Employers are facing the largest increases in health insurance premiums in over a decade.
In the past, employers shared the yearly increase in premiums by absorbing a portion and passing the rest along as a premium increase to their employees. This practice offsets any increase in compensation that employees might have received and is viewed with dismay at open enrollment. But even this practice is not going to be enough for the increases that are projected for 2026.
MotivHealth is proving there’s a better way. The MotivAdvantage is a validated set of programs that help employers and employees combat rising costs instead of absorbing them.
How? By tackling some of the fastest-growing cost drivers and actively guiding members to high-value care options.
Employer health insurance costs are projected to rise nearly 10% in 2026—the steepest increase in over a decade.”
– Wall Street Journal, September 11, 2025
MotivHealth’s validated savings programs directly counter these pressures by reducing pharmacy costs, guiding care to lower-cost settings, and preventing improper payments.
With MotivHealth, employers gain a sustainable way to manage benefit costs while employees and their families feel cared for and see direct financial relief.
Driving Down Healthcare Costs:
A Validation of the MotivAdvantage
MotivHealth was founded with a clear purpose — to “spend less” on healthcare while preserving and even enhancing the member experience. Through its MotivAdvantage framework, the company has built an integrated program that combines:
- Innovative pharmacy solutions
- Proactive care navigation
- Reward programs that incentivize high-value decisions
- Rigorous payment integrity initiatives
The result is not just a promise of savings but a demonstrable impact on employer costs, member affordability, and health outcomes.
Independent actuarial validation conducted by strategic advisory firm Third Horizon illustrates these results. Leveraging actuarial standards and robust statistical methodologies, Third Horizon confirmed that MotivHealth’s approach delivers measurable and meaningful savings while ensuring members maintain access to high-quality care. This external validation provides employers with confidence that the solutions offered are not only innovative but also effective, sustainable, and backed by objective financial analysis.
Two of the fastest-growing drivers of healthcare cost are pharmacy spending and care provider selection.
Third Horizon analyzed data from MotivHealth alongside the Utah All-Payor Claims Database, assessing the financial impact of the MotivRx program and the SmartPay program. These are the anchors of the MotivAdvantage and are proven to bend the cost curve in ways that the traditional approaches to cost containment cannot.
MotivRx – Transforming Pharmacy Spending
Prescription drugs represent one of the fastest-growing drivers of healthcare costs, outpacing other categories of medical spending.
MotivRx directly addresses this challenge, producing a statistically significant 15.6% reduction in total medical and pharmacy costs compared to a control population. Third Horizon’s validation confirmed $753 in allowed cost savings per member per year (PMPY), alongside a notable reduction in prescription costs — with the average allowed cost per prescription coming in $25.58 lower than the control group. These savings were consistent across diverse chronic conditions, demonstrating that MotivRx is broadly impactful.
How do we do it? By providing concierge-level experience for every member spending more than $200 a month on medications. This spending unlocks a dedicated case review to uncover every available savings opportunity, involving the member and the clinician to ensure appropriate and financially sustainable care. Options explored may include:
- Therapeutic alternatives
- Patient assistance programs
- Manufacturer copay support
- International sourcing of medications
Beyond the numbers, MotivRx delivers long-term value by improving affordability, adherence, and trust. By lowering out-of-pocket costs, the program reduces the likelihood that patients will skip doses or abandon treatment due to financial barriers.
Employers benefit from healthier, more productive workforces, while employees and their families experience greater financial security and peace of mind. Together, these outcomes highlight MotivRx as a powerful example of how thoughtful innovation in pharmacy management can simultaneously improve health outcomes and bend the cost curve.
SmartPay: Engage, Educate, Reward
The cost of healthcare is notoriously inconsistent. The same procedure with identical outcomes can vary thousands of dollars in price depending on whether it is performed in a Hospital Outpatient Department (HOPD), an Ambulatory surgery center (ASC), or a clinic — with no difference in clinical quality.
SmartPay empowers members to make cost-effective choices. By sharing these cost differences transparently and rewarding members who choose lower-cost, in-network options, SmartPay helps employers control spending while directly benefiting employees.
The program engages an impressive 56% of targeted members, and each SmartPay event generates an average of $3,000 in savings. Members receive meaningful rewards, ranging from $100 to $3,000, which are deposited directly into their integrated MotivHSA accounts — reinforcing affordability and member engagement.
A conservative analysis by Third Horizon estimates that SmartPay may contribute up to 1% savings on total medical and pharmacy spend, a significant reduction given the scale of healthcare budgets.
