10 Tips from Benefits Leaders Redefining Specialty Care

If you had 10 benefits leaders in a room and asked them where their budget keeps disappearing, they’d all point to the same culprit: specialty care. It accounts for half of the average organization’s healthcare spend, yet it remains one of the hardest areas to manage.

But here is the good news: We actually did get those leaders in a room (figuratively speaking) throughout this past year, whether at events, during webinars or in meetings.

Benefits leaders from major organizations across the country have shared how they’re slashing costs without sacrificing quality. From busting the myth that “expensive equals better” to getting creative with communication, here is their playbook for finding a specialty care solution that actually works.

1. Prioritize Quality First to Achieve Better Costs

Focusing on high-quality care leads to better long-term outcomes and cost savings.

“We keep our associates and their family members with us for their whole career in most cases,” says Ryan McCracken, Director of Benefits at a leading financial services firm. “Having effective and safe outcomes is really important to us, because that’s what allows us to help bend the long-term cost curve — reducing complications, reducing readmittance and reducing repaired surgeries.”

A provider-first Center of Excellence solution that carefully vets its surgeons based on quality metrics like board certifications, fellowships and pre- and post- surgical optimization protocols will typically achieve a higher surgical avoidance rate and lower complication rate than the national averages.

“Many of us have seen in our data that high cost almost never equates to high quality,” says Suzanne Usaj, former Senior Director of Total Rewards for The Wonderful Company. “But you typically come out with the right result if you focus on quality first.”

2. Ensure Local Access to Specialty Care is a Priority

You must consider the size of any network and whether it enables local access for your employees. When members have to travel for care, it lowers program utilization. It also results in more time away from work and home for those using the program.

“Local access was of critical importance to us,” says Dawn Beaudin, VP of Benefits for Hyatt Hotels. “We were not willing to put in a program that would require everyone to drive hundreds of miles or get on a plane for care.”

When travel is required, consider offering a travel benefit that covers the cost of the trip and lodging.

3. Demand Rigorous, Procedure-Level Vetting of Providers

Not only should each provider be vetted for their credentials, but they should also be evaluated down to the procedure level. For example, an orthopedic surgeon may not perform knee and hip replacement surgeries equally well. While both surgeries fall within the same category, they are very different procedures on a technical level.

“You have to look at quality down to the procedure level,” says a healthcare benefits manager at a national insurance company who recently joined a webinar with Lantern. “It’s not enough to be a great orthopedic surgeon. It has to be someone who has done hundreds of knee surgeries. And if you go to the doctor that’s great at neurosurgeries to work on your back, you may not have the same outcome. That specificity is most important when we look at our members getting access to appropriate care.”

4. Use Plan Design to Incentivize Members to Use Your Specialty Care Benefits

The best specialty care platform on the market is only effective if your employees use it. One of the best ways to drive utilization is to remove financial barriers by waiving cost-sharing for high-value programs.

“Waiving cost share has been the No. 1 reason this program has been successful,” says Lantern client Sara Richards, the director of benefits for a national beverage brand. “When you say, ‘Hey, do you want to get this for free?’ your employees are suddenly paying attention.”

5. Independently Validate Vendor Savings

When a vendor shares ROI metrics, you’re often not getting the full story. For example, their numbers could include hard-dollar and soft-dollar savings. They may not account for differences in site of care or geography. That’s why it’s crucial to use internal data, consultants or lookback analyses to confirm the financial impact of a specialty care solution.

“Reduction rate is important, but don’t give me a reduction on the national average,” says Derek Butts, VP, Total Rewards at a leading energy product manufacturer. “There are variations in costs from state to state. I need a reduction on a geographically appropriate amount. I want to see data. I asked Lantern, and they thankfully obliged. But I’ve seen some very weird math in my career on calculated savings.”

A national insurance provider had their financial analyst work with the data analytics team at Lantern to confirm the procedures performed through Lantern compared to the cost and the outcomes of the procedures that would’ve been completed through their national network.

“We were close enough to realize these are real savings we were seeing,” the healthcare benefits manager says. “Our plan would’ve spent $62.8 million more had we not implemented Lantern and all of these surgeries were performed with just our general network.”

6. Harness the Power of Word-of-Mouth to Increase Engagement with Benefits

A positive, high-touch member experience is a powerful marketing tool, with employee testimonials and peer referrals being a primary source of engagement for new programs. For example, more than 50% of members at a national insurance provider who utilize Lantern found out about the benefit via word-of-mouth from another employee.

“That statistic in itself speaks to how well the Care Advocates take care of our members and how positive that member experience is,” says the insurance company’s healthcare benefits manager. “There’s no other benefit that we have the statistic of word of mouth being the primary source of engagement with the partner.”

7. Communicate Your Specialty Care Benefits Creatively and Repeatedly

Leaders advise going beyond standard emails by using targeted mailings, internal champions and creative, multi-channel campaigns to reach employees and their families.

“The one lesson that I learn every time we roll out any new program is you cannot over-communicate,” McCracken says. “Repeat the message over and over, because a lot of benefits communications can get lost in the noise.”

In addition, seek out vendors that will help with your engagement/communication strategies.

“We’ve had multiple vendor summits now where we’ve brought vendors and other point solutions to our main corporate location and challenged them to think about how they can integrate solutions better when our members reach out to them versus it always coming from us,” says Tammy Fennessy, Senior Director of Benefits at Dick’s Sporting Goods.

8. Define Your Own Benefits Success Metrics

Instead of letting vendors dictate performance metrics, benefits leaders recommend developing internal scorecards to hold partners accountable to what matters most to the organization.

“Every point solution, when they present their ROI calculation to me, that’s just smoke and mirrors,” says Denise King, VP of Global Benefits and Payroll at Medtronic. “No vendor will ever admit that their solution didn’t save me any money. What I often ask of vendors is, ‘What are they doing to work with their customers to really develop a meaningful ROI calculation that actually tells me a story that I can trust?’”

Ensure vendor agreements are truly mutual and transparent, specifically regarding how ROI is calculated. You can even request the specific ROI calculation to be included in the contract itself.

9. Remove Administrative Barriers to Care

Simplifying the member journey by removing hurdles like prior authorization for trusted, pre-vetted provider networks can speed up access to care and reduce stress for members.

When Scott Kirschner, Senior Director of Total Benefits at Greystar, joined his organization, he noticed many restrictions around Lantern’s surgery program. For example, only a limited number of CPT codes applied for the program.

“In my mind, you’re setting up an organization for failure. It won’t make an impact if there are so few things you can impact,” Kirschner says. “Take away the restrictions.”

The Greystar team removed limitations, opening the program to all plannable procedures and ramped up communication efforts.

10. Be Transparent with Employees About the “Win-Win” of Lantern

“Sometimes when something’s free, it makes people skeptical. ‘Why are you giving it away if it’s so good?’” says Tabitha Pittman, Director of Compensation and Benefits for Integrity.

To overcome skepticism about free or incentivized benefits, leaders advise transparently explaining how the program benefits both the employee (through better, more affordable care) and the company (through cost savings).

“We are transparent and share with employees that there are savings with the plan. It’s a win-win situation,” Pittman adds. “That helped.”

Fennessy from DICK’s Sporting Good agrees: “We stopped talking about ‘plan design’ and started talking about ‘winning,’” Fennessy said. “We used simple, bold headers like ‘Pay $0 for your surgery’ or ‘Get a top doctor for free.’ When you lead with the financial win, you get their attention. Then you can explain the details.”