Introduction: What is Specialty Care for Employers?

HR and benefits leaders must traverse a healthcare system that’s becoming more complex and more expensive every day, especially when it comes to specialty care.

You’ve surely seen firsthand how cancer drives a huge portion of your organization’s healthcare spend. In fact, the U.S. now spends over $200 billion a year on cancer care. Surgeries aren’t far behind. Just one total knee replacement can cost nearly $45,000.

These rising healthcare costs for employers aren’t just numbers on a spreadsheet; they’re putting real pressure on your budget and your people. Together, they represent almost 50% of healthcare spend.¹

Specialty care covers the kind of healthcare that goes beyond routine check-ups or common illnesses. It’s the serious diagnoses like cancer, heart disease, or joint replacement, plus the complex treatments that follow, like surgeries, infusions or long-term care plans.

For employers, managing specialty care spend is a big deal. Not just because it accounts for a large slice of your total healthcare spending, but because it’s where you can make the biggest impact.

When employees get the right diagnosis and the right treatment, without delays or unnecessary steps, it doesn’t just lower specialty care costs. It leads to better health outcomes, faster recoveries and a more productive workforce.

So, choosing the right specialty care provider is vital, but not always easy. You need a partner with a strong network that reaches all your employees–close to where they live. You need exceptional providers you can rely on, and personalized care navigation to support employees through every step.

It’s a tall order, but we’re here to break it all down and guide you through what really matters, so you can find the best specialty care program for your team.

¹ Business Group on Health, 2025 Employer Health Care Survey, IQVIA Oncology Link 2023, IQVIA’s Global Use of Medicines; Am J Health Syst Pharm. 2022 July 15; 79(14); Internal analysis of client spend

What Falls Under the Umbrella of Employer Specialty Care?

Specialty care covers a wide range of healthcare services that go beyond your standard primary care visit. It’s the kind of care people turn to for complex issues or when they require deeper expertise and advanced treatment.

Key areas of specialty care typically include:

• Oncology
• Cardiology
• Orthopedics and surgeries
• Neurology
• Infusion therapy
• Autoimmune therapy

Cancer care, for example, is one of the most expensive and emotionally charged areas, as treatment can stretch over months or even years. Today, cancer accounts for 15 to 20% of total spending in employer healthcare.

Surgeries are another major driver of healthcare spending, often costing tens of thousands per procedure. Infusion therapy, used to treat conditions like rheumatoid arthritis and MS, is not only costly, but requires close coordination to ensure it’s done safely and effectively. When administered in a traditional hospital setting, the average cost for infusion therapy ranges $5,500 to $11,500.

These are the moments when quality truly matters. The right care, at the right time, from the right provider, can make all the difference in outcomes, recovery time and healthcare cost containment.

Joanne Hinton, the City of Fort Worth’s Benefits Manager, says they chose Lantern for their 6,000 employees and retirees under 65. “Part of our commitment is to get employees to the right care at the right time,” she says. “I trust Lantern. I had two different surgeries myself and a really good experience.”

The city has seen a 95% member-satisfaction rate with Lantern. “My people love it,” Hinton says.

The Challenge for Benefits Leaders and Specialty Care

Employers often run into major roadblocks when relying on traditional health plans for specialty care. Most notably, costs are wildly unpredictable. One employee’s care might cost 5x more than another’s for the same condition, simply because of where or how they’re treated.

Finding high-quality providers can feel like a guessing game, with little guidance on who delivers the best outcomes. Multiple providers within the same care facility have varying levels of experience and training. For instance, approximately one-third of surgeons in any given market lack board certification.

In addition, care journeys are often fragmented. Employees bounce between specialists and frequently travel long distances for care with little coordination. Sometimes, the closest in-network specialist requires getting on a plane.

Dawn Beaudin, Vice President, Benefits at Hyatt, says local access to high-quality care was a top priority when looking at specialty care solutions.

“We really wanted a strong local network,” Beaudin says. “One of the reasons we felt comfortable introducing Lantern was that over 80% of our colleagues were within driving distance of a Lantern-affiliated surgeon.”

