Healthcare strategy no longer moves claims—activation does
For most executive teams, healthcare sits on the P&L as a volatile line item with too many unknowns and too few levers that reliably bend the trend. The latest KFF Employer Health Benefits Surveys signal a decisive response: more employers are leaning into direct contracting and value-based care to regain control of costs and reintroduce predictability into renewals (KFF Employer Health Benefits Survey, 2025; 2026). But here’s the truth we see every day—strategy by itself doesn’t change employee decisions or spend. Activation does.
At JA, we partner with CFOs and CHROs to close that gap between intent and impact. Our approach combines rigorous, truly integrated analytics—cost and quality, not cost alone—with employee-centric education, navigation, and incentives. The result is the holy grail for leadership: better care, better outcomes, and materially lower costs, delivered with a governance model your finance team can trust.
Why direct contracting and value-based care are the moment—and what the C‑suite should expect
Three dynamics make now the right time for executive action. First, price transparency rules have finally given employers and their advisors the data needed to identify outlier pricing and make apples-to-apples comparisons across sites of care. Second, provider readiness has matured: health systems, independent groups, and centers of excellence are better equipped to participate in bundles, shared savings, and outcomes-tied arrangements. Third, benefits technology, navigation services, and communications capabilities have caught up, enabling targeted steerage without friction.
For CFOs and CHROs, the implications are material. Direct contracting and value-based models can improve budget predictability, rebalance vendor risk, and introduce governance structures with clearer accountability. As the KFF surveys underscore, more employers are pairing these models with education and navigation so that contracted value becomes real utilization—exactly the kind of measurable shift finance leaders need to defend plan changes and negotiate renewals.
The cost–quality disconnect: A uniquely dangerous healthcare reality
One of the most consequential insights we surface with leadership is counterintuitive but pervasive: in healthcare, higher cost does not guarantee higher quality. Wide variation in allowed amounts and outcomes can exist across facilities in the same market, for the same procedures, without corresponding gains in clinical performance. Left unaddressed, that disconnect compounds both financial and clinical risk.
That’s why our starting point is never price alone. We evaluate current and historical claims to see how your members actually use care. We pair this with quality signals relevant to each service line—readmissions, complications where applicable, and verified third-party measures. Then we identify the high-value options and design contracting and activation strategies that steer real decisions to those pathways.
Our difference: Analytics that matter, activation that employees trust
“When people understand their options, they make better decisions.”
That simple belief guides our work. We help leaders make smarter investments with credible insight, and we help employees act confidently with transparent, practical guidance.
Here’s how that looks in practice:
We analyze utilization patterns and total episode costs across sites of care to find what we call value oases—providers that combine quality with efficiency. We prioritize categories with high spend, wide price variation, and clear steerage potential (imaging, ambulatory surgery, joint replacements, GI, maternity, select cardiac procedures, among others). We then match the commercial model to the category and provider readiness: preferred direct rates, episodic bundles, shared savings, centers of excellence, even ACO-like constructs for broader populations.
And then we do the thing that too often gets treated as an afterthought: we activate. We remove complexity for members with simple, transparent education, real navigation support, and plan design incentives that make the high-value choice the obvious choice. The result is consistent: employees gain confidence, access high-quality care at the most efficient cost, and employers see meaningful improvement in both experience and spend.
Case in point: The imaging decision that unlocked immediate value
Consider an anonymized employer where claims data flagged consistently high utilization of an expensive imaging site. We zeroed in on outpatient CT/MRI and compared total facility plus physician pricing across four facilities used by members. The finding was stark: for the same class of services, there was a greater than 500% variance in price across these locations—with no evidence that the highest-cost site delivered better quality.
Armed with this insight, we aligned with leadership on a targeted activation plan:
We started with clear, employee-focused education. Members received straightforward comparisons for common imaging procedures at nearby facilities, paired with practical instructions for scheduling at the high-value sites. We established a simple access point for navigation support to reduce friction—one contact to confirm eligibility, identify the right provider, and complete scheduling.
We complemented education and navigation with aligned incentives. For targeted imaging services, the plan reduced or fully waived out-of-pocket costs when members selected preferred high-value providers. That alignment mattered: it respected members’ wallets and reinforced the organization’s value strategy.
Communications rolled out first to leaders and managers—equipping them with context and confidence—then to employees in short, timely messages matched to moments of need (e.g., when an imaging order was placed). The message never changed: here is the better option, here is why it’s better, and here is how to use it today.
