Reducing healthcare costs. Expanding access to cross-border care.
Challenge
A municipality employer was looking for ways to improve healthcare affordability while maintaining access to quality care for employees and dependents. Like many municipality employers with geographically diverse populations and rising healthcare utilization, increasing healthcare costs and limited access to affordable services continued to place pressure on both the health plan and employees.
The organization needed a solution that could create meaningful healthcare savings opportunities without disrupting member access to care or reducing benefit quality.
Solution
Pinnacle implemented a cross-border healthcare strategy through its Mexico Cross-Border Program, helping eligible members access lower-cost healthcare services, preventive care, diagnostics, dental services, and office visits through participating providers in Mexico.
The analysis compared U.S. claims data against Mexico-based claims across hundreds of comparable procedure codes to identify cost savings opportunities and utilization trends.
Working closely with the employer, Pinnacle helped:
- Expand access to lower-cost healthcare services
- Reduce overall healthcare spend
- Improve affordability for employees and dependents
- Support preventive and routine care utilization
- Deliver savings without major plan disruption
Highlight Stats
- 655 comparable procedure codes analyzed
- 25,089 U.S. claims reviewed
- 9,504 Mexico claims reviewed
- Office visits averaged ~87% lower cost through the Mexico Program
- Vision services averaged ~87% lower cost
- Dental services averaged ~75% lower cost
- Diagnostic services averaged ~54% lower cost
- Mammograms averaged ~63% lower cost
- Colonoscopies averaged ~35% lower cost
- Outpatient procedures averaged ~70% lower cost
Results
Reduced healthcare costs through cross-border care access
By leveraging the Mexico Cross-Border Program, Pinnacle helped create substantial savings opportunities across routine healthcare services, diagnostics, office visits, dental care, and preventive services.
Delivered significantly lower office visit and preventive care costs
The analysis showed office visits through the Mexico Program averaged approximately 87% lower cost compared to equivalent U.S. claims, creating meaningful affordability improvements for both employees and the health plan.
Improved affordability across multiple categories of care
The program generated savings opportunities across a wide range of services, including:
- Dental services averaging approximately 75% lower cost
- Vision services averaging approximately 87% lower cost
- Diagnostic services averaging approximately 54% lower cost
- Mammograms averaging approximately 63% lower cost
Expanded access to cost-effective healthcare options
Through strategic cross-border provider access, Pinnacle helped this municipality employer create additional affordable care pathways while maintaining employee access to quality healthcare services.
See what Pinnacle Health Solutions can do for you
Reach out to learn how Pinnacle helps municipality employers reduce healthcare costs through innovative cross-border healthcare solutions.