Roadblocks add stress for your employees and increase the risk of errors or delays. In many cases, employees prolong or avoid care altogether. This increases absenteeism and reduces productivity, while increasing costs due to ER visits or even hospitalization.

Without a beacon to follow, employees often seek support from HR.

“Often the HR benefits manager is the person who patients come to and say, ‘Where do I go? What do I need to do?’” says Nicki MacManus, SVP, General Manager at Lantern.

Learn more about how a specialty care program provides surgery benefits for employees, cancer care benefits for employees, and infusion therapy benefits for employees.

Considering an Independent Specialty Care Solution Like Lantern

Employers have traditionally offered access to specialty care and Centers of Excellence through their health plan. Access is often limited to hospital systems in large cities.

What is an independent specialty care solution?

An independent specialty care solution gives you something traditional health plans usually can’t:

• Control
• Clarity
• Confidence in care delivery

Lantern’s independent specialty care model ensures employees and their loved ones get the best care possible by curating top-performing doctors nationwide. Lantern personally evaluates clinical outcomes, licensure and certification, patient satisfaction and site of care options—not just availability.

When looking for a specialty care partner, Phillips 66 wanted to make sure the solution included the highest-quality care and positive outcomes to help employees live their best lives.

“We didn’t want a partner to just plop as many surgeons as they can around our people to make geographic requirements. We wanted to make sure that all surgeons are high quality,” says Derek Butts, Manager of Global Benefits at Phillips 66. “We also wanted to keep our employees from those unfortunate cut-happy surgeons, and ideally help employees avoid surgery. For those who actually need surgery, we wanted to help them determine their best course of care.”

Our dedicated Care Advocates and nurse oncologists provide comprehensive support, from doctor recommendations and priority scheduling to treatment plan evaluation and second opinion coordination.

To make care more accessible than in the traditional system, we partner with 500+ facilities and 3,000+ surgeons nationwide. This places 98% of our members within driving distance of their appointments.

Ultimately, Lantern solutions are purpose-built to coordinate care across every step of the journey, so nothing falls through the cracks. And because we focus on quality from the start, we help avoid unnecessary procedures, reduce complications and drive better long-term outcomes.

What to Look for (and What to Avoid) in a Solution

When evaluating specialty care solutions for your company, look for a few critical features that truly move the needle on cost, quality and employee experience.

A rigorously vetted Network of Excellence: The best solutions methodically curate top-performing doctors and facilities nationwide, carefully evaluating clinical outcomes, patient satisfaction and cost. This is why 99.4% of our members make a full recovery, compared to the industry average of 85%.

Focus on specific high-cost, high-impact areas: Your network should focus on high-cost, high-impact areas like surgery, cancer care and infusion therapy, where the stakes (and the spending) are highest. But it shouldn’t stop there. At Lantern, we cover 100% of cases and all plannable surgeries.

Proven cost savings methodology and transparency: Independent specialty care providers can negotiate rates that are 130% of Medicare prices through direct contracts, a competitive reimbursement model, fast payments and strong outpatient facility partnerships. Lantern clients see a 4% total reduction in their overall healthcare spend, while members save $17,000 annually.

Dedicated member support and navigation: Employees need a clear, guided path through complex care, not a maze of referrals and confusion. Lantern’s white-glove approach to healthcare navigation provides a guiding light at every stage of the employee’s care journey. Our Care Advocates have an NPS score of 84, much higher than other plans.

Measurable outcomes: A strong partner should show you tangible data, such as fewer complications, better recovery time and hard dollar savings. On average, Lantern helps members avoid surgery 30% of the time, opting for less invasive procedures like physical therapy.

Red Flags to Avoid When Vetting Solutions

As you vet specialty care programs, it’s important to keep an eye out for a few red flags that can end up costing you more in the long run.

Include these questions in your RFP and be cautious of networks that seem too broad or lack proper vetting. Just because a program offers a bunch of provider options doesn’t mean those providers deliver high-quality or cost-effective care. Quantity doesn’t equal quality.

Also, watch out for a lack of personalized support. If employees are left to figure things out on their own, the care journey can quickly become overwhelming and fragmented.

