How an Employer Defied Healthcare Cost Trends with a Quality-First Navigation Strategy

Case Study

Background

Like many U.S. employers, this employer organization faced the unsustainable rise of healthcare costs. Since 1980, healthcare costs have quadrupled, growing from 8.9% of GDP to 18.1% by 2024. While the average single deductible was under $200 in 1980, by 2024, it had ballooned to $2,500 for employers with fewer than 2,000 employees. Despite these trends, this employer took bold steps to break the cycle.

Challenge

Healthcare spend was projected with a steady increase:

• 2020 spend: $1,006,493
• 2024 spend: $1,521,857

Leadership knew they couldn’t sustain these increases without sacrificing employee satisfaction or financial stability. They sought a way to control costs without cutting benefits or shifting more expense to employees.

Solution: Quality Navigation + Benefit Redesign

The employer partnered with a forward-thinking benefits consultant to reimagine their health plan. Their solution focused on navigation to the highest quality care by:

• Steering employees to providers based on proven quality metrics including outcomes, complication rates, and certifications.
• Offering significantly reduced copays when employees used preferred providers: $250 for outpatient surgery $500 for inpatient surgery $0 for Direct Primary Care (DPC)
• Introducing concierge navigation services to help employees identify and access the top 3 quality providers in their area.

Benefit Plan Highlights

Plan Feature Details

Deductible $1,000 Single / $3,000 Family

Specialist Copay $40

Imaging Copay $100 (X-ray/CT/MRI)

Outpatient Surgery Copay $250 (when using preferred providers)

Inpatient Surgery Copay $500 (when using preferred providers)

Primary Care $0

 Results

• Flat Costs: For the first time in years, 2025 renewal rates remained flat, reversing the rising cost trend.
• Improved Member Experience: Employees benefited from easier access to top-tier care, clear guidance, and lower out-of-pocket costs, 90% of our membership spent less than $1,000 on healthcare in 2024.
• Enhanced Outcomes: By steering employees toward the highest quality providers, the plan improved clinical outcomes while reducing avoidable complications and readmission.

Key Takeaways

• Bold Moves Pay Off: By choosing quality navigation over status quo network utilization, this employer improved both financial and health outcomes.
• Cost Control Without Cost Shifting: Employees enjoyed better care at lower out-of-pocket costs, which included lowering employee contributions by $200 a month, while the employer controlled its financial exposure.
• A Repeatable Model: This strategy sets a precedent for other public and private employers seeking to transform healthcare from a cost liability into a competitive advantage.

I look forward to hearing your comments and having some discussion on how you can accomplish this.