The outcome was decisive. Ongoing utilization reporting showed a measurable shift away from the highest-cost facility toward lower-cost, high-value alternatives. Members paid less at the point of service, reported a more streamlined experience, and the employer reduced overall spend in that category within the plan year. This is how strategy becomes savings: by empowering people with transparent information and making the right action easy—and financially attractive.
How we proved it: CFO-grade attribution and governance
Executives need results that stand up to scrutiny. Before launch, we locked a pre-intervention baseline for utilization by facility and modality. We tagged communications and navigation touchpoints to support pre/post comparisons and monitored claims by place-of-service and provider identifiers to confirm steerage. We reviewed unit costs and allowed amounts against targeted rate expectations and conducted regular readouts with finance and HR to maintain alignment and trust.
Transparency was non-negotiable. We reported early leading indicators—engagement with communications, navigation calls, scheduled appointments—within weeks. Then, as claims matured, we quantified the lagging indicators leadership cares about: utilization shift by site, unit cost reductions in targeted categories, quality safeguards, net savings after incentives and admin costs, and renewal implications.
Activation that moves real decisions: what works and why
Activation is not a newsletter. It’s an operating system that makes the right choice obvious, easy, and rewarding. Across clients and markets, five elements consistently convert strategy into behavior change:
Clarity over complexity. Give members one action per message and connect the dots: why this choice is better (quality + cost), where to go (named providers/sites), and how to do it (simple steps to schedule and save). When employees truly understand their options, they make better decisions.
Proximity to the decision. Time outreach to real care moments, not open enrollment abstracts—diagnostic orders, pre-authorizations, and care-plan checkpoints. Embedding navigation into these touchpoints multiplies impact.
Frictionless navigation. Offer a single, well-publicized contact (phone/chat/app) that can verify benefits, identify the high-value provider, schedule the appointment, and confirm cost share. Removal of friction is a savings strategy.
Incentives that matter. Align plan design so high-value care is the easy financial choice—zero or reduced out-of-pocket costs for preferred sites, cash rewards or HSA/HRA contributions for using them, contribution differentials for engaging with high-value primary care or ACO-like models, and streamlined approvals when members choose high-value pathways.
Manager and clinician engagement. Equip leaders with talking points and equip ordering clinicians with simple referral pathways to high-value sites. The person writing the order often determines the downstream spend—support them accordingly.
Choosing the right model: Direct contracting and value-based options that fit your risk and readiness
“Direct contracting” and “value-based care” are umbrellas covering models that range from preferred direct rates for targeted services to centers of excellence, episodic bundles with warranties, shared savings arrangements, and broader accountable-care constructs focused on total cost of care. The right fit depends on your goals, population size, provider market maturity, and risk appetite.
For organizations early in the journey or with midsize populations, start where the signal is strong and the friction is low: preferred direct contracts for high-variation services such as imaging and ambulatory surgery, paired with clear steerage and waived cost share. As readiness grows, expand into COEs for defined procedures where predictable episode costs and superior outcomes matter, then into bundles and shared savings as provider capabilities and your governance model mature. In integrated markets and larger populations, ACO-like arrangements can create longitudinal value—provided you have attribution clarity, primary care engagement, and the analytics and care-coordination infrastructure to manage total cost of care.
Across all models, five design principles hold: anchor economics to outcomes, focus on total cost of care (not just unit price), balance access and steerage with tiered designs, be pragmatic about data by triangulating multiple sources, and invest in activation from day one. Treat communications, navigation, and incentives as core cost of goods sold for your strategy—not optional extras.
The most important first step leaders can take
Start with data, translate insights into a clear definition of success, and communicate the specific behaviors each stakeholder must take to achieve it.
That sequence—data, definition, behaviors—is your guardrail against pilot purgatory. It narrows scope, aligns leadership, and clarifies exactly how employees and clinicians turn strategy into savings.
A practical 180‑day roadmap from concept to impact
Day 1–30: Align your CFO, CHRO, and COO on two to three service lines with high price variation and steerage potential (imaging is often first). Lock your baseline and define success measures: target utilization shift, unit cost reductions, quality thresholds, and member experience metrics. Begin a provider market scan and preliminary rate and quality assessment.
Day 31–60: Shortlist providers and validate cost, quality, capacity, and service-level commitments. Choose the commercial model that fits each category—preferred rates, bundles, or shared savings. Design plan incentives that make high-value choices obvious (e.g., waived cost share) and integrate navigation. Draft leader toolkits and concise, plain-language employee communications.
