Healthcare as a Consumer Product: Navigating the System with Price and Quality in Mind | Employee Benefits

June 2nd, 2025

Louis C. Bernardi, “The Benefits Whisperer”

💥 Certified Healthcare Fiduciary Coach and Health Value Advisor 💥 I work with Business Leaders of mid-sized

Did you know that optimizing your healthcare plan can contribute directly to your company’s survival and growth?  ✨ When we compare the benefits of healthcare savings to findings from a recent college essay, “Ten Reasons Why Companies Keep Failing,” the connections are clear. Let’s explore how healthcare optimization addresses these pitfalls:

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The healthcare system often feels like a maze, where confusion reigns and the cost of care seems arbitrary. Plan sponsors and employees alike are often left feeling powerless, uncertain of how to navigate this complex world. But what if it didn’t have to be that way? What if you had the same tools and resources to make informed decisions about healthcare that you use for every other purchase in life—price and quality?

The truth is, navigating healthcare doesn’t need to be difficult. It’s about approaching it the same way we approach every other consumer decision: by understanding both the price and the quality. If health systems (hospital networks) and insurers lived up to the promises in their mission statements, this would already be a reality.

Empowering the Consumer

Most of us would never buy a car without checking the price, reading reviews, and ensuring it fits our needs. The same logic applies to healthcare. With the right tools, plan sponsors and their employees can make smarter healthcare decisions that not only improve care outcomes but also reduce costs.

Price Transparency: The First Step

Just like shopping for any major purchase, understanding how much things cost is the first step. Yet, in healthcare, price transparency has often been elusive. Many plan sponsors and members don’t realize that the cost of a procedure, test, or medication can vary significantly from one provider to another. This variation can be as high as 300% for the same service, depending on the provider, location, and payment model.

If health systems and insurers were genuinely transparent, this disparity would be eliminated. Price transparency would not be a luxury or an afterthought—it would be standard practice. Unfortunately, many insurers and health systems continue to hide behind opaque pricing models and complex billing systems. That leaves consumers in the dark, unable to make informed decisions about the care they need.

However, tools and resources already exist today that can help plan sponsors build high-performance health plans. These tools include apps, websites, and people support systems that guide members throughout their healthcare journey. Transparency in pricing is no longer just a hope—it is now a requirement, with regulations mandating the release of data from all payers and providers.

The Data Advantage

The amount of data being released is significant and complex, but it’s designed to empower the consumer. It took technology experts to design tools that are consumer-friendly and leverage this vast amount of data. Some tools even use AI to help consumers understand their benefit plans, out-of-pocket costs, and identify providers who deliver the highest level of care.

These tools don’t just rely on reputation or Google reviews—they are based on data evidence that shows which providers consistently ensure the best outcomes for patients and adhere to higher standards of appropriate care. Consumers now have the ability to shop for care just like any other purchase: by comparing not only price but also quality, ensuring that they make the best decisions for both their health and their financial well-being.

Quality Matters, Too

Price is just one part of the equation. The other—often overlooked—is quality. In healthcare, knowing the quality of care you’re receiving can feel like a mystery. But in today’s world, quality is measurable. Resources like patient reviews, outcome data, and certification systems allow consumers to assess the effectiveness of a provider before making a decision.

If insurers and health systems truly prioritized patient outcomes, this quality information would be readily available and easy to understand. But instead, consumers often find themselves relying on word of mouth or incomplete data when trying to make informed decisions. Quality should be just as transparent as price—ensuring that patients receive not only affordable care but the best possible care.

As a plan sponsor, empowering your employees with access to these tools not only leads to better healthcare choices but also strengthens your company’s bottom line by reducing unnecessary or low-quality care. Encouraging employees to seek high-quality care providers ensures they’re getting the best results for their health, while avoiding wasteful spending on treatments or procedures that don’t work.

Avoiding Unnecessary Out-of-Pocket Costs

Out-of-pocket costs can be a significant burden for employees, but many of these costs are avoidable. The key is awareness—knowing where to go, what to ask for, and how to leverage health plan benefits effectively. Tools like healthcare navigators, second-opinion services, and telemedicine can provide guidance, help avoid unnecessary visits, and reduce the number of avoidable expenses that often occur when employees don’t know where to turn for care.

What You Can Do Today

As a plan sponsor, there are several steps you can take to empower your employees with the tools to make smarter healthcare decisions:

Promote Price Transparency: Work with your health plan partners to provide employees with price comparison tools and information on expected costs.
Leverage Quality Data: Ensure employees have access to provider reviews, quality scores, and outcome data so they can make informed decisions about their care.
Encourage Preventive Care: Help employees understand how proactive, preventive care can reduce long-term healthcare costs by preventing more expensive treatments down the road.
Support Decision-Making Tools: Introduce resources like healthcare navigators or telemedicine services to help employees make more informed choices without incurring extra costs.

Don’t Wait for Insurers and Health Systems to Catch Up

Here’s the hard truth: If plan sponsors and members continue waiting for health systems and insurers to implement these changes, they’d likely wait a very long time. The reality is that both insurers and health systems have repeatedly shown, through their actions, that they place profits before people. Their business models are built around maintaining the status quo—keeping pricing opaque, discouraging competition, and limiting transparency to preserve their margins.

That’s why it’s time for plan sponsors and employees to take control. Price and quality transparency should not be optional—it is a supplement to healthcare and insurance, one that ensures consumers get the most out of their healthcare and insurance investments. Empowering employees with the right tools to navigate the healthcare system is the only way to bridge the gap between what’s promised and what’s delivered.

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