Multi-Location Retailer Identifies $800K in Network Leakage

The Challenge

This national retailer with locations across 12 states struggled with inconsistent healthcare costs between regions. Some markets were performing well below budget while others consistently exceeded projections, with no clear explanation from their current consultant.

Our Approach

Med-Vision performed a geo-access network analysis, mapping employee locations against provider networks, utilization patterns, and cost variations. We analyzed out-of-network utilization by service category and geography to pinpoint where leakage was occurring and why.

Key Findings

• 18% of high-cost claims were going out-of-network
• Three markets had inadequate in-network specialist coverage
• Employee awareness of in-network options was critically low in 5 regions
• Reference-based pricing could save 28% on facility fees in two markets

Results

Targeted employee education campaigns, network adequacy improvements in underserved markets, and a reference-based pricing pilot reduced out-of-network leakage by 60% within two quarters. The retailer identified $800K in annualized savings with minimal disruption to employee access.