New Survey Results Reveal Gaps in Employer Site-of-Care Strategies

Executive Summary: Site-of-Care Survey Results from HGAN and Lantern Reveal Confidence Gap

Employers know specialty care costs too much. They also know better-value options exist. So why aren’t more steering employees toward them?

New research from Lantern and Health Growth Advisory Network (HGAN) exposes a wide gap between interest and action. Across surgery, cancer care and infusion therapy, large employers recognize the potential of site-of-care steerage. Still, few have moved from consideration to formal programs.

The research, which gathered insights from 121 benefits leaders, points to a clear barrier: Benefits leaders need proof. They want credible evidence showing where they can reduce costs while protecting clinical quality and the employee experience.

Consider hospital costs. Ninety-three percent of benefits leaders rank managing hospital costs as important or a top priority. Yet 65% lack confidence their health plan secures the best possible hospital rates, and 52% express dissatisfaction with the pricing transparency their health plan provides.

Site-of-care strategies show a similar disconnect. Forty-three percent of employers express interest in steering appropriate surgeries to ambulatory surgery centers (ASCs), but only 7% have a formal program. Cancer care follows the same pattern: 43% express interest in site-of-care steerage, while 14% have implemented a formal program.

Infusion therapy trails even further behind. Only 9% of employers use a dedicated point solution, and nearly one-third can’t name a single vendor in the category.

What would give employers greater confidence to act on a site-of-care strategy?

Evidence of better outcomes and meaningful savings.

For surgery, 55% of respondents say evidence of quality outcomes would motivate them to implement an ASC steerage program, while 54% cite demonstrated cost savings. For cancer site-of-care steerage, 59% identify improved clinical outcomes as a top motivator, while cost savings and easier coordination for employees needing treatment both landed at 44%.

Independent research reinforces why both sides of that equation matter. RAND’s Hospital Price Transparency Study found employers and private insurers paid an average of 254% of Medicare rates for hospital services in 2022. Those prices also vary significantly by market, provider and care setting.

But simply moving care to a different setting doesn’t guarantee savings. Lantern’s analysis with Merative found ASCs don’t consistently cost less than hospitals. In some markets, ASC physician rates for certain procedures exceeded 1,000% of Medicare.

In other words, steerage alone isn’t the strategy. Employers need reliable cost and quality data to identify providers and care settings capable of delivering better value.

They also need confidence to direct employees toward those options without sacrificing clinical outcomes.

This report examines the gap between interest and action across specialty care, the evidence benefits leaders need to move forward, and how they can use cost and quality data to make more informed steerage decisions.

The Confidence Gap in Hospital Costs

Employers spend heavily on hospital care. But many don’t know whether they’re getting a competitive price.

The Lantern-HGAN survey found 65% of benefits leaders lack confidence that their health plan secures the best hospital rates, while fewer than 2% feel very confident. Prioritizing hospital costs doesn’t resolve that doubt: even among employers who rank it as a top priority, 58% still question whether they’re getting the best rates.

Pricing transparency offers little reassurance. More than half (52%) express dissatisfaction with the level of pricing transparency their health plan provides.

The disconnect creates a costly blind spot. Ninety-three percent of benefits leaders consider managing hospital costs important or a top priority, yet many lack the information to evaluate their rates or identify better-value options.

Some haven’t taken any action. Despite the attention hospital costs demand, 18% report taking no specific measures to address them.

Employers Have Good Reason to Question Hospital Prices

Independent research shows just how much hospital prices can vary. Employers can face drastically different negotiated prices for the same procedure depending on which hospital members use — even within the same market.

RAND’s latest Hospital Price Transparency Study analyzed commercial claims and compared prices paid by employers and private health plans with Medicare prices for the same services at the same facilities.

In 2022, employers and private insurers paid an average of 254% of Medicare prices for hospital services. Put another way, a hospital service priced at $10,000 under Medicare would cost a private health plan approximately $25,400 at that national average.

RAND also found significant variation among states, with 2022 prices ranging from 162% of Medicare in Arkansas to 346% in Florida.

For employers with workforces spread across multiple markets, those differences make the negotiated price especially important.

Research from PatientRightsAdvocate.org (PRA) shows the variation can be even more pronounced at the local level. Its Price Variation Report found that, within a single hospital, negotiated insurance rates for the same procedure varied from the hospital’s own cash price by an average of 10.7 times — a sign of how disconnected negotiated rates can be from any consistent baseline.

The variation is larger still across hospitals. Comparing negotiated rates for the same procedure at different hospitals within the same state, PRA found an average range of 31.3 times. For some procedures, the gap was far wider: in Kentucky, negotiated rates for arthroscopic knee surgery varied by 57 times across hospitals.

For employers, these differences make it difficult to judge value based on a negotiated discount or hospital name alone. Two employees receiving the same procedure in the same market can leave their health plan with dramatically different costs depending on the hospital and negotiated rate. Employers need to know what they actually pay and how those prices compare across providers and markets. Without those comparisons, a negotiated discount can still leave an employer paying a high price.