And avoid opaque pricing at all costs. If a program can’t clearly explain what services cost or how they’ll save you money, that’s a problem. You should never be in the dark when it comes to your healthcare spend.

Denise King, VP of Global Benefits and Payroll at Medtronic, says you really need to understand how a specialty care vendor calculates projected savings.

“My question is always around 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,” she says.

The Power of Support: Why Care Advocacy Matter

Navigating complex health issues like cancer or major surgeries can be overwhelming. That’s where our dedicated Care Advocates come in. They provide a white-glove approach to guide members throughout their entire care journey.

The role of Care Advocates in managing specialty care includes:

• Priority scheduling for specialty care
• Treatment plan evaluation and second-opinion review
• Logistics coordination, including travel and lodging
• Emotional support to the employees and their families

Lantern member Larinda D. said having a Care Advocate by her side made the process so much easier when she needed surgery. “My Care Advocate was so helpful,” she says. “I don’t have time to sit on the phone and find doctors. All of that was taken care of for me.”

Member Yolanda C. agrees and told us: “Tyler [my Care Advocate] walked me through everything from start to finish. He is amazing.”

When you make the recovery journey smooth and stress-free, your employees can focus on what matters most, taking care of themselves, spending time with their families and getting better.

Care Advocates can also support HR leaders, who commonly face complex questions from employees in time of need.

“They have become my right-hand person for everything and have taken what is such a scary, uncertain situation and just made it feel like I have an advocate who’s holding my hand,” says Sarah Richards, Director of Benefits at Red Bull. “And what’s really interesting is almost 30% of our members with cancer who engage with Lantern stay engaged. They’re like, ‘I need more support than I get from my doctor’s office.’”

Engagement: Driving Employee Benefits Utilization

Offering a comprehensive specialty care program is the first step to transforming employee health. But if workers don’t know about available services or how to access them, they might as well not exist. It’s like having a gym membership you never use. It sounds good on paper, but it’s not helping your health unless you actually go and work out.

“If we want employees to actually use and appreciate their benefits, we need to think like marketers. We need to distill complex information into clear, compelling soundbites,” says Shelly Towns, Chief Marketing Officer at Lantern. “It means meeting employees where they are and using multiple channels to get the message across.”

Strategies to increase employee utilization of specialty care benefits include:

• Email
• Slack and Teams posts
• Social media posts, memes
• Intranet
• Text messages
• Print: posters, banners, desk drops, table tents
• Home mailers, letters to spouses
• Lunch and learns, webinars
• Contests and gamification

Make sure to keep the messaging to the point and jargon-free. Clear, simple language helps employees understand their options, making them more likely to use their benefits. You also need to communicate in a way that fits with your employees’ job function, as some workers work in the field and don’t use computers or check email.

Richards says word-of-mouth and employee testimonials help to drive employee engagement with Lantern, but Red Bull also gets creative with communications, sharing bite-sized educational content on digital slides that are on TVs within their offices. The content includes QR codes that employees can scan to get more information. “We approach it like an ad,” she says.

You can also use data to understand what different employees need and send the right message to the right group, whether it’s new hires, spouses or folks with a specific medical condition.

Let’s say your claims data shows a bunch of CPT codes linked to musculoskeletal issues. That’s a clear signal that many employees are dealing with joint or back pain. That’s your cue to reach out and remind them of the care options available before things get worse.

For more on driving engagement with specialty care, download our COE Engagement Playbook, featuring tangible incentives you can deploy to increase utilization.

Partnering for Better Specialty Care Outcomes

Partnering with a specialty care provider like Lantern isn’t just about upgrading your employee benefits strategy; it’s about making it work smarter. With a strategic approach, you can improve employee health outcomes by connecting people to the right care at the right time. That means fewer missed opportunities and better long-term wellness.

At the same time, this kind of targeted care leads to meaningful cost savings by reducing unnecessary treatments and avoiding more serious issues in the long term. And because Lantern streamlines the process for both HR teams and employees, the whole experience becomes simpler and less stressful.

Ready to take the next step in transforming your specialty care strategy?

Talk With Lantern