Your healthcare costs are rising. Are you managing the right problem?

Why benefits leaders should look beyond utilization and focus on the cost of care

Same drug. Same hospital. Nearly six times the price.

STAT recently compared what employers could pay for one infused drug at one Houston hospital under two major health plans. Under one, roughly $780 a vial. Under the other, nearly $4,400. Medicare pays about $300.

That doesn't mean one carrier always beats another. Healthcare contracting is too complicated for that. It means there's almost never one price. What gets paid depends on the payer, the contract, the site of care, and the payment arrangement.

For benefits leaders, the important question isn't just whether they can see the price. It's whether their health plan can do anything about it.

That gap between seeing a price and being able to use it is where Curative CEO and co-founder Fred Turner has spent a lot of time lately, including in a new op-ed for the Texas Tribune and in recent testimony on healthcare affordability and competition.

His argument is straightforward: transparency matters, but it only creates leverage when employers and health plans can actually act on the information.

The cost pressure is real, and it's moving to the C-suite

Start with what employers are facing. A Willis Towers Watson (WTW) survey, reported by the Wall Street Journal, found employers expect healthcare costs to rise 11.1% in 2027, the steepest jump in more than two decades. That's before savings measures. WTW puts the figure at 9.7% if employers redesign their plans.

One lever employers have historically had is cost sharing: deductibles, copays, and coinsurance that put more of the cost decision in the member’s hands. That lever has limits.

In his testimony, Turner argued that high deductibles can reduce spending in the short term because members defer care broadly, not selectively, and that some of that deferred care may return later in higher-acuity settings. That's an understandable response when price isn't something employers can touch.

And the pressure is moving up. Aon's Mike Pasterick told the WSJ that benefits decisions at larger companies are moving from HR into the C-suite, with finance, the CEO, and the board paying attention.

So the question gets sharper: is there a way to manage costs that doesn't depend on putting more of the cost burden on employees?

What most employers manage well

Healthcare spending comes down to one simple equation:

Price × quantity = spending

Employers have gotten good at the quantity side. Utilization management helps make sure care is appropriate. Navigation helps employees find the right setting. Plan design shapes how people use their benefits. And quantity is real: the WSJ points to cancer treatments and GLP-1 drugs, and Aon says employee use of GLP-1s for weight loss grew 75% in 2025 across its clients.

But Irene Papanicolas, a Brown University health economist, told STAT that if you think of spending as price times quantity, the bigger thing to fix is often price.

There's a reason price is hard to move. RAND's analysis of employer and state claims data found that in 2022, employers and private insurers paid hospitals about 2.5 times what Medicare would have paid for the same services at the same facilities. And most of the variation in those prices is explained by hospital market power, and very little by a hospital's share of Medicare or Medicaid patients. In other words, high prices track leverage more than they track a hospital's payer mix.

For years, employers had almost no access to prices or even their own data while they kept writing the checks, STAT reports. Now more of that data exists. That's progress. But data in a file doesn't create a functioning market.

A posted price isn’t always a usable price

A hospital can publish a price. A plan can publish negotiated rates. A provider can post a cash price. And an employer or patient can still struggle to answer a basic question: what will this actually cost, and what are my other options?

A useful price needs to be:

• Visible: you can find it

• Comparable: you can line it up against alternatives

• Accurate: you can trust it

• Actionable: you can choose a different option

The first three help you understand the market. The fourth gives you leverage. RAND's researchers make the same point: price transparency alone won't change anything if employers can't or don't act on the information.

The FTC made that connection explicit in a press release on October 5, 2026. In warning letters to 24 large hospitals, the agency said incomplete, inaccurate, or untimely pricing information can prevent people from comparing providers and can undermine competition itself. Simply meeting CMS price-transparency requirements is not enough. Healthcare companies can still face scrutiny if the pricing information they provide is misleading or incomplete.

And here's where public pricing can break down. Turner described providers that publicly post cash prices but won't honor them when the patient has insurance. The price is public. It may even be lower. But if the buyer can't choose it, it does nothing to discipline the market.

What acting on a price looks like

Same surgeon, different building. A member needed a complex multi-level spine fusion. The original facility quoted more than $175,000. Curative's Care Navigation team found another credentialed facility that could do it for $40,000. That's a difference of more than $135,000, or roughly 77%.

The surgeon was exactly the same. The member kept their physician. The cost difference came from the facility.

So what? For an employer, one case like this can move a claims year. For the member, it's a clinically comparable path with no change in who operates. The goal isn't the cheapest care. It's understanding what drives a price and whether a clinically appropriate alternative exists.

