Healthcare benefits vendors know how to make a strong impression. They refine presentations, polish case studies and showcase their most compelling data. By the time employers or unions reach the finalist stage, every solution looks good on paper.
But slick presentations don’t always predict great results. So, how do you determine which solution will actually deliver for your organization?
That was the focus of Lantern’s recent webinar featuring Magda Rusinowski, Vice President at Business Group on Health; Dickon Waterfield, Chief Revenue Officer at Lantern; and Shelly Towns, Chief Marketing Officer at Lantern.
The discussion centered on one simple idea: the best healthcare and COE vendor decisions start with the right questions.
What questions should I ask healthcare and COE vendors?
Vendor evaluations for healthcare benefits typically follow a predictable pattern.
“They’ve thought about the questions and diligently prepared the answers they want you to hear,” Waterfield said. “That’s going to point you in a certain direction and take you on a certain journey. They’ll show everything in a good light.”
Waterfield recommends challenging rehearsed answers and digging deeper into the details. By asking more specific questions, buyers can gain a clearer understanding of the outcomes they can realistically expect.
Rather than taking broad claims at face value, ask vendors to show exactly how they calculate and measure results. For instance:
- Who’s included in the eligible population?
- How’s engagement defined?
- What’s included in the savings calculation?
- What assumptions are driving projected outcomes?
- Are these results being achieved today or are they part of a future roadmap?
At the same time, Rusinowski encourages buyers to look beyond the data itself.
“Data is important, but so are the feelings about the solution itself,” she said. “We hear a lot about accountability and transparency and trust. How willing is the vendor to be held accountable for the results they promised and how well they can adapt, not only to the evolving needs of my members as an employer, but also to the changing healthcare environment?”
Questions worth asking include:
- How transparent will this partner be with data?
- How do they respond when things don’t go according to plan?
- How willing are they to be held accountable for results?
- Does their long-term strategy align with ours?
A vendor relationship is ultimately a long-term partnership. Benefits leaders should evaluate transparency, accountability, adaptability and cultural fit alongside financial projections.
Measuring COE engagement and utilization
Few metrics create more confusion than utilization. Engagement can mean very different things depending on the solution.
For some programs, engagement may mean creating an account or logging into a platform. For others, it means completing treatment, attending appointments or achieving a measurable clinical outcome.
Buyers need to understand not only how many people enter a program, but how many successfully move through it.
“What’s the difference between the people who start and then stop versus the people who continue through?” Waterfield asked. “The specificity to which you can get this question answered is really important.”
Standardize Utilization Across COE Vendors
Calculate completed procedures per 1,000 enrolled employees for mandatory and voluntary plan designs.
Example:
All annual procedures ÷ (enrolled eligible employees ÷ 1,000) = procedures per 1K eligible employees
Voluntary procedures ÷ (enrolled eligible employees ÷1,000) = voluntary rocedures per 1K eligible employees
Employers also need to evaluate utilization within the context of their broader benefits ecosystem. Employees don’t interact with benefits in isolation. They must navigate health plans, point solutions, primary care providers, communications campaigns and incentive programs simultaneously.
According to Rusinowski, successful adoption often depends on how well a solution fits into that ecosystem.
“If we talk about utilization and engagement, ultimately member engagement is going to be contingent on whether they see value in it,” she said.
That value comes down to three factors:
- Cost to the member
- Ease of access
- Clear communication
Make sure to examine whether a vendor’s integration claims actually produce real-world results. Waterfield suggested asking for evidence instead of simply accepting that integrations exist.
“Can you walk me through the details of how that works and how many people use the integrations you’ve built?” he said. “It’s very easy for people to say, ‘Oh, we integrate.’ I think the depth of integration that really drives change is too often presented as a beautiful picture versus a true reality of how those integrations work.”
Evaluating proposed savings
Evaluating proposed vendor savings
Savings projections are the centerpiece of vendor evaluations. They’re also one of the areas where buyers need to apply the most scrutiny.
Rusinowski encourages employers to focus first on whether the math actually makes sense.
“If you can’t get it from that meeting and from that finalist presentation, you won’t be able to explain it internally and you won’t be able to hold your vendors accountable,” she said.
Several questions can help validate savings claims:
- Has the methodology been validated by an independent third party?
- What assumptions are built into the model?
- What data was used to generate the projections?
- How were outcomes measured?
- Over what timeframe were savings achieved?
Calculate PEPM Savings
Normalize total savings to a per-employee-per-month figure so results are comparable across employer sizes.
Example:
Gross savings by plan ÷ total enrolled employees ÷ 12 = PEPM savings
Employers should also distinguish between clinical efficacy and real-world performance.
According to Waterfield, randomized controlled trials can prove that a solution works under ideal conditions. They don’t necessarily prove that members will use the solution at scale.
“Usage in a randomized controlled trial isn’t what I’ll call utilization in the real world,” he said.
That’s why employers should evaluate both outcomes and adoption rates when assessing projected savings.
Rusinowski challenged employers to look critically at savings claims. “If every solution delivers savings, we should have negative trends,” she said.
The reality is that savings must be viewed through the lens of total cost of care. A solution that reduces spending in one area while increasing costs elsewhere may not create meaningful value for the organization overall.
Finally, employers should consider whether projected savings align with their timeline.
Some organizations need measurable results within 12 months. Others can invest in longer-term population health improvements. Understanding when savings are expected to materialize is just as important as understanding how they’re calculated.
What to challenge when comparing healthcare benefits solutions
The panel encouraged employers to rethink how they view disruption. Historically, employers have viewed disruption as something to avoid. Today’s healthcare environment may require a different mindset.
“I would argue that it’s impossible to achieve significant savings without disrupting members,” Rusinowski said.
That doesn’t mean creating unnecessary friction. Instead, employers should understand meaningful improvements often require changing behaviors, care pathways, provider choices and benefit design.
In many cases, the status quo may actually be more disruptive than the proposed solution.
“The current environment that members navigate is nothing but disruptive,” Rusinowski said.
Benefits leaders should challenge assumptions that can quietly derail good decisions:
- Challenge averages without context.
- Challenge engagement metrics without definitions.
- Challenge savings claims without validation.
- Challenge future promises that aren’t backed by current performance.
- Challenge integration claims that lack measurable results.
And when conducting reference checks, don’t settle for generic feedback.
Waterfield recommends asking a simple question: “What were you promised? Did they deliver?” The answer often reveals more than any sales presentation ever could.
The best decision starts with better questions for healthcare and COE vendors
The strongest vendor evaluations don’t come from asking more questions. They come from asking better questions.
By pushing for specificity, validating assumptions, understanding your own ecosystem and focusing on real-world outcomes, benefits leaders can move beyond polished marketing messages and make decisions with greater confidence.
When the stakes involve both healthcare costs and employee outcomes, the best question may be the most valuable tool you have.
Specialty Care COE Evaluation Toolkit
Use this template to normalize COE vendor data and compare specialty care COE solutions.
