Better Experience. Cost Clarity. Effortless Choice.
The Challenge
A regional professional services employer with 650 benefit-eligible employees on a self-funded PPO concentrated around a four-hospital metro area saw rising spend in outpatient imaging as members routinely defaulted to a high-cost regional facility for CT and MRI. Leadership lacked clear visibility into price dispersion and how to steer members to better options without compromising access or quality, leading to unnecessary plan costs and member out-of-pocket expenses. Without actionable data or simple tools, the status quo persisted and costs climbed.
The IMPACT
Within the plan year, utilization reporting showed a measurable shift away from the highest-cost facility toward lower-cost, high-value sites, confirmed through place-of-service and provider identifiers. Members saved at the point of service via reduced or waived out-of-pocket costs when selecting identified high-value providers, and the employer realized a meaningful reduction in CT/MRI spend. The streamlined experience and hands-on scheduling support built trust and made the right choice the easy one. As one leader shared, “The side-by-side cost clarity and hands-on scheduling support made it effortless for our people to choose better options. We saw savings quickly without sacrificing quality, and employee feedback has been overwhelmingly positive.”
The Strategy
JA began with a claims deep-dive to map CT/MRI utilization and compare total facility-plus-physician pricing across four commonly used sites, layered with quality and safety indicators. We translated insights into targeted, plain-language education that showed side-by-side costs and offered a single point of contact for scheduling at vetted, high-value locations. Plan design reinforced behavior by reducing or waiving out-of-pocket costs when members chose designated providers. To ensure attribution, JA established a pre-intervention baseline, tagged outreach and navigation touches, and monitored claims by place of service, provider identifiers, and allowed amounts in a monthly governance cadence.
THE OUtcome
Price transparency confirmed: Claims analysis identified a >500% price variance for equivalent CT/MRI services across four facilities (e.g., median CT $2,900 vs. $450) with no quality advantage at the highest-priced site.
Steerage achieved: Share of studies performed at the highest-cost facility dropped from 46% pre-intervention to 17% within nine months (a 63% relative reduction), with 71% of redirected scans moving to designated high-value locations.
Employer savings: Category spend for CT/MRI decreased 28% versus baseline, yielding $238,000 in allowed-amount savings within the first plan year.
Member savings: Average out-of-pocket cost per imaging episode fell by $212; cumulative member savings reached $61,000 as copays and deductibles were reduced or waived at high-value sites.
Engagement & experience: 78% of redirected cases used JA’s navigation and scheduling support; post-visit surveys averaged 4.7/5 satisfaction, with 89% reporting the process was “easier than expected.”
Governance & ROI: Six weeks from analysis to launch; 100% outreach tagged for attribution; monthly dashboards tracked place-of-service, unit cost, and allowed amounts, delivering a 4.1:1 ROI on program fees.
Things Employers Should Consider
Do you know your true price dispersion for common imaging and which facilities deliver the best value for your population? Start with a rigorous baseline, then pair transparent comparisons with friction-reducing navigation and plan design that rewards smart choices. Close the loop with tagged communications and monthly utilization dashboards so you can tie each action to outcomes and scale what works.