Select the levers active in your current health plan to see your optimization score and savings opportunities.
Care Setting & Site-of-Service
Where your employees get care drives 30–40% of cost variation
0/4
Lab & Bloodwork SteeringHigh Impact
Are employees incentivized to use independent labs vs. hospital labs?
Imaging & Radiology SteeringHigh Impact
Does the plan favor freestanding imaging centers over hospital imaging?
Outpatient Surgery Center PreferenceHigh Impact
Does the plan incentivize ambulatory surgery centers (ASCs) over hospital ORs?
Drug Infusion Site ManagementMedium Impact
Are Part B drug infusions steered to office-based or home settings?
ER & Urgent Care Navigation
Unnecessary ER visits are one of the largest controllable cost drivers
0/3
ER Copay DifferentiationHigh Impact
Is there a meaningful cost difference between ER and urgent care for the employee?
Telehealth & Virtual Care AccessMedium Impact
Is telehealth positioned as the first option for non-emergency care?
24/7 Nurse Line PromotionLower Impact
Do employees know about and actually use the nurse line before deciding where to go?
Pharmacy & Formulary Optimization
Pharmacy is 20–30% of total plan cost and often the easiest lever to pull
0/3
Generic & Preferred Brand IncentivesHigh Impact
Does the formulary actively steer toward generics and preferred brands?
Specialty Drug ManagementHigh Impact
Is there a strategy for managing high-cost specialty medications?
Mail-Order & 90-Day SupplyMedium Impact
Are maintenance medications incentivized through mail-order or 90-day fills?
Provider Network Strategy
Not all providers cost the same — even within the same network
0/3
High-Value PCP EmphasisHigh Impact
Does the plan encourage or steer members toward efficient primary care physicians?
Specialist TieringMedium Impact
Are there copay incentives to see high-value specialists?
Centers of Excellence for Major ProceduresMedium Impact
For planned surgeries, are employees directed to high-quality, cost-efficient facilities?
Member Engagement & Wellness
The most affordable care is the care you prevent or manage early
0/3
Preventive Care UtilizationMedium Impact
Are preventive visits, screenings, and vaccinations truly $0 with active promotion?
Chronic Condition ManagementHigh Impact
Is there a program targeting high-cost chronic conditions (diabetes, cardiac, MSK)?
Mental Health & EAP AccessMedium Impact
Is behavioral health easy to access with adequate provider availability?
Plan Optimization Score
Significant Gaps
High-impact levers active0/8
By Category
Care Setting0/4
ER0/3
Pharmacy0/3
Provider Network Strategy0/3
Member Engagement0/3
Top Opportunities
Lab & Bloodwork Steering
$50–$200 per test
Imaging & Radiology Steering
$200–$1,500 per scan
Outpatient Surgery Center Preference
$1,000–$10,000+ per procedure
Want to explore these opportunities?
Talk to a benefits advisor →
Savings estimates are directional and vary by plan size, geography, and current design. This tool is for educational purposes — consult a licensed benefits advisor for plan-specific analysis.