This modeled case study illustrates how a mid-size self-funded employer can use hospital price transparency data to identify significant savings opportunities — using real published hospital prices and CMS utilization benchmarks.
Company Profile
A 500-employee technology company headquartered in Dallas-Fort Worth, TX. Self-funded health plan with roughly $4.8M in annual healthcare spend. Employees distributed across the DFW metro area with access to 40+ hospitals.
The Challenge
The company's benefits team knew healthcare costs were rising 8-10% annually but had no visibility into whether they were overpaying for specific services. Their broker provided renewal analysis and network discount reports, but couldn't identify hospital-level savings opportunities without a full claims data analysis — which would take 3-4 months and cost $40,000+.
The Analysis
Using MyCareCost's employer tools, the benefits team entered their employee count (500) and primary state (Texas). Within minutes, the system generated a savings projection based on:
- CMS/HCUP utilization benchmarks for a 500-person employed population
- Published prices from all 40+ DFW-area hospitals
- CMS quality and safety ratings for provider steerage validation
- Per-procedure savings ranked by annual dollar impact
Key Findings
The analysis identified $1.2M in annual savings opportunities across five high-impact procedure categories:
- Joint replacements: $18,000-62,000 price range → $440K annual savings opportunity (est. 20 cases)
- Spinal procedures: $22,000-85,000 range → $315K annual savings opportunity (est. 5 cases)
- Advanced imaging (MRI/CT): $350-3,500 range → $210K annual savings opportunity (est. 300 scans)
- Cardiac procedures: $12,000-45,000 range → $132K annual savings opportunity (est. 8 cases)
- Maternity: $6,000-28,000 range → $110K annual savings opportunity (est. 25 deliveries)
Recommended Actions
The savings projection came with named provider recommendations — specific hospitals in the DFW area with the best combination of price and quality rating for each procedure category. The implementation plan included:
- Tiered benefit design: waived deductible for using top-value providers
- Employee education: price comparison tools in the benefits portal
- Maternity center of excellence: partnership with a high-value OB facility
- Imaging steerage: $500 cash incentive for using freestanding imaging centers
Projected ROI
At a conservative 40% steerage adoption rate, the company projected $480K in first-year savings against $24K in annual platform costs — a 20:1 ROI. Even at 20% adoption, projected savings of $240K represent a 10:1 return.