Smarter cost strategies. Lower healthcare spend.
Challenge
A transportation employer with 258 covered lives and 210 employees, was facing rising healthcare costs driven by high billed charges and increasing claim complexity across inpatient, outpatient, and professional services.
Like many transportation employers with geographically dispersed workforces, maintaining affordable healthcare benefits while controlling long-term healthcare spend had become increasingly challenging. The organization needed a strategy that could meaningfully reduce claim costs without increasing member disruption or creating balance billing concerns for employees.
Solution
Pinnacle partnered with Fairos to implement a Reference-Based Pricing (RBP) and cost containment strategy focused on reducing excessive provider charges while maintaining employee access to care.
The program leveraged Medicare-based reimbursement methodologies and advanced claim negotiation strategies to lower overall healthcare costs across multiple care settings.
Working closely with the employer, Pinnacle helped:
- Reduce excessive billed charges
- Improve claim payment efficiency
- Minimize employee balance billing exposure
- Support nationwide provider access
- Deliver savings across inpatient, outpatient, and professional claims
- Improve overall healthcare cost transparency
The strategy allowed the transportation company to gain stronger control over healthcare spend while continuing to provide competitive employee benefits.
Highlight Stats
- 258 total covered lives
- 210 employees
- 289 claims processed
- $2.7M total billed charges reviewed
- 84.0% savings off billed charges
- 128.4% average effective Medicare reimbursement
- 0.0% balance bill rate
- 75 unique providers utilized
- 62 utilizing members analyzed
Results
Reduced healthcare spend through Reference-Based Pricing
Through Fairos RBP and enhanced cost containment strategies, Pinnacle helped the organization reduce healthcare costs by approximately 84% off billed charges, generating more than $2.27 million in savings between October 2025 and May 2026.
Eliminated member balance billing exposure
Despite significant healthcare savings, the program maintained a 0.0% balance bill rate, helping protect employees from unexpected provider balance bills and reducing disruption to the member experience.
Delivered savings across multiple care settings
The program generated savings across inpatient, outpatient, and professional claims, with inpatient services representing approximately 60.7% of total allowed amounts.
Improved healthcare cost management and transparency
Using Medicare-based pricing methodologies and advanced claim negotiation strategies, Pinnacle helped improve healthcare cost predictability and transparency while maintaining broad provider access across multiple states and provider systems.
See what Pinnacle Health Solutions can do for you
Reach out to learn how Pinnacle helps transportation employers reduce healthcare costs through Reference-Based Pricing and advanced cost containment strategies.