Day 61–90: Stand up navigation workflows and train stakeholders. Finalize data-sharing agreements and your reporting cadence. Confirm baseline dashboards for leading (engagement/adoption) and lagging (utilization/cost/quality) indicators. Pilot messaging with a small cohort and refine for clarity.
Day 91–150: Launch communications, go live with navigation, and enable frictionless scheduling. Monitor adoption in near real time. Hold regular operations huddles with providers and navigation partners to remove barriers quickly. Share early wins to build momentum while addressing issues transparently.
Day 151–180: Validate utilization shifts, unit cost changes, and member experience. Quantify net savings after incentives and admin costs and translate results into renewal implications. Decide what to scale next—additional categories or geographies—and codify your governance rhythm for the next phase.
A note on risk, access, and experience
Direct contracts do not have to mean narrow networks or disruption. Thoughtful tiering can preserve broad access while creating meaningful differentials—financial and experiential—that guide members to value. Robust exception processes and continuity-of-care policies protect clinical relationships when needed. Just as important, collaborative provider relations—shared data, fast problem-solving, and recognition of wins—prevent small issues from becoming systemic.
What to avoid: Common pitfalls that stall programs
Don’t over-index on price alone. Without quality guardrails and experience standards, short-term savings can turn into long-term costs through complications, readmissions, or member distrust. Don’t boil the ocean. Starting everywhere at once dilutes focus and delays visible wins. Don’t underfund activation. Even the best contracts underperform when employees are left to navigate complexity on their own. Don’t ignore clinician behavior. The ordering decision sets the downstream spend; give clinicians easy, high-value referral pathways. And don’t measure too slowly. Use leading indicators early so you can adjust within weeks, not after the plan year has passed.
What the data enables today—and why that changes your playbook
Transparency requirements and advancing analytics let you benchmark negotiated rates and identify outliers at the code and category levels, model steerage scenarios and expected savings before you sign, and monitor performance in near real time. In practice, that means you can pursue higher-confidence pilots, pivot faster, and accumulate wins that compound into durable trend management. It also means finance and HR can govern with clearer definitions of savings and ROI, and with the reporting cadence required to drive executive decisions.
Executive takeaways you can act on this quarter
Pick two or three service lines with pronounced price variation and clear steerage paths. Imaging is often first because it’s high-variation and low-disruption, but ambulatory surgery and GI frequently follow.
Define success in concrete terms and lock your baseline now. Agree on target utilization shifts, unit cost reductions, quality thresholds, and member experience measures—and on how you will calculate net savings after incentives and administrative costs.
Fund activation from the outset. Budget for navigation, communications, and incentives as core components, not optional add-ons.
Design plan features that make high-value choices obvious: zero or reduced cost share for preferred providers, concierge scheduling, and simplified approvals when members choose high-value pathways.
Institutionalize governance. Establish monthly operating reviews with providers and navigation partners and quarterly executive dashboards that stand up to CFO scrutiny.
Communicate with empathy and clarity. Lead with quality and experience, then show employees how the program benefits their wallets and wellbeing.
Start small, learn fast, and scale what works. Early wins create the cultural and political capital to expand into more complex value-based arrangements.
Why this works: Empowerment, not enforcement
The most durable programs respect and empower employees. We consistently see that when people understand their choices and are supported in acting on them, they choose better care paths—without feeling forced. In one imaging example, transparent education, frictionless navigation, and targeted incentives turned a confusing, high-cost status quo into a confident, lower-cost decision for members. The data told us where to start; activation made the difference.
A final word—and a stat that should focus every CFO’s attention
In a single local market and a single clinical category, we found a greater than 500% variance in price across four facilities for the same class of imaging services—without evidence that the highest-cost site delivered superior quality. That is both the problem and the opportunity. When employers pair direct contracts and value-based models with real activation, those hidden deltas become measurable savings and a better member experience.
Conclusion and next steps
Direct contracting and value-based care are no longer experimental. They are pragmatic tools to reintroduce predictability into healthcare spend while elevating the employee experience. The employers winning right now are those that unite rigorous analytics with thoughtful activation: start with data, evaluate cost and quality together, negotiate for measurable value, then make the right choice obvious, easy, and rewarding. Measure relentlessly, attribute fairly, and govern with transparency.
If you are ready to turn strategy into savings you can see on the P&L—and into care your employees trust—let’s talk about where to start. Imaging, ambulatory surgery, and GI often offer fast, low-friction wins. From there, we can scale what works into COEs, bundles, and broader accountable-care constructs aligned to your goals and risk appetite.
Author: Carrie Divens
Contact JA to learn more.