Internal reporting further demonstrates the program’s measurable impact, showing a clear per member per month (PMPM) savings that is incorporated into underwriting and renewal decisions. This means SmartPay not only works on the ground but also influences how benefits are priced and sustained over time.
The key driver of these results is member behavior change. By exposing cost variation and coupling it with direct financial rewards, SmartPay shifts utilization away from higher-cost HOPDs and toward lower-cost alternatives. Actuarial validation confirmed that members enrolled in SmartPay are 12.6% less likely to use HOPDs compared to the Utah market baseline. Instead, they turn to ASCs and outpatient clinics, where the savings are substantial: procedures at ASCs cost on average 31% less, and outpatient clinics deliver an average 78% cost reduction compared to hospital outpatient settings.
SmartPay shows that when members are informed and rewarded for smarter choices, everyone benefits. Employers see lower medical costs, employees save money and earn rewards, and the more efficient providers gain patients. SmartPay turns unpredictable costs into sustainable savings and lasting impact.
Payment Integrity – Ensuring Network Value
Improper or inflated payments are a hidden but significant driver of rising costs. Claims errors, duplicate billing, and out-of-network overcharges can quietly erode employer budgets and compromise the overall value of a health plan. It’s difficult for employers and benefits managers to identify these issues without a partner like MotivHealth.
MotivHealth’s Payment Integrity Program tackles these errors head-on.
We apply advanced analytics, continuous monitoring, and rigorous auditing practices to ensure that every claim paid is accurate, appropriate, and aligned with contracted rates. This safeguards employer dollars while reinforcing the integrity of the provider network.
By leveraging AI-driven systems alongside clinical and financial audits, we’ve significantly reduced claim costs—delivering lower healthcare expenses and premiums to our clients.”
– Dale Lyman, EVP Network, Cost Containment & Point Solutions
The impact of this approach is both measurable and meaningful. Our studies show that Payment Integrity delivers an average of $23 per member per month (PMPM) in net savings, which flows directly to employers’ bottom lines.
Third Horizon Methodology
The validation study applied rigorous actuarial standards to ensure the credibility of its findings. Using claims data from both MotivHealth and the Utah All-Payer Claims Database (APCD) across the full 2022 and 2023 calendar years, researchers conducted detailed analyses of MotivHealth’s core programs. For the pharmacy program (MotivRx), a matched cohort analysis aligned MotivHealth members with comparable individuals in the APCD, accounting for demographics, chronic conditions, and plan type. This methodology allowed for a fair and statistically reliable comparison of prescription utilization and costs, demonstrating how MotivRx drives savings across diverse populations.
For the SmartPay program, analysts examined site-of-care distributions and cost variations, comparing procedures performed in hospital outpatient departments (HOPDs), ambulatory surgical centers (ASCs), and outpatient clinics. Where HOPD services were unavoidable, the study further distinguished between high-value, in-network hospitals and non-preferred facilities, highlighting the significant financial impact of price variability. This independent validation reinforces the reliability of the savings results and provides employers with confidence in MotivHealth’s ability to deliver measurable, sustainable value.
Strategic Implications
MotivHealth delivers proven results against the #1 challenge in healthcare: cost.
By targeting the key drivers of rising expenses, MotivHealth has reduced total medical and pharmacy spending by double-digit percentages, with savings validated through independent actuarial review.
This focus on affordability is not a short-term fix but a sustained outcome — reflected in consistently favorable renewal results for employers year over year. With a relentless emphasis on bending the cost curve, MotivHealth provides employers with a measurable path to long-term financial stability while ensuring employees and their families can access affordable care.
Conclusion
Affordable healthcare isn’t just possible— it’s happening now.
The actuarial validation of MotivHealth’s programs confirms what our clients already experience: targeted, data-driven strategies can meaningfully reduce total healthcare spending while improving access and outcomes.
By aligning incentives, promoting transparency and rewards, and applying proven methods across pharmacy management, site-of-care choices, and payment integrity, MotivHealth has created a durable framework for lasting savings.
In 2023, employers in CO, AZ, and UT spent an average of $6,300 per employee per year on healthcare. With MotivAvantage’s 17% savings, that cost drops to $5,229 – delivering over $1,000 in savings per employee per year.
This is not theory — it is measurable, independently validated impact.
As employers brace for continued cost escalation, MotivHealth offers a clear path forward: helping employers spend less, helping employees and families pay less, and ensuring that affordability and good healthcare remain within reach.