When the cost of care rises beyond what families and employers can reasonably manage, it creates real strain on household budgets, businesses, and on access to timely treatment. Today’s pressures reflect system-wide trends: rising hospital and physician prices, increased utilization, and growing prescription drug costs that are affecting every coverage market and every health plan.
No single organization can solve this alone. Lowering the cost of healthcare requires shared responsibility, practical reforms, and sustained collaboration across the healthcare system.
We recognize that responsibility includes us, and we are taking action. Here are a few examples of how we’re addressing healthcare costs.
Focusing on value, not volume
Aligning care provider incentives around outcomes is one of the most effective ways to lower costs over time. To that end, our value-based care arrangements reward providers for better outcomes, prevention, and coordination rather than the number of services delivered.
Reducing avoidable utilization
Through care management, advocacy, and navigation programs, we support more than seven million people in managing chronic conditions and closing gaps in care. This helps reduce preventable ER visits and hospitalizations as national utilization continues to rise.
Shifting care to appropriate, lower-cost settings
We promote care in the right setting at the right time, including virtual care and alternatives to hospital-based services when clinically appropriate.
Improving outcomes to lower long-term costs
Through our value-based cancer care program, we decreased year-over-year inpatient utilization among members with cancer by over 14% and year-over-year emergency department visits by 8% compared to pre-program levels.*
Streamlining administration and reducing waste
Since January 1, 2024, we have removed prior authorization requirements for more than 400 services and procedures, with prior authorization now applying to only about 3% of claims. We’ve also expanded electronic prior authorization and automation which is reducing denials and administrative rework.
Supporting meaningful policy reform
Public policy plays an important role in healthcare costs. We support:
- Greater hospital price transparency and accurate site-of-care billing practices.
- Requirements for unique National Provider Identifiers tied to site of service.
- Improvements to the No Surprises Act IDR process, where case volumes have exceeded expectations and added cost pressures.
- Continued expansion of telehealth.
- Policies that promote competition, innovation, and pricing tied to clinical value, especially for prescription drugs.
Lowering the total cost of healthcare will not be solved by one action or one group. But as we work together — plans, providers, employers, policymakers, and brokers — we are making meaningful progress.
* Carelon Insights Oncology TCOC Analytics Readout January 2026