How to give Americans the healthcare experience they want by prioritizing value

According to a recent Gallup poll, 70% of Americans say that the U.S. healthcare system is either in a state of crisis or has major problems. Yet, in the same poll, 71% of people say that the individual care they receive is excellent or good.

This begs the question — how can people believe that the healthcare system is broken while being satisfied with their own care? 

The answer can be found in one final result — 81% of polled adults said they are dissatisfied with healthcare costs. These three data points make one conclusion increasingly clear; despite having access to some of the highest quality care in the world, healthcare is unaffordable for most Americans. 

Gallup is not the only organization with these findings. PwC predicted that healthcare costs will rise to the highest levels in more than 13 years. Given the majority Americans receive health coverage through their employers, companies — and their hardworking employees — will unfortunately pay the price.  

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Prioritizing access over value

Before diving into how things can and should change, it's important to understand how we got here.

In 2024, nearly half of employees with employer-sponsored health plans were enrolled in a Preferred Provider Organization (PPO) plan. PPO plans partner with a group of clinics, hospitals, and doctors to create a network of preferred doctors. With PPOs, plan members (employees and dependents) and sponsors (employers) pay less when accessing care in that network. Members can still access out-of-network providers, but the same discounts do not apply. In recent years, health plans have prioritized creating a large "network" of covered providers, ensuring that members can easily access doctors in their area. In theory, this makes sense. 

However, preferential access to discounted care usually comes at a price: higher healthcare costs and employee cost sharing. Last year, the average annual premium for single employer-sponsored health insurance was $8,951 — 15% of the U.S. median salary. This, on top of other healthcare expenses including co-pays and deductibles, are making healthcare increasingly unaffordable. 

Due to these prohibitively high costs, many employees with health coverage still cannot afford the care they need, causing them to delay necessary medical treatment or forgo it altogether. This situation is often referred to by benefits professionals as being "functionally uninsured."

This situation raises an important question: If so many employees find it difficult to afford the healthcare coverage provided by their employers, what value do traditional PPO plans really offer? When evaluating something's worth, we consider both the quality and cost of a good or service. While PPO plans offer access to a broad network of physicians, they have lost a crucial component of the value equation: affordability.

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How to address a growing rift between healthcare prices and satisfaction

As the Gallup poll revealed, the cost of healthcare is a major problem and it's time for employers, benefit leaders and consultants to strongly consider alternatives that prioritize cost effectiveness without sacrificing quality. 

However, change is hard, and despite the growing concern around healthcare costs, many employers are hesitant to explore non-traditional health plans. They prefer what's familiar and do not want to upset employees. The good news is that there are now proven alternative health plan solutions that bring value back to healthcare. 

Instead of using opaque healthcare rates through traditional PPO plans, health plans utilizing reference-based pricing (RBP) use standard rates, including Medicare, as a baseline to make fair and transparent healthcare payments. RBP is proven to save nearly 20% on overall healthcare costs, and given that employers pay an annual average of $7,034 to cover individual workers and $17,393 for family coverage, these savings add up quickly. 

While RBP offers significant savings, it is a different experience than the traditional PPO plan. It may require members to further engage in their healthcare — like making an extra phone call to ensure their provider understands the health plan. While most Americans will happily make an extra phone call for hundreds of dollars of healthcare savings every month, it's not a one-size fits all approach. The best RBP plans offer concierge-level support for members. At Imagine360, our member satisfaction scores are 98%.

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Employers that don't want to make the full leap to RBP can explore a dual-option plan which offers a traditional PPO plan alongside a significantly discounted RBP plan. Offering multiple health plan options can provide cost savings to employers and flexibility for employees to choose a health plan that meets their needs.

By exploring alternatives to solely offering traditional health plans, companies can bring value back to their healthcare solutions by prioritizing the physical and financial well-being of their most valuable asset — their people.

Failing to consider an alternative approach may exacerbate a growing rift between consumer satisfaction with the increasingly unaffordable American healthcare system. 

As the ones footing the bill, it's up to employers to do their part in addressing these runaway costs and the impact on their employees. If you're not considering alternative health plan options, you're missing out.