Key Highlights
Want to Win More Renewals? Start With These 4 Cost-Cutting Tactics
Let’s face it—no one’s really "controlling" healthcare costs right now.
With employers anticipating 2026 to once again have the biggest healthcare cost increases in over a decade, brokers are under more pressure than ever to bring real, measurable savings to the table. Employers are frustrated. CFOs are demanding solutions. And the old playbook to “tweak the deductible and hope for the best” just isn’t cutting it anymore.
The challenge? Helping employers rein in healthcare spending without gutting benefits or sparking employee backlash.
The good news? There are proven, data-backed strategies that are helping brokers and employers get tangible results. These aren’t one-size-fits-all solutions. They’re practical, scalable tactics that reduce waste, improve outcomes, and keep companies compliant.
Here are four ways SISCO can help you cut costs and stay competitive this year and beyond.
1. Make Sure You’re Not Paying for People You Shouldn’t Be
Eligibility Audits: A Fast, Low-Investment Way to Cut Costs
If you haven’t done a dependent eligibility audit recently, you’re probably paying for people who shouldn’t be on your plan. Eligibility status can quickly change based on marital status, children’s age, and job changes that affect benefits. And dependents, including spouses and children, can be among the most expensive members of your plan.
On average, 4%–8% of dependents on employer-sponsored plans are not eligible for the medical benefits they receive.
Considering that the average annual claim cost to the employer for each dependent is $3,850, the math is clear. A plan with 1,000 covered employees is spending between $154,000 and $308,000 per year on ineligible participants. That’s a significant financial drain and a compliance risk.
The worst time to identify a dependent who doesn’t qualify for coverage is when there’s a significant medical claim. Conducting regular eligibility audits helps you:
Making Eligibility Audits Easy for HR Teams
HR teams are pushed to the max with responsibilities. SISCO’s expertise is in doing all the heavy lifting by asking the tough, but necessary, questions to determine eligibility for employees and their dependents.
And we’ve mastered the process for efficient and effective eligibility audits. Over the past several years, SISCO has saved our clients an estimated $33.6 million dollars by identifying ineligible dependents. How much could your company save?
Employers can no longer afford to overlook eligibility audits as part of their benefit plan management given the potential expense and cost exposure of covering ineligible dependents.
Right now is the best time to protect your plan. Start your eligibility audit with SISCO today.
2. Manage Chronic Conditions—Relentlessly
Condition Management: The Most Profound Way to Control Healthcare Spend
If you’re not managing chronic conditions, you’re not managing healthcare costs. Nearly half of U.S. adults have high blood pressure, with annual medical costs $2,759 higher than people without high blood pressure. And affecting 38 million people, diabetes is the most expensive chronic condition in the nation, accounting for $1 out of every $4 in healthcare costs.
Chronic conditions collectively account for up to 80% of employer healthcare spend, and members with these conditions cost 2.2 to 5.5 times more than those without.
Yet, most employers’ condition management programs rely on voluntary sign up and participation. If your most at-risk employees aren’t engaged, your company’s health plan costs can skyrocket.
That’s why a proactive, personalized approach to condition management isn’t a “nice to have” tactic, but rather a “must have” for any effective cost containment strategy.
Smart Identification and Automatic Enrollment
Traditional programs that rely on voluntary sign-ups only reach 20%–40% of eligible members. Our data-driven approach automatically identifies and enrolls 100% of eligible employees based on:
Why does this make a difference? We reach the right people at the right time for you, even if they were not previously engaged with condition management services on their own.
Personalized, Persistent Clinical Support
Everyone wants an expert in their corner when it comes to navigating an ongoing condition. Each member enrolled in our condition management program is paired with a dedicated nurse who helps them:
Technology That Drives Engagement
Our mobile app is the digital backbone of our condition management program. It empowers members with access at their fingertips to:
Flexible Rewards That Motivate
We’ve seen it firsthand: Incentivized wellness programs increase compliance by 29% and save companies an average of $2,490 per member per year. Flexible rewards can include HSA/HRA contributions, insurance premium discounts, or gift cards.