Surgery & ASC Steerage: Interest Without Action

Ambulatory surgery centers have become synonymous with lower-cost surgery. Benefits leaders appear interested in the opportunity but cautious about acting. Our survey found 43% of employers express interest in ASC steerage, while only 7% have a formal program in place.

When asked what would motivate them to implement an ASC steerage program, 55% cited evidence of quality outcomes and 54% cited demonstrated cost savings. Employers don’t simply want a less expensive place to send employees for surgery. They want tangible proof they’re directing people to high-quality care at a better price.

Organizations with full access to medical and pharmacy claims data use nearly 50% more cost-management strategies than organizations with limited or no access.

Look Beyond the ASC Label to Guide Employees to Higher-Value Care

At first glance, shifting appropriate procedures from hospitals to ASCs seems like a straightforward way to reduce costs. But it’s key to note the actual price depends on the procedure, provider, facility and market. Sending a procedure to an ASC doesn’t guarantee a lower price.

From 2021 through 2023, Lantern partnered with Merative to analyze MarketScan commercial claims across 10 major U.S. metro areas. The analysis uncovered wide price variation across procedures, providers, care settings and markets.

In some markets, ASC physician rates for certain procedures exceeded 1,000% of Medicare. The analysis also identified elevated anesthesia fees across care settings.
The findings expose a critical flaw in steering based on care setting alone. An ASC can offer a lower-cost alternative in one market and an expensive option in another.

Employers need to compare what they’ll actually pay at a specific facility and evaluate the quality of the providers who practice there. Directing every eligible procedure to an ASC without examining those factors can leave significant price variation untouched.

Put simply: effective steerage requires more precision: match the right patient with the right provider and facility at the right price.

Better Data Helps Employers Move From Interest to Action

Research provides another clue as to why some employers act while others remain on the sidelines.

The National Alliance of Healthcare Purchaser Coalitions’ 2026 Pulse of the Purchaser surveyed 408 employers and found organizations with full access to medical and pharmacy claims data use nearly 50% more cost-management strategies than organizations with limited or no access.

Claims data gives employers the visibility to pinpoint price variation, compare providers and facilities and identify where targeted interventions could produce meaningful savings. Without it, benefits leaders have less evidence to determine where and how to intervene.

Pair Cost Savings with Quality for Effective Site-of-Care Steerage

Cost data solves only part of the problem. Employers also need confidence in the care their employees will receive.

Ben Jackson, Vice President of Global Benefits at AT&T, says focusing on high-quality providers can also prevent downstream costs when employees experience better outcomes.

“The highest-quality surgeon that we can navigate someone to, there’s less likelihood of an infection following a post-op care plan or ending up back in the ER for a follow-up or cleanup procedure. And every time you’re having to go back into the settings of care, now your costs are getting away from you.”

Lantern’s Network of Excellence individually vets and contracts with providers and facilities rather than steering members based on site of care alone. Lantern evaluates care using more than 300 appropriateness and outcome measures across a network of 2,000+ surgeons and 725+ facilities.

Lantern’s approach delivers a complication rate below 1% and 75% lower readmission rates at ASCs compared with hospitals. Its model also helps patients avoid unnecessary procedures, with more than 30% MSK surgical avoidance.

Employers can also capture significant savings. Lantern delivers 55%+ average savings compared with carrier rates. For example, Lantern prices a total knee replacement at approximately $19,072, or 100–130% of Medicare, compared with an average carrier allowed amount of about $46,281.

Effective ASC steerage requires more than a change of venue. Employers need to know which providers and facilities deliver strong outcomes at a competitive price, then direct employees to those specific options.

Cancer Site-of-Care Steerage: What Actually Moves the Needle

Employer surveys regularly find that cancer is the top cost driver for many large plans. Cancer costs vary significantly by site of care, with hospital outpatient costs running 28% to 53% higher than physician offices.

Yet, few employers have put a formal cancer steerage strategy in place.

Our survey found 43% of employers express interest in cancer site-of-care steerage, while only 14% have a formal program in place. Clinical evidence could help close that gap. When asked what would motivate them to implement a program, 59% cited improved clinical outcomes.

Hyatt Hotels faced this challenge as cancer incidence and costs increased across its employee population.

The message from benefits leaders is clear: Any cancer steerage strategy must prove employees can access high-quality care and specialized expertise in lower-cost settings.

The Site of Cancer Care Can Dramatically Change Price

Hospital-based cancer treatment can carry a steep premium.

Lantern data shows community oncology care costs 50% less than hospital-based treatment. Moving care from a hospital outpatient department to an office-based setting can save $55,000 to $81,000 per patient annually. Lantern also reports more than 40% cost reductions for ongoing cancer care.

