One Percent of Employees Are Wrecking Your Health Plan. Here’s How to Stop It.

Every employer has that year.

One big cancer case. One premature baby. One surgery-gone-sideways.

Then BOOM—your renewal jumps 20%, and no one wants to talk about why.

But here’s the uncomfortable truth:
Just 1% of your employees are driving nearly a third of your total health care costs.

Next year, it’ll be a different 1%.
And if you're still trying to fix that by changing networks or tweaking copays, you're wasting your time.

Why This Keeps Happening

The data’s crystal clear:

• The top 1% of spenders account for 20–30% of all U.S. health care spending
• The top 5% account for over 50%
• Meanwhile, the bottom 50%? Just 3% of spending

Let that sink in.

You’re budgeting for everyone, but getting crushed by a handful. And no matter how many “wellness programs” or “utilization reviews” you run, you can’t predict who lands in that 1% next.

That’s what makes it dangerous.
It’s random.
It’s expensive.
And unless you do something different, you’re going to get hit again.

The Only Fix: Control What You Pay When Claims Happen

Let’s cut through the noise.

Claims drive cost.

And the only way to control claims is to control what you pay to providers when care happens.

Here’s how most employers operate:

• Insurance company "negotiates" rates behind closed doors
• You pay a percentage of… who knows what
• When a big claim hits, your costs explode
• Your renewal shows up with a double-digit hike
• You shop it out, raise deductibles, maybe switch carriers

Rinse. Repeat.

But that whole cycle misses the point.
If you’re not controlling the price of care, you’re not controlling anything.

Enter: Reference-Based Pricing (RBP)

RBP flips the script.

Instead of playing the hospital's pricing game, you say:

“We’re going to pay you a fair, benchmarked rate—based on Medicare plus a reasonable margin.”

No inflated sticker shock. No mystery billing. No blind negotiations.

Just simple, transparent payments based on actual data.

And you know what happens?

You finally get control over those 1% of high-cost claims.
You finally protect your budget.
You finally stop overpaying for the same care everyone else is getting—just with more markup.

What We’ve Seen Firsthand

I’ve been running our private benefits program for small and midsize businesses since 2013. Here’s what we’ve seen across the board:

• 📉 48% lower medical claims vs. national benchmark
• 🏥 59% lower inpatient
• 🧪 39% lower outpatient
• 👨‍⚕️ 50% lower office visits
• 💊 63% lower pharmacy
• 🔁 4% average renewal increases—often with no plan changes

It’s not a fluke.
It’s not “managed care.”
It’s a better system that puts you, the employer, back in control.

And most importantly—it protects you from getting nuked by the next lightning strike.

Let Me Be Real With You

You can’t control who gets sick.

You can’t see around corners.

But you can decide what you’re willing to pay when care happens.

If you're not doing that, then every year you're playing health care roulette. And eventually, it’s going to land on you.

Stop Playing Defense. Start Paying Smarter.

Want to see how RBP could protect your plan—and help you stop that 1% from wrecking your budget?

We’ll get you a custom quote. No fluff. No pressure. Just the real numbers.