Cost & Quality
For a self-funded employer, the provider network is not just a list of doctors—it is the primary driver of the plan’s financial performance and the legal safety of the company’s leadership. Because self-funded employers pay for every claim directly, the “cost and quality” of the network are the two most powerful levers they have to control their spend. HealthCareTN can show employers where to look for low value care opportunities to eliminate and high value care opportunities to implement.
Why do cost and quality matter?
Case Study: Emergency Department Overutilization
66%
Approximately two-thirds of all ED visits for commercially insured individuals are for conditions that are treatable in a primary care or urgent care setting.
24%
24% of adults who used the ED in 2025 resulted in “non-urgent” diagnoses, such as minor coughs, sore throats, or skin rashes.
25.9%
Tennessee consistently sees higher-than-average ED utilization, on average 25.9% higher than other states.
Even commercially insured patients get caught in the double trap; copays are typically higher in emergency departments, and the coinsurance cost more because facilities fees are much higher.
Plans using effective Advanced Primary Care experience a 15% to 17% reduction in emergency room visits.
A single ER visit for a self-insured employer averages $2,000–$3,000. HCTN promotes APC models that employers can deploy.
Value Happens When Employers Work Together
Your voice is important. Combined with other employers, it is unstoppable.