Like many employers, Amtrak faced runaway costs for surgery and specialty care infusions. The benefits team needed a solution that would get spend under control while creating an excellent experience for all members, including their union population.
In this webinar, leaders from Amtrak and Lantern shared how a modern specialty care strategy—rooted in access, appropriateness and aligned incentives—is helping Amtrak control rising costs while removing roadblocks to ensure members can access the care they need.
In this webinar, you’ll hear from:
Nathan Counts, Vice President, Total Rewards, Amtrak
Dickon Waterfield, President, Lantern
Key Takeaways
- The real ROI and clinical outcomes—not just marketing metrics—Amtrak demands from its solution partners
- How a Network of Excellence solution for surgery and infusions lowers costs without sacrificing quality or experience for Amtrak
- Advice for bringing a new specialty care solution to both union and non-union populations
Local Access is Key to a Successful Specialty Care Benefit
Amtrak is a unique environment: heavily distributed, 24/7 operations, high‑skill essential workers, and 85% union representation. Many employees can’t access phones for long periods and live far from major health centers. That means traditional Centers of Excellence models—which often require long‑distance travel and narrow procedure lists—simply don’t work.
Historically, high‑quality surgical programs have required travel to brand‑name health systems. But for rail employees who may be on a train overnight, working in a snowstorm, or living in frontier regions, that wasn’t realistic.
Lantern’s network‑based model addressed that barrier head‑on.
“We’ve been trying to move the market to a Network of Excellence—locally accessible, covering all plannable procedures. The simple message to a member becomes: if you need specialist surgical care, call Lantern,” said Dickon Waterfield, President, Lantern.
Local access also drives trust, faster consults and significantly higher engagement—key for populations that can’t wait weeks for an appointment.
“Access locally to all plannable surgeries was the game changer,” said Nathan Counts, Vice President, Total Rewards, Amtrak.
And because Lantern’s model evaluates clinical appropriateness upfront, employees often avoid unnecessary surgeries entirely. Nathan emphasized the value of this: “A great outcome is not needing the surgery at all.”
Look for Guaranteed Hard-Dollar Savings when Choosing a COE
Five years ago, employers prioritized “quality” in COE evaluations. Today, with trend hovering between 10% and 18%, Counts sees a different reality: “Benefits leaders are in a real moment of crisis. You can’t sustain wage increases or reinvest in the business if healthcare costs keep rising.”
This pressure pushed Amtrak to look for guaranteed savings—not promises of long‑term behavior change. Surgeries were a natural place to start: a top spend category and one with significant price variation.
For Amtrak, savings needed to be real and measurable. “We spent a lot of time digging into the methodology,” Counts said. “We needed aligned incentives—not just great surgeries, but avoided surgeries when they aren’t needed.”
Lantern’s prospective bundles, steep unit‑cost reductions (often 50% lower), and value‑based contracting created that alignment.
“We start with network quality—not just outcomes, but appropriateness,” Waterfield said. “If conservative care is the right option, we send members there first.”
These dynamics allow employers to waive member cost‑share while still saving meaningfully—an increasingly rare win‑win.
Even early in Amtrak’s launch, the impact was clear. “We saw a big halo effect,” Counts said. “Even employees who didn’t need surgery appreciated knowing they had access to something high‑quality and no‑cost.”
Union Partnership Succeeds Thanks to Lantern’s Value
Many employers assume union populations make innovation harder. Counts was clear that the opposite can be true—if the solution adds real value.
“We lead with quality and close with cost,” he said. “Union members understand that if we cannot control healthcare costs, that reduces the wage increases they receive.”
Because the program improves access, improves outcomes and reduces waste, union leaders viewed it not as a takeaway, but as a benefit expansion. In fact, Amtrak was able to introduce Lantern outside the normal bargaining cycle—something Counts described as rare.
This also allowed mid‑year launch, months ahead of open enrollment, avoiding what Dickon calls “the awkward period”—when employees hear about a future benefit they can’t yet use.
Looking ahead, Amtrak is already exploring expanded offerings across infusions and cancer care. Infusions (often a profit center for hospitals) showed particularly strong potential.
“There’s no easy way today for carriers to impact infusion pricing. It’s a huge opportunity for member value and plan savings,” Counts said.
And because Lantern’s platform offers surgeries, infusions, conservative MSK care, oncology navigation, and more, Amtrak can point employees to a single entry point for specialty care—removing confusion and reducing “benefits homework.”
Key Takeaways for Benefits Leaders when Choosing a Specialty Care Solution
What stood out most is how aligned Amtrak and Lantern are on a philosophy that benefits leaders across all sectors can learn from:
- Keep solutions simple and easy to communicate
- Provide care locally whenever possible
- Lead with quality, but evaluate with cost
- Use appropriateness to avoid unnecessary care
- Give members something truly valuable—don’t just shift cost
- Choose partners who grow with you
“Offering the status quo will be disruptive to your employees,” Counts said. “Those premium and contribution increases, those deductibles and out-of-pocket costs are disruptive to our employees. They aren’t sustainable, so why not bring in something that is disruptive in a positive way? I think it’s an opportunity to really make a change.”
For benefits leaders facing rising costs, employee skepticism and operational constraints, Amtrak’s experience demonstrates that a modern specialty care strategy can deliver meaningful savings while strengthening the employee experience.
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