Where You Get Care Matters

Helping employees understand site-of-care options can lead to better healthcare decisions — and meaningful savings for employees and employers.

You find out you need surgery. Naturally, you start thinking about the procedure. Who will perform it? What should you expect? How long will recovery take? When is it being scheduled? And maybe you’re wondering, how long can I put this off?

But there’s another question that should come much earlier in the conversation: Where will you have it done? The answer can make a significant difference in what you pay, what your health plan pays, and your overall care experience.

As employers, we spend a lot of time helping our people understand what their benefits cover. But we have an opportunity to take that education one step further by helping employees understand not only what care is covered, but where they can receive it.

Site of care is becoming an increasingly important part of the healthcare conversation. Many services that once took place primarily in hospitals can now be provided in ambulatory surgery centers, standalone imaging facilities, independent labs, and other outpatient settings. Yet employees may not realize they have options. If they don't know there is a choice, are we really giving them one?

Same Procedure, Different Place

Let’s start with surgery. Ambulatory surgery centers, or ASCs, are facilities designed specifically for outpatient procedures that do not require an overnight hospital stay. For an appropriate elective procedure and patient, an ASC can offer a more streamlined experience and often at a substantially lower cost than a hospital outpatient department.

In 2024, Medicare paid ASCs, on average, 62% of what it paid hospital outpatient departments for the same procedures. When a procedure can be moved from a hospital outpatient setting to an ASC, there may be an opportunity for savings.

The federal government is also expanding the number of procedures that can be performed in outpatient settings when clinically appropriate, giving physicians and patients greater flexibility in determining where care takes place.

Of course, the lowest-cost location is not automatically the right location for every person or procedure. An employee's health, the complexity of the surgery, physician recommendations, and other clinical factors should always be part of the decision.

>>Take Action: Encourage employees to ask these questions early on in the decision-making process. If surgery is recommended: Can this procedure be performed at an ambulatory surgery center? What are my options? Is there a difference in quality, cost, or recovery? What does my health plan cover at each location

Educate and Reiterate

Here is where you can make a difference. Pull out your benefits materials and look at how you explain surgery. Does the plan simply list a copay, coinsurance, or deductible under surgery? Or does it help employees understand that what they pay may vary depending on where that surgery takes place?

During a recent conversation about benefits design, we discussed whether ambulatory surgery centers should have their own clearly defined line in benefits materials. I think there is real value in that approach.

Rather than expecting an employee to understand that outpatient surgery can mean different things, show them.

Open enrollment is an ideal time to do this. Employees are already looking at their benefits, evaluating options, and thinking about how they may use their health plan in the year ahead. It’s an opportunity to educate them not only about what is covered, but also how to use that coverage more effectively.

>>Take Action: As you begin thinking about future plan design, ask another question: Does our plan encourage employees to consider appropriate, high-quality sites of care?

Think Beyond Surgery

Once you start looking at healthcare through a site-of-care lens, you’ll see the opportunities. Consider imaging. An MRI or CT scan might be available through a hospital-based facility or a standalone imaging center. The same is true for lab work.

Depending on the employee's network and provider requirements, testing may be available through a hospital-based lab or an independent laboratory. Some infusions and other treatments may also be delivered in multiple settings. Employees don't necessarily know this. And why would they?

>>Take Action: Benefits education can drive better decision-making. An employee may never think to ask whether another in-network location could provide the same service at a lower cost. Help employees understand what options are available.

Start the Conversation Sooner

Cost should not override appropriate care. There will be situations when a hospital is absolutely the right place to receive a procedure or service. Our role as employers is to help employees understand their benefits, know what questions to ask, and have access to information that allows them to make informed decisions with their healthcare providers. Site of care belongs in that conversation.

As you move through open enrollment, take another look at how your organization communicates healthcare choices.

• Are there places where you could make differences in cost and care settings easier to understand?
• Could you highlight ambulatory surgery centers, independent imaging facilities, or labs?
• Do employees know where to find quality and cost information before scheduling care?

>>Take Action: Make site-of-care education part of the ongoing healthcare conversation. Reinforce it through timely communications and the resources you make available throughout the year.

Voice the Choice

We often talk about helping employees become better healthcare consumers. But first, we have to make sure they know they have choices. Sometimes one of the most important questions is also one of the simplest: Where should I go? Need answers? Get in touch.