Those savings give employers a powerful reason to examine where employees receive treatment. Clinical quality determines whether they can confidently act on the opportunity. Employees still need the right treatment plan, appropriate monitoring and access to specialists with deep expertise in their specific type of cancer.

Bring Specialized Cancer Expertise Closer to Home for Employees

Lantern’s partnership with AccessHope connects community oncologists with subspecialists from leading National Cancer Institute (NCI)-Designated Comprehensive Cancer Centers. Seventy percent of members receive treatment in community settings while AccessHope’s oncology subspecialists continuously review their cases.

Those specialists do more than validate the existing treatment plan. They recommend a change in 68% of reviewed cases, and providers adopt at least one recommendation in 65% of cases.

This model gives employees access to specialized cancer expertise without requiring them to receive all of their care at a major cancer center. Employees can remain closer to home while their community oncologist benefits from input from a specialist focused on their specific cancer.

According to AccessHope data, each adopted recommendation improves outcomes by 35%.

Beaudin says Hyatt has already seen the model bring specialized expertise to employees with complex cancer cases.

Put Clinical Quality at the Center of Steerage

The survey results show what benefits leaders need before they move forward with cancer site-of-care steerage: evidence of better clinical outcomes.

Cost data can identify opportunities to move appropriate care away from expensive hospital settings. Clinical data helps employers evaluate whether a community setting can provide the expertise, treatment and oversight an employee needs.

The strongest cancer steerage strategies evaluate cost and clinical quality together, then connect employees with the appropriate care setting and specialized expertise for their individual case.

Site-of-Care Strategies for Infusion Therapy: An Overlooked Cost Opportunity

Most employers have barely begun to address infusion therapy as part of their specialty care strategy.

The Lantern-HGAN survey found just 9% of employers use an infusion therapy point solution, and nearly one-third (31%) couldn’t name a single vendor offering one. Employer priorities reinforce the gap: 41% rank infusion therapy as a low priority, compared with 19% who consider it a high priority.

For benefits leaders searching for additional ways to manage specialty care costs, those numbers point to an area worth examining more closely.

Hyatt Hotels took a closer look at infusion therapy after seeing specialty pharmacy costs rise faster than its overall pharmaceutical spending.

“We saw our costs were going up in the space,” Beaudin said. “We’ve been monitoring our specialty pharmacy costs for some time, and those were just growing exponentially compared to our overall pharmaceutical cost. And infusions was a big part of that.”

Look Beyond the Hospital Setting to Help Employees who Need Infusions

Employees can receive infusion therapy in hospital outpatient departments, physician offices, standalone infusion centers or, when clinically appropriate, at home.

Those options give employers an opportunity to compare what they pay across care settings and identify therapies appropriate for lower-cost alternatives.

The potential savings can be significant. Pharmaceutical Strategies Group’s 2026 Trends in Specialty Drug Benefits Report found hospital outpatient infusions cost 42% more than infusions delivered in other settings.

Home infusion can offer another lower-cost option for appropriate patients. A National Home Infusion Association literature review found the average cost per day was $122 for home infusion for antibiotic therapy compared with $798 for inpatient infusion, a difference of $676 per day.

Benefits leaders need to consider the medication, clinical needs, provider quality, network access and actual treatment cost before directing an employee elsewhere.
Lantern expands access to alternative settings, including in-home infusion for eligible members. Lantern identifies appropriate sites of care, connects members with treatment options and offers $0 member cost share for covered care.

For Hyatt, expanding site-of-care options also addressed practical barriers employees faced when receiving infusions.

“They might have transportation issues, scheduling issues because of the hours they work,” Beaudin said. “The infusion program gave us an opportunity to take those infusion medications out of the hospital settings, but also give our colleagues an opportunity to have it done more locally or even at their homes.”

Low adoption and limited vendor awareness suggest many employers have yet to closely examine infusion site of care.

Benefits leaders can start by identifying where employees receive infusions today, comparing costs across settings and determining which therapies could safely move to alternative sites.

For employers looking for additional ways to control specialty care spending, infusion therapy deserves a closer look.

A Clear Path to a Better Site-of-Care Strategy for Surgery, Cancer Care and Infusions

Across surgery, cancer care and infusion therapy, the research reveals a consistent gap: Employers see opportunities to manage specialty care costs, but many lack the evidence to act with confidence.

Benefits leaders need visibility into what they pay, how prices compare across providers and settings and what clinical outcomes those options deliver. Without those answers, they can’t confidently determine where to direct employees for care.
The research also shows why broad site-of-care strategies can miss the mark.

• An ASC can still carry a high price.
• A lower-cost cancer setting still requires specialized clinical expertise.
• An alternative infusion site still needs to meet the patient’s clinical and access needs.

Effective steerage accounts for those differences. Cost and quality data help employers identify providers and care settings capable of delivering better value for a specific patient, procedure or treatment.

Employers can take a more precise approach by understanding what they pay, identifying where better options exist and giving employees a clear path to high-quality care.