Site of Care Optimization
The Challenge
Employees were frequently utilizing high-cost hospital-based facilities for routine outpatient services like labs and imaging. There was no mechanism in place to direct members to high-quality, lower-cost independent facilities that provided the same clinical outcomes.
The IMPACT
The use of hospital-owned facilities for routine care was inflating the plan’s overall claims spend by a significant margin. This forced the municipality to consider tax increases or service cuts to balance the rising cost of employee healthcare benefits.
The Strategy
We implemented a Site of Care program that provided employees with clear information on the cost and quality differences between facilities. By incentivizing the use of independent, high-value providers, we empowered employees to make more informed choices about where they received care.
THE OUtcome
The program led to a measurable shift in where care was delivered, resulting in substantial savings for both the plan and the employees. This outcome allowed the municipality to maintain its benefit levels without placing an additional burden on local taxpayers.
Things Employers Should Consider
Where care is delivered is often just as important as the care itself. Many employees assume that the most expensive hospital facility is the best, but data often shows that independent centers provide equal or superior outcomes at a fraction of the price. Employers should focus on removing the friction that prevents employees from utilizing these high-value alternatives.