost of employer sponsored healthcare.
As Head of Population Health and Partner at Conner Strong & Buckelew, a prominent independent brokerage on the East Coast, she applies the same clinical analytical lens she once trained on her patients to the health data of entire workforces. “My brain is clinically analytical,” she says, “and leveraging the clinical claims data that we have to try and make meaningful interventions for our clients is really what drives me to come to work.”
For Ambrose (pictured), understanding the American employer health challenge begins with an honest look at how people relate to their own wellbeing. “In the United States, we practice sick care. We don’t practice well care. We don’t, as humans, truly look at ourselves and our body and our wellness as an investment.”
The dominant cost drivers right now are cancer, GLP-1s for obesity management and specialty drugs. On GLP-1s, she is measured: the return on investment is unclear in the short term and still unknown in the long term. Specialty drugs present a particular transparency challenge. A patient taking STRENSIQ®, a biologic and long-term enzyme replacement therapy, pays a nominal copay while their employer absorbs roughly 40k-125k per month, or 500k-1.5M annually. The employee has little sense of what any of this actually costs, which makes it difficult to frame healthcare as a shared responsibility.
The opportunity, she believes, lies in prevention. “100 out of 100 times. I’ll die on that sword.” The goal is not to cure what cannot be foreseen but to catch conditions earlier, when treatment is both more effective and more cost efficient for the consumer and the employer alike.
To bring that case to life for clients, Conner Strong has begun presenting employers with something quietly powerful: a de-identified timeline of an employee’s cancer journey from early onset cancer, defined as cancer diagnosed before the age of 50, drawn from years of clinical claims data. Sadly, many of these folks have succumbed to their cancer.
“More often than not, the HR folks say, ‘they told us about their cancer, so we know who this person is,’” Ambrose says. The intent is not to play on emotion for its own sake. “I don’t necessarily think heartstrings are the place I want to be, but that’s where we have to be to make it personal because cancer is personal. Healthcare is personal.” What that moment often reveals, she suggests, is that employers genuinely do want their people to be well. The data simply makes that human reality visible in a way that spreadsheets rarely can.
One of the more persistent challenges in employee health engagement is the incentive model. Five generations share today’s workforce, yet the approach tends to be uniform across all of them: a $20 gift card in exchange for completing a health screening. The difficulty, Ambrose observes, is that no single reward resonates equally with people at very different life stages.
A worker approaching retirement might respond warmly to an extra quarter percentage point on a 401(k) or 403(b) contribution. A parent of young children might find a half day of paid time off more valuable than any cash equivalent. A 27-year-old might genuinely appreciate the chance to win a cruise. “We have started to tell our clients: ask your people what they want.”
The window of opportunity is particularly important for employees in their 30s, before diabetes, hypertension and hyperlipidemia begin to take hold. “Ask the 30-year-olds what they want. Ask them what they want to stay with the company forever.” The longer term reality, she acknowledges, is that employers invest today and may wait 20 years to see the return. “That’s what we’re doing.” It is, she suggests, an investment worth making.
Ask Ambrose whether employers can simply mandate preventive care and the answer is characteristically candid. “It’s a cute little dumpster fire over here.” The landscape of what employers can and cannot do is genuinely complex, and the aftermath of getting it wrong can have significant consequences.
In some cases, changes to GLP-1 coverage for weight management have sparked public criticism before leadership teams have had an opportunity to explain their reasoning. "To a degree, employers are constrained in the choices they can make." Coverage decisions involving serious illnesses require particular caution. "If those decisions attract media attention, employers can quickly find themselves under heavy public fire."
The result is a system in which employers carry significant financial responsibility while navigating equally significant reputational considerations. It is a tension that calls less for meaningful and equitable coverage and more for thoughtful, proactive planning.
Conner Strong works with both fully insured and self-funded employer groups. Ambrose mainly works with the self-funded organizations that have taken on their own financial risk. The cost of fully insured plans, given their workforce’s health profile, has become difficult to sustain. The current environment is demanding. Stop loss and reinsurance renewals are coming in with premium increases of 30% to 40% in addition to lasers for high-cost treatment related to specific diseases. Many groups have January 1st renewals, so strategic conversations are happening all at once.
The internal framing at Conner Strong has evolved to reflect this. Ambrose states, “This is not population health anymore. This is really health risk mitigation and management.” The firm is tracking gene therapies in the pipeline, including a Phase 1 study targeting LDL and triglycerides, safely reducing the numbers by approximately 52% and 47% respectively. Furthermore emerging gene therapies are in trials for complex Type 1 diabetes. The implication is clear: conditions that are manageable today may carry very different cost profiles in the years ahead. “By the time I’m a catastrophic heart attack or stroke, we’ve missed the boat.”
When it comes to selecting vendors, Ambrose is consistent in her starting point: the claims data comes first. The historical challenge with conditions such as diabetes, she says, was a matter of precision. “What we’ve been doing is taking the arrow and shooting it into the sky at the invisible moving target and hoping we hit it somewhere.” With clinical claims, that target becomes visible.
What the data often reveals is counterintuitive. A population with a high prevalence of diabetes is not necessarily a cost concern if those patients are well managed. In one client example, the compliance rate for diabetic management was just 6%, meaning 94% of employees with the condition were not actively managing it. That disease management gap, rather than the diagnosis rate itself, was where the real cost pressure lie.
Getting people properly diagnosed creates a short term cost spike before management brings spending down, and that timeline sits uncomfortably within annual budget cycles. It is, Ambrose notes, one of the structural tensions that makes sustained progress difficult. “The program is set up to fail because of how long it takes to change behavior.”
At Conner Strong, the advisor relationship goes well beyond plan design and procurement. When clinical claims surface a pattern worth investigating, the population health team engages with the third party administrator (TPA) early, before a cost event has the chance to arrive unannounced.
Gene therapy is a particularly clear illustration. Treatments for conditions such as sickle cell disease carry costs in the millions, not including administration and years of follow up care. When a member appears in claims as a potential candidate, Conner Strong works with the TPA to assess whether their age and disease severity actually place them in the treatment pathway, rather than facing a surprise prior authorization down the line. “We see the problem before it’s a problem,” Ambrose says.
That early engagement has in some cases led to reimbursement back to the client. In others it brings either welcome reassurance or a clear eyed forecast. “I can’t tell you when, I can’t tell you how, but I can tell you it’s here and I can tell you it’s coming.” The most valuable service, she reflects, is being able to distinguish between what is present and what is genuinely pressing. “They’re not always one and the same.”
Away from claims reviews and renewal conversations, Ambrose finds her way back, at least in spirit, to that original plan. The family skis in the winter and paddleboards on lakes in the summer. Being outdoors, she says, is the one thing that reliably quiets the clinical mind.
Even on the slopes, the clinician is never entirely off the clock. She admits to quietly calculating the risk of a femur fracture mid-run. Some habits, it turns out, are considerably harder to leave at the office than others.
