If you’ve ever gotten surgery, you know the challenges: finding a good surgeon, getting an appointment before your symptoms get worse and paying your bill, which can be costly even with insurance. Meanwhile, employers paying for the brunt of the procedure see costs increase without better outcomes.

Traditional Centers of Excellence (COEs) can give employees a better option for quality, but they’re rarely convenient—so employees simply don’t use them.

Faced with rising musculoskeletal pain costs, a national insurance company with a dispersed employee population went in search of a more modern solution that would give members better options close to home.

“As we’re looking to manage the cost when we add a benefit, if members won’t utilize it, it doesn’t matter how much money it saves you,” the benefits manager says.

They conducted a comprehensive market analysis, which included assessing geographical access, to see how established surgeon networks lined up with their employees’ locations, and ultimately chose Lantern.

The four factors the benefits manager evaluated when choosing a vendor were:

• Accessibility: World-class care close to home
• Quality: Confidence in clinical outcomes
• Human touch: Guidance through a complex and emotional journey
• Financial sustainability: A model that saves money for both the company and employees

Accessibility Matters More than Ever for Surgical Care

Having to travel for surgical care is not only disruptive. It also introduces real risks.

“Your family and friend support systems are not as available around that surgery if you have to travel. And it limits the continuity of care both for your local providers and for your COE surgeon,” says Raymond Hwang, MD, Associate Chief Medical Officer at Lantern. “There are also real medical risks associated with traveling, especially after a major surgery. This includes blood clots and infections, which can have meaningful negative impacts on your clinical outcome.”

Destination COEs also disproportionately impact those with less flexibility, lower incomes or family caregiving responsibilities. “This exacerbates existing health disparities, because vulnerable populations are less able to travel, and then may forgo needed procedures,” Dr. Hwang adds.

The paradox is that there are typically better options locally. “If you ask a surgeon where you should go to get a routine surgery, like a knee replacement, to really get the best outcomes, they’ll probably tell you that you should go to the high-volume surgeon in your community who’s doing it day in and day out with the same team every day,” Dr. Hwang says.

True Surgical Quality Focuses on the Surgeon, Not the Hospital Name

The most important factor in surgery is the surgeon, not the four walls they operate within. When considering a surgical network, it’s important to ensure quality is vetted at the provider level.

“When we looked at carrier-based Centers of Excellence, they were painting with a broad brush,” the insurance healthcare benefits manager says. “They couldn’t narrow it down and help us identify the best physician for the procedure that needs to be performed. That specificity is the most important when we look at our members getting access to care.”

To assess provider quality, Lantern examines:

• Training and board certification
• Procedure-specific experience
• Clinical protocols used
• Adherence to best practices
• Appropriateness of the care delivered

This assured the national insurance provider that Lantern was the right choice.

“Year to date, we’ve had 116 procedures that the Lantern specialists identified as not being necessary or where they offered a less invasive step to take prior to surgery,” the benefits manager says. “They’re truly looking out for the best interests of our patients, so that if a surgery is performed, it’s likely to have the best outcome and not have complications.”

Expert Care Advocacy Guides Members Through Complex Surgical Decisions

When it comes to a major surgery, getting the right care can be daunting for patients. “From the terminology to the logistics, there’s just so much friction standing in the way of getting the right care, having a good experience and not breaking the bank,” Dr. Hwang says.

Lantern aims to remove these barriers through dedicated Care Advocates. Each Lantern member gets paired with one of our 200+ multilingual Care Advocates, who help support their journey and personalize the experience.

“They help answer the member’s questions, schedule appointments, get medical records and coordinate care, so the member can really focus on the things that matter, like understanding their condition, making the best decisions for their care and focusing on their recovery,” Dr. Hwang says. “Each member has a different set of needs, and we really focus on empowering our Care Advocates to provide that personalized human connection.”

Employees at the insurance provider rave about the care they receive from Lantern, from the process and Care Advocates to the providers and follow-up. In fact, 54% of employees who utilize the benefit found out about it through positive word of mouth from their fellow employees.

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

A Win-Win on Costs: Waiving Fees While Reducing Plan Expenses

Surgery is expensive, even with insurance. Many people on family plans have a five-figure out-of-pocket maximum, so they’re responsible for a significant part of the cost.

Many employers with Lantern choose to waive member costs when members have a procedure completed through Lantern. For members on a high-deductible health plan, they waive any costs after employees meet the IRS minimum deductible.

Lantern makes cost-waiving financially possible for clients by significantly reducing costs for the plan, too. Lantern contracts directly with providers and facilities within our network to offer rates that are approximately 55% lower than carrier rates, so plan sponsors save thousands on each procedure.

Achieving Health Equity with Proven Surgical Outcomes

Offering a more affordable, accessible care option with higher-quality providers results in better health equity for employee populations.

“Our narrow network of high-quality surgeons inherently leads to consistently better outcomes,” Dr. Hwang says. “When you combine that with the expert guidance of our Care Advocates, that helps overcome the inequities that often lead to variability in outcomes. That means everyone in the population then benefits from fewer complications and better results.”

Those results speak for themselves. Since launching with Lantern in 2022, the insurance company has achieved:

• $32.10 PEPM savings
• 3,340+ procedures successfully completed
• 93% member satisfaction
• 20% surgical avoidance for MSK procedures

“Lantern is one of the most successful benefits that we’ve launched in my tenure,” the company’s benefits manager says. “This is a program where you can take the savings to your CFO.”