Proven Condition Management Results
Our clients have saved $2,000–$4,700 per compliant member annually, with compliance rates reaching 75%–95%, far exceeding the national average. By combining clinical expertise, smart technology, and meaningful incentives, our condition management program helps employers significantly reduce costs while improving employee health.
Download this free checklist with four ways to evaluate your chronic condition management program.
3. Help Employees Choose Better Healthcare at Lower Costs
When employees don’t understand their benefits, they make costly decisions. They may choose out-of-network providers or have unnecessary procedures.
Our advocacy program changes that. By educating members on their available benefits, provider and treatment choices, and cost-conscious options, the program helps them make informed decisions that keep plan costs in check.
And it works: 30% of members who use our advocacy services choose less invasive or complex procedures, reducing costs while receiving evidence-based care.
Expert Navigation, Real-Time Support
Our convenient mobile app gives employees a single point of contact for concierge-style support—helping them find in-network providers, understand deductibles, and access their benefits in real time.
Support for HR Teams
HR departments are stretched thin. Our advocacy program acts as an extension of your HR team, handling routine questions and requests so your staff can focus on strategic priorities. One client saved their HR team over 700 hours of work previously spent fielding healthcare questions by using the advocacy program.
Incentives That Drive Engagement
An advocacy program is only as good as the incentives that drive members to use it. With shared savings models and custom incentive strategies, our clients see a 340% ROI. Using advocacy services, employers can align employee behavior and choices with cost-saving goals. Member incentives provide maximum value, creating a win-win for everyone and supporting broader employee benefits cost savings.
4. Rethink the Way You Pay for Healthcare
Alternate Plan Models: Flexibility and Savings Without Shifting Costs to Employees
Sometimes, thinking outside the box offers better solutions. For employers ready to rethink traditional coverage, self-funded healthcare plans and reference-based pricing offer flexibility and long-term savings.
As an independent third-party administrator (TPA), SISCO offers integrated claims management and expert adjudication—keeping auto-adjudication below 25%. Our licensed call center connects members with experienced agents for fast, accurate service, with 91% of calls resolved in just six minutes.
Self-Funded Models
With the peace of mind delivered by SISCO's guidance, employers can design tailored plans and manage their own claims using self-funded plan models. These plans offer greater control and transparency while avoiding state regulatory burdens.
Though self-funded plans are complex, SISCO simplifies the process, helping manage predictable costs, optimize plan design, and control volatile risk through stop-loss coverage. Learn how one client reduced annual healthcare costs by 35% in just one year with SISCO.
Reference-Based Pricing Without the Pain
Reference-based pricing, or RBP, is a cost containment model used by self-funded employers that sets fair prices for specific medical services or procedures based on a percentage of Medicare rates.
Traditional preferred provider organizations (PPOs) provide a standard discount on already inflated medical costs. RBP flips the model—determining a fair, reasonable cost for treatment while often eliminating restrictive provider networks.
Many RBP models have open access to providers with no networks and no limits on where members can seek care. When a claim is submitted, the plan pays a percentage of the predetermined benchmark, such as the Medicare reimbursement rate.
Reference-based pricing doesn’t need to feel risky with SISCO’s reimagined approach:
If you’re looking for sustainable cost savings, these alternate plan modeling options are effective and growing options.
Reach Out to SISCO for Help
SISCO helps self-funded employers take control of healthcare costs—without compromising care or employee experience.
We don’t just offer third-party administration (TPA) services—we deliver strategic, results-driven solutions that address the biggest cost drivers in your health plan. In this article, we’ve highlighted four of the most effective tactics our clients use to reduce spending and improve outcomes:
These are just a few of the ways SISCO helps employers build a healthier workforce and a more sustainable, affordable benefits strategy. Whether you’re looking to optimize your current plan or rethink your entire benefits approach, we’re here to help.
Let’s Talk Strategy
Ready to reduce healthcare costs without cutting benefits? Don’t wait for costs to climb even higher—book a 20-minutes strategy session before the busy renewal season.