When it comes to employer-sponsored health plans, the status quo is broken. For too long, employers have watched profits leak away into an opaque system that prioritizes volume over value. But today, a new era is emerging—one defined by strategic leadership, measurable results, and employer health plan cost savings that regularly exceed 20%. These aren’t hypothetical solutions; they’re proven strategies that forward-thinking benefits leaders are deploying right now to stop waste and create sustainable care models for their employees.
Let’s walk through the key solutions employers are using to reclaim control—and money—from a dysfunctional system.
Advanced Primary Care as a Foundation
The most transformative cost-saving measure is a reimagined approach to primary care. Advanced primary care, including direct primary care (DPC), creates a high-functioning front line by prioritizing access, continuity, and shared decision-making. These models intentionally reduce unnecessary specialist referrals and eliminate fragmented care by “closing the loop” when external care is needed. The result? Improved health outcomes and drastically reduced employer spending.
The value here goes far beyond dollars. Employees receive longer visits, stronger patient-provider relationships, and a reduction in medical debt. As the Hint Health 2023 Employer Trends report shows, employer-funded DPC adoption jumped from 21% in 2017 to 49% in 2022, with 84% of employers renewing after the first year. It’s clear this is more than a trend—it’s a movement toward a more personalized, cost-effective care experience.
Pharmacy Benefits: No More Black Box
Another massive area for employer health plan cost savings lies in pharmacy benefit management. Traditional PBMs are rife with hidden fees and profit spreads, often distorting the true cost of medication. Employers who take control of their pharmacy benefits follow three essential steps:
- Scrutinize PBM contracts to uncover spread pricing and rebates that drive up costs
- Shift to evidence-based formularies that create savings with minimal disruption
- Manage specialty drugs closely to ensure both medical appropriateness and financial efficiency
These reforms empower employers to create pharmacy plans that align with employee health rather than vendor profits.
Planning for High-Cost Claims
A small subset of employees—those requiring dialysis, transplants, or NICU care—can account for a large portion of total spending. Strategic planning for these inevitable cases is key. Employers are finding savings by contracting with high-performance Centers of Excellence (COEs) for complex surgeries and investing in prenatal programs to reduce the risk of premature births.
Even when travel is involved, these investments pay off. Reducing complications and improving outcomes not only minimizes financial risk—it also protects employees when they need care the most.
Evidence-Based MSK Programs
Musculoskeletal (MSK) issues are another top cost driver, often representing up to 20% of claims. Unfortunately, many hospitals offer inappropriate or unnecessary care, leading to inflated costs and avoidable surgeries. The solution? Implementing MSK management programs rooted in evidence-based medicine.
When employees receive the right care—such as physical therapy or conservative treatment first—employers save significantly. These programs also reduce the risk of long-term disability and opioid dependence, two common MSK-related outcomes that compound costs over time.
Demand Price Transparency
Opaque pricing is a hallmark of the legacy healthcare system. Without transparency, employers can’t make informed decisions. One powerful solution is the use of bundled payments—a single all-in price that covers an entire episode of care. These models reduce surprise billing and ensure employers know what they’re paying for.
Forward-thinking employers are identifying high-integrity providers willing to be transparent and working exclusively with them. This move doesn’t just reduce costs—it builds a culture of accountability and trust.
Reward Safety and Quality
Not all hospitals are created equal. Directing employees to facilities with poor safety records is both financially and ethically costly. Top-performing benefits leaders treat hospital safety like airline safety—you wouldn’t fly with a carrier known for accidents.
Plans should be designed to prioritize providers with strong safety scores, such as those rated highly by the Leapfrog Group. Doing so protects employees from harm and prevents unnecessary readmissions, surgical errors, and litigation risks.
Optimize Your Plan Documents
The fine print in your ERISA plan documents matters more than most realize. Hidden language can lead to unexpected costs or even legal trouble. That’s why expert benefits leaders meticulously review their plan documents and consult reliable resources, such as those offered at healthrosetta.org/opensource, to ensure compliance and clarity.
Well-written plan documents protect both the organization and its employees. They also set the groundwork for implementing innovative plan features without bureaucratic delays.
The Plan Grader™ and Strategic Roadmapping
To help assess and guide these reforms, the Health Rosetta Plan Grader™ was developed. It evaluates a plan’s health across 40 criteria, offering a data-driven view of strengths and weaknesses. Employers receive a standardized score and a clear roadmap for improving both financial and clinical outcomes.
One case study involved a furniture company that used the Plan Grader to uncover key improvement areas. With advisor support, they developed a three-to-five-year strategy focused on self-funding, transparent contracting, and direct provider access—leading to significant cost reduction and employee satisfaction.
In a 2024 capstone project, Traci McGinnis (MS in Health Informatics) analyzed the Plan Grader’s effectiveness. Her findings highlighted that the top-performing health plans shared these traits:
- Self-funded structure
- Clear compensation disclosure
- Direct contracting with providers
- Executive-level involvement
- Unrestricted claims data access
- Strategic carve-outs for specialty care
These ingredients aren’t just nice to have—they’re what differentiate reactive plan design from proactive transformation.
A Flywheel for the Future
The cumulative effect of these reforms is profound. Employers and unions across the country are using these tools to create a flywheel of improvement: better health outcomes, higher employee satisfaction, and lower costs. With advanced primary care at the center and tools such as Plan Grader to track progress, employer health plan cost savings are not just achievable—they’re sustainable.
We are seeing a system being rebuilt from the inside out—one employer at a time. And with each successful implementation, the case grows stronger for moving away from fee-for-service models toward value-based, data-informed, and employee-centric care.
Contact Verve Advanced Primary Care Today
By adopting these proven strategies, your organization can stop the financial bleed, boost employee health, and build a benefits plan that actually benefits everyone. Contact Verve Advanced Primary Care today to start saving money and improving care.