How Connecticut saved costs by steering employees to high-quality providers

Unwarranted variation in how care is delivered can lead state employee health plans to pay vastly different amounts for similar care, often driven by differences in provider practice patterns, locations where services are performed, and levels of care coordination. That can mean more follow-up visits than needed, avoidable emergency care and higher rates of inpatient admission – all of which raise costs without reliably improving outcomes. By addressing this variation, state and local leaders can reduce unnecessary spend and make it easier for employees and their families to access the right care in the right setting.

Provider choice can have a meaningful impact on both health outcomes and cost. Many employers use quality-based steerage to guide employees toward high-performing providers that emphasize preventive and appropriate care. Navigation and transparency programs, like Embold Health* and Quantum Health*, support members at the point of decision by helping them find in-network options, compare estimated out-of-pocket costs, identify high-quality settings and providers, and schedule care.

When done well, navigation reduces leakage, improves steerage to high-performing providers, and prevents redundant testing and consults. Together, these capabilities can create a cohesive experience that helps members compare high-quality options for planned procedures and understand expected costs. The result is a more reliable path to better outcomes and fewer avoidable costs.

The State of Connecticut’s experience

The State of Connecticut’s State Employee Health Plan (CT SEHP) deployed Embold Health’s solution for its 220,000 members, making it easier for them to select high-value providers for elective procedures and surgeries. Over time, program performance data highlighted a familiar reality: meaningful variation in costs and outcomes persisted across providers within the network.

When CT SEHP refreshed its program, Embold Health helped strengthen steerage through a “Providers of Distinction” program, pairing broad incentives with clear quality signals and simpler navigation.

By guiding members to higher-quality care, the State of Connecticut has achieved:

• Cost savings: The average cost of care from a Provider of Distinction was 25% lower than from a non-Provider of Distinction, translating to about $1,600 in savings per upper gastrointestinal procedure.

• High-quality care: For colonoscopies, utilization of Providers of Distinction increased from 21% to 32% after designations were introduced, leading to about $1,300 in savings per procedure.

• Better outcomes: Members who saw a Provider of Distinction were 61% less likely to have lower knee and hip replacements, alongside lower rates of opioid prescribing.

Steer-to-Quality: design and implementation considerations

Connecticut’s experience points to a few practical considerations for state and local health plans looking to make provider quality more visible and actionable for members. A successful steer-to-quality approach starts with clearly showing which providers deliver high-quality care and making it easy for members to access them.

When designing these programs, consider:

• Credible provider-level quality measurement: Use a transparent, clinically credible, risk-adjusted methodology to identify top-performing physicians (not just facilities or broad network tiers), aligned to procedure-driven outcomes and defensible to stakeholders.

• Copay differentials: Decide whether any differential applies to primary care, specialty care or procedure-driven episodes. Define whether it is a lower cost share in-designation and/or a high-cost share out-of-designation.

• Publication of data: Decide whether designations appear only in the provider directory/member experience or also published on public-facing state portals.

• Provider scoring methodology: Determine how quality outcomes, safety, experience and cost efficiency are weighted, and set minimum quality thresholds.

• Access-constrained geographies: Establish how to handle markets with limited supply of high-quality providers and consider allowing expanded lists or exceptions (for example, top-20% models or telehealth options) to help patients access services in care deserts.

When implementing these programs, consider:

• Seamless path to action: Pair quality designations with an easy member experience that helps members find, choose and schedule with top providers – ideally through centralized network integrated tools, like a “Provider Look Up” tool.

• Adoption-focused communications: Drive engagement through multichannel campaigns (including emails, mailers, webinars or short videos) that explain the “why,” address concerns, and show members exactly how to use the program.

If interested in helping guide members to high-quality care, start by asking:

1. How do we define “high-quality” providers? Can we see where these providers are by market and specialty?
2. Where is unwarranted variation or low-value care showing up most for our members? What is this costing us in spend or outcomes?
3. Are our current navigation tools changing member or provider behavior, or do they add friction?
4. Can we reliably guide members to the best care? Do we have clinical support to do that?
    

For other cost-containment strategies and SEHP resources, click here.

Morgan Health is a business unit of JPMorganChase Bank, N.A., focused on improving the quality, affordability and equity of employer-sponsored health care in the United States. Morgan Health holds a minority interest in Embold Health. This document is for informational purposes only and does not constitute investment, legal, tax, or financial advice.