Over the last 100 years, a leading financial services firm has seen a lot of changes, but one trend feels constant: healthcare costs continue to rise.

When Ryan McCracken, the firm’s Director of Benefits, began looking at what was driving the company’s latest spikes in healthcare spend, he discovered that musculoskeletal conditions fell in the top three cost drivers. The firm knew it needed to find a solution to help members and lower costs.

“Healthcare navigation is a constant struggle and it’s really challenging to help educate members on how to find care that’s right for them and what questions to ask, so we really needed something that was easy for our members to use,” McCracken says. The firm has 19,000 locations across the U.S. and Canada (more than Starbucks!) with 50,000 associates and 80,000 covered lives.

McCracken says they looked across a variety of solutions, and determined they needed an independent Centers of Excellence (COE) that also worked with the rest of their health benefits ecosystem, including their digital physical therapy solution, Hinge Health.

“It’s all about helping improve the total care for our population,” he said. “We have very low turnover. We keep our associates and their family members with us for their whole career in most cases. We needed a solution to be both highly effective and it had to be at a competitive cost to incentivize members to engage with it.”

Financial Firm Impressed by Lantern’s Vetting Process for Surgeons

When reviewing surgical solutions, quality care that improved health outcomes was at the top of the list, McCracken says, and why they ultimately chose Lantern. To bend the cost curve, they wanted to achieve effective and safe outcomes, and reduce complications, readmittance and repaired surgeries.

The firm was impressed by Lantern’s approach to ensuring their network included only quality surgeons, including their rigorous vetting process that reviews them on an individual basis. Lantern looks at factors like procedure volume, complication rate and appropriateness to make sure every surgeon is providing the right care, to the right patient, at the right time. They also wanted to make sure their program could help direct patients to Hinge Health for physical therapy or find an alternative treatment route when necessary.

McCracken says he was surprised to learn how many procedures are performed that are unnecessary, and talked with his friend, who’s a retired surgeon, about it and appreciated his candor.

“He said, ‘if you go see a barber, they’re going to give you a haircut and if you go see a surgeon, they’re going to give you a surgery.’”

Lantern has an exclusive partnership with Global Appropriateness Measures (GAM) Consortium to ensure its network surgeons follow best practices and aren’t performing unnecessary surgeries.

“That’s really been huge in terms of helping direct our members to the best available care, not just can we get them the best available surgery, understanding that sometimes it’s not the appropriate path for them,” McCracken adds. In the first six months with Lantern, the financial firm has seen a 15% surgery avoidance rate for musculoskeletal conditions.

McCracken says the firm also appreciates that Lantern Care Advocates support members in navigating their care journey, too: “They have someone to assist them through what’s usually a rare, scary and expensive time in their life.”

Financial Services Firm Lowers Specialty Care Spend, Helps Members

To keep costs down for members, the financial services firm waives co-insurance. Elaine, an associate at the firm, had lived with hip pain for years, so when she learned about the Lantern benefit, she reached out. A Lantern Care Advocate helped to match her to an excellent surgeon and she’s now recovering with less pain.

“I’m definitely living a better life now because I had the hip replacement surgery,” she says. “I would not have been able to afford this care without my Lantern benefit.”

The firm also offers a travel benefit when members need to travel for care. So far, about 88% of associates have been able to drive to care to see providers in Lantern’s Network of Excellence, with the median distance for travel being 35 miles.

“We have people who live in semi-rural areas, small towns and urban environments, and we’re helping them find top-quality care with Lantern,” McCracken says. “This is huge for us.”

The financial services firm has also seen success with $1.4M in savings in just the first six months of their partnership with Lantern. They expect that number to continue to grow as more associates have positive experiences and spread the word.

“We’re still fairly young in the program,” McCracken says. “But this is one of those rare win-win type of scenarios where we can explain to our members that they’re getting the best possible surgical care at a time and place that works best for them, and it’s going to cost less. Anything we can do to help our members get better quality, save out of pocket, and then help bend down the cost curve means that we can keep premiums lower for our members and our associates going forward into the next year.”