As healthcare costs continue to rise, employers are exploring innovative ways to offer affordable, high-quality care. Our recent Best Practices in Healthcare Survey found that 41% of employers are considering or planning to adopt alternative plan design features, a number expected to grow to 87% by 2027.
Broad networks offer flexibility but often come with wide variability in cost and quality, leaving employees to navigate a complex system. Alternative plan designs, such as Surest, Coupe and SimplePay, aim to simplify the experience by guiding members to high-value providers through lower out-of-pocket costs and greater price transparency.
The concept of guiding members to select certain providers through plan design isn’t new; tiered plans have existed for decades. What’s different now is the technology and data powering a smarter, more user-friendly experience.
Today’s alternative plan designs benefit from advanced analytics that allow carriers to more accurately identify high-value providers and those delivering high-quality care at a fair price. Simultaneously, member-facing tools have evolved dramatically. These platforms now offer real-time, personalized information at the moment care decisions are being made, including clear, upfront, out-of-pocket costs.
This shift enables members to “shop” for healthcare in a way that mirrors how they make everyday decisions in the same way they shop for a product online or pick a restaurant. It’s a far cry from the earlier push toward consumerism, which relied heavily on high-deductible health plans but lacked the tools to support informed decision making. Alternative plan designs are bringing that vision to life, combining transparency, simplicity and smarter navigation to help members make better choices and access more affordable care.
When evaluating alternative plan designs, employers should assess two critical factors:
When choosing an alternative plan design, understanding how providers are rated and how those ratings influence plan tiers is essential. Employers should also consider whether members will have sufficient access to top-rated providers and whether any conflicts of interest exist in the evaluation process. Carefully reviewing these factors will help you find the option that best fits your organization’s needs.
Alternative health plans aren't one-size-fits-all. Success depends on aligning the plan design with a clear goal — whether it’s improving member experience, reducing costs, enhancing affordability or balancing all those priorities.
If the goal of offering an alternative plan design is cost savings, driving high enrollment is essential. Employers should avoid setting copays and contributions too low, as mispricing can shift savings back to employees through richer benefits and reduced contributions. In some cases, replacing one or more existing plans may be necessary to achieve meaningful enrollment and financial impact.
If affordability is the priority, offering the plan at a lower contribution rate can be especially appealing. Many employees, particularly lower-wage earners, tend to over-insure due to the high deductibles in traditional “cheapest” options. Copay-based plans with transparent pricing offer a simpler, more predictable alternative at a lower cost, helping employees feel more confident in their coverage decisions.
To evaluate the impact of an alternative plan design, employers should track:
Robust reporting and analytics are essential to monitor whether the plan is driving positive behavior change and delivering long-term value.
By carefully evaluating and implementing alternative plan designs, employers can offer cost-effective, copay-based plans on traditional broad networks. This approach not only guides members toward higher-value care but also enhances affordability and simplicity in healthcare.