The broader data points the same way. In 2023, Massachusetts commercial insurers paid an average of $2,527 for certain colonoscopies in hospital outpatient departments, versus $884 at surgery centers and $963 in physician offices, according to state data reported by STAT. A lower-cost setting isn't always right. Clinical needs, quality, geography, and employee preference all matter. But a plan should be able to spot the gap and help work out whether there's a good alternative.

Less friction, not more. Better price data can also show where a plan doesn't need to intervene. At the 41 facilities where Curative kept prior authorization (the plan's approval step before certain care), the average MRI facility cost was $3,067. Everywhere else in the network, it averaged $684. So Curative removed prior authorization at nearly all in-network facilities and kept it only for scheduled outpatient scans at the unusually expensive locations where lower-cost in-network options were available.

Why it matters: one hurdle in front of every member was solving a price problem at a few dozen facilities. Targeting the problem removes friction for employees who aren't part of it while preserving a meaningful cost-control lever for the employer.

It shouldn't feel like homework. Someone preparing for spine surgery shouldn't have to compare facility economics, find out where their surgeon operates, and negotiate payment. The plan is better positioned to do that upstream. At Curative, high-cost elective procedures can be flagged before authorization, and Care Navigators help coordinate an alternative, including scheduling, logistics, and payment routing.

Alternatives are what create leverage

Steerage works when there's somewhere to steer. A price only pressures the market if the buyer has a credible alternative, and that's harder than it sounds.

Turner told the Texas legislative committee that some large provider groups won't contract with new health plans, and that some asked for well above the going rate. A new plan needs those systems to meet network requirements, but it needs members to attract them, and employers want a broad network before moving members over. His testimony was that new entrants often rent a network from an incumbent, which can add roughly 30% to the rate. For employers, those barriers matter because they can make it harder for new plans to compete on equal footing with established players.

Curative's Cash Card came out of a practical version of this problem. Front-desk staff didn't recognize a new insurance brand, but providers already had card terminals and understood Visa. The card lets Curative pay an available cash price directly, often before the service, without a claims process. Turner testified that it can reach more than a million providers nationwide.

It doesn't always work. Turner also said hospitals accept the Cash Card most of the time, but some refuse, and that uncertainty is the safety net traditional networks still hold over employers. Employers want to guarantee that employees can use the hospital they know. That's why one alternative isn't enough. A plan needs several: another facility, direct payment, another provider relationship. Negotiated rates still matter.

The goal is a market where they face enough pressure to earn their place. The point isn't to route around uncompetitive prices forever. It's to create enough credible choice that providers have a reason to offer competitive prices in the first place.

Employers have a role too. Matt Robben of Serif Health told STAT that extreme pricing is a reason for the market to "vote with its feet," including by changing carriers.

What this changes for your budget and your people

When the cost of care keeps climbing, employers absorb it somewhere: the benefits budget, employee contributions, plan design, or other compensation. Putting pressure on price adds another option. For CFOs, that can mean a more credible cost strategy. For HR teams, it can mean fewer tradeoffs between affordability and employee experience. For employees, it means the plan handles the complexity.

None of this is about buying the cheapest care. Healthcare isn't office supplies. But treating a high price as untouchable because it sits inside a familiar network doesn't make sense either.

Five questions for your next health plan conversation

You don't need to become a pricing analyst. You do need to know what to ask the people managing your spend.

1. What can the plan do when it finds a price that doesn't make sense?

Make sure the answer goes beyond, “That’s our negotiated rate.” Can the plan identify a better option, help the member use it, or change how the care is paid for?

2. How many ways can the plan pay for care?

Network contracts matter, but they shouldn’t be the only option. Direct payment, alternative facilities, and other provider relationships can create more pressure on rates.

3. Is every hurdle there for a reason?

Prior authorization and similar controls should solve a specific problem. If a small number of facilities are driving the cost issue, can the plan focus there instead of creating friction everywhere?

4. Can the plan turn price data into something you can actually use?

Not a raw disclosure file or a discount off a chargemaster. Can it show where prices vary, which facilities are outliers, and what’s driving the difference?

5. Does the plan have enough leverage to create real competition?

Ask how it builds provider relationships, what alternatives it has when a provider demands an uncompetitive rate, and whether its network strategy gives it enough options to push back.

The shift

Utilization tools still matter. But if you've spent years working one side of the equation, the other side is waiting.

The choice isn't paying whatever the system asks or passing it on to employees. Better price data gives you a third option: steer care, remove unnecessary barriers, and buy care in more than one way.

So the question for your next renewal, RFP, or benefits strategy meeting isn't whether your plan has a transparency tool. It's whether it has a strategy for turning price information into leverage.