Health funds and union trusts are committed to keeping care affordable for members. But when costs rise, that means they have one fewer tool in their toolbox to keep costs under control.
Faced with skyrocketing healthcare costs in New York City and other large metro areas, 32BJ Health Fund decided to take a fresh approach.
With nearly 200,000 covered lives, a multilingual membership and zero-premium coverage locked in as a non-negotiable, 32BJ Health Fund needed a solution to not only control surgery costs, but ensure its members were getting the highest quality care. In this webinar, they shared why Lantern fit the bill, the results they’ve seen so far and advice for other funds considering making the switch to an independent COE.
In this webinar, you’ll hear from:
Shelly Towns, Chief Marketing Officer, Lantern (Moderator)
Claire Brockbank, Director, 32BJ Health Fund
Lindsay Leeder, VP, Labor Market, Lantern
Key Takeaways:
- Making your COE mandatory, with full cost coverage for members, is the single most powerful lever for driving utilization and savings.
- Quality in specialty care starts at the individual surgeon level, not the facility, and procedure volume is one of the strongest predictors of outcomes.
- The status quo is the disruptive choice. The cost of inaction is higher than the cost of change.
The Problem with Hospital-Centric Care
When Claire Brockbank joined 32BJ Health Fund, she inherited a COE program that was run by a hospital system. The results showed it. Inpatient utilization was extraordinarily high, costs were climbing and the model was built around facilities rather than physicians.
“When I needed a new knee and the surgeon said I should expect a three-night hospital stay, I came back and said I want to look at our data,” Brockbank said. “That’s actually what started us down this path.”
The data, she said, showed their COE wasn’t designed around what the fund needed, namely, predictable costs and appropriate care. Hospital prices were rising at twice the rate of other care categories, and the COE wasn’t doing enough to counter that trend. For a fund that can’t simply raise premiums, that’s not a sustainable position. Brockbank and her team went looking for something different.
The answer wasn’t just a new vendor. It was a different philosophy. Instead of steering members to marquee hospitals and hoping for good outcomes, 32BJ partnered with Lantern in January 2025 to build a program centered on individual surgeon quality — vetting providers on board certification, fellowship training, procedure volume and appropriateness of care across 300+ distinct metrics.
“I liked that model more than saying we’re going to have the marquee hospital, which can have good docs and bad docs,” Brockbank said. “When you’re having your hip or spine operated on, it’s the surgeon that counts.”
Defining Quality Healthcare in a Modern COE
One of the most important conversations in this webinar was about what “quality” really means in specialty care, because the word is used loosely and measured inconsistently across the industry. Most plan members assume their health plan’s entire network has been quality-vetted.
Lindsay Leeder, who spent 14 years practicing primary care before joining Lantern, sees this education gap constantly in her conversations with fund administrators and trustees.
“There is a lot of explaining of how we approach quality,” she said. “A lot of leaders I talk to will say, ‘My buddy went and got his knee done. He went to the neighbor’s brother who’s a surgeon.’ Or the primary care provider just referred me someone, so I went. But then they also have stories of, ‘I had this knee surgery and I didn’t need to have it.’”
General orthopedists typically do about 20-50 joint replacements a year. Lantern, however, won’t refer a member to a surgeon who performs fewer than 100 procedures in their sub-specialization (by CPT code) annually, and most in their network do more than 300. That gap matters. When 32BJ ran their 172 spine surgeons through Lantern’s quality criteria, the list dropped to about 32. A few weren’t board certified, but the bigger factor was volume. “That’s the proof that our members are going to be so well protected [with Lantern providers],” Brockbank said.
Quality also shows up in avoided procedures. 32BJ has seen roughly a 15% surgery avoidance rate since launching with Lantern, meaning members who came in expecting surgery were redirected to a more appropriate treatment path. That matters because the Network doctors are putting the interest of 32BJ’s members first.
Mandatory Procedures & Network Growth
When launching a specialty care solution, Brockbank said plan design was key, along with discussion on whether to make procedures voluntary or mandatory. They decided to make joints, bariatric and spine surgery mandatory, and the cost share for members costs nothing. “Lantern equals zero cost, your hand gets held and it’s really good quality,” Brockbank said. “And that’s worked.”
One bump in the road after the initial launch of the program was surgeon availability. Geographic coverage looked fine on paper, with surgeons within 50 miles of most members, but the data didn’t capture how members actually think about travel.
In the Philadelphia area, members wouldn’t cross the river into New Jersey, even for a surgeon 10 miles away. “We had not anticipated that,” Brockbank said. “So Lantern came in and really upped their contracting game to deal with that psychological barrier.”
That kind of flexibility, including a willingness to grant exceptions during the early months while trust was being built, made the difference to their success of rolling out the surgery program. As of March 2026, 32BJ had processed about 1,400 procedures through the program with a 93% member satisfaction rate.
How 32BJ Sees Savings Through Lantern
Lantern’s pricing model differs from what most buyers assume they’re already getting from their carrier. The average commercial payer reimburses surgeons at about 250 to 300% of Medicare rates. Lantern’s direct-contracted rates run closer to 140% of Medicare — roughly 50 cents on the dollar for the same procedure. That’s not a carrier discount applied to a standard fee schedule. That’s a hard-dollar contractual savings passed directly to the plan.
“We get asked, ‘Why would the surgeon work with us? Why, if they’re already contracted with all these health systems, would they do it?’ It’s because one, we’re going to pay them very quickly. We’re going to pay them within 10 days,” Leeder said. “On average, providers are waiting sometimes six to 12 months to get reimbursed. And, then lastly, we’re bringing them additional volume. And we have great partnerships with health plans. I think it speaks to the safety and quality standards we have.”
Why a Specialty Care Program is Right for Unions
If you’re managing a labor or union population and wondering whether your fund is big enough for a solution like this, Leeder said groups with about 1,000 active subscribers should start the discussion, and there’s flexibility. “The labor community has been more receptive than I ever imagined,” she said. “We want to look at every group and ask, are we a good fit for you?”
Leeder also shared that funds are more open than ever to solutions like these that were once considered too different and disorienting. “There was a long time where folks said some of these changes are just too disruptive,” Towns added. “The current consensus is it’s too disruptive not to do something.”
For 32BJ, doing something meant partnering with Lantern, making their COE mandatory, communicating hard and trusting the process. With a 93% member satisfaction rate, a 15% surgery avoidance rate and significant cost savings in the first 16 months, Brockbank said launching a specialty care solution was the right call.
“You’re one of the only vendors that we allow to communicate directly with our members. Lantern has demonstrated they were willing to listen,” she said. “For us, it’s not a vendor, it’s a partner.”
Center of Excellence Buyer’s Guide for Labor, Union & Trust
