How to Solve One of the Most Expensive Problems in Employer Healthcare

Summary:

A small share of employees drives a disproportionate share of employer health-care spending: They are patients whose complex conditions go undiagnosed as they cycle through a fragmented care system. A diagnostic-focused “center of excellence” model—such as the Mayo Clinic Complex Care Program—offers a different approach: coordinated, multidisciplinary evaluations that identify the right diagnosis quickly. Evidence from employer claims shows that earlier, accurate diagnoses can improve outcomes, reduce unnecessary procedures, and lower costs by shifting care from repeated testing toward targeted treatment.

In 2019, Monte Leifheit, a warehouse operator at 3M, noticed his left eye was bloodshot and swollen. What began as a minor irritation turned into a yearlong medical odyssey marked by the lack of a diagnosis, ineffective treatments, and compounding side effects—all while costs escalated.

“I had some really low moments,” Leifheit recalls. “At one point I remember thinking, ‘If I die in my sleep, it would be better than the pain I’m dealing with.’”

Leifheit’s story illustrates a systemic failure in American healthcare, one rooted in unnecessary utilization, repeated visits, redundant tests, and delayed interventions that account for a disproportionate share of healthcare spending.

According to the Employee Benefit Research Institute, a small proportion of enrollees in an employers’ health plan account for a huge amount of annual spending by the plan and employees: The top 1% account for 29% of spending, the top 5% account for 57%, and the top 10% for 71%. A significant portion of this amount is spent on individuals with undiagnosed or complex conditions who are caught in fragmented care systems and are receiving care that may not address their underlying conditions.

For years, employers have looked to centers of excellence to contract directly with providers and manage costs for high-volume, high-cost procedures like joint, spine, or bariatric surgery. But for complex patients with undiagnosed conditions or unmanaged symptoms, a new center-of-excellence approach focuses on getting the right diagnosis through coordinated, multidisciplinary care. By compressing months of specialist visits and testing into days and utilizing employer-integrated benefit design, a diagnostic-first, center-of-excellence solution for complex, high-cost members can improve patient outcomes and health plan costs.

Cost Containment Through Precision Care

Human resources and benefits leaders have long worked to balance two goals: supporting employees’ health needs and responsibly managing plan resources on behalf of all members. To meet these obligations, employers have commonly used tools such as narrower networks and utilization‑management requirements, strategies built into most plan designs and widely deployed by health plans and third‑party administrators.

Yet for a small subset of members with complex or unresolved conditions, these traditional mechanisms may not address the core challenge: persistent diagnostic uncertainty that drives repeated visits, serial specialist consultations, and escalating costs. These individuals often experience fragmented evaluations and redundant testing, and many cannot easily access multidisciplinary expertise concentrated at academic medical centers due to travel logistics or cost-sharing barriers. In these situations, substantial spending may occur without bringing the member closer to a definitive answer or an effective treatment path.

Over the last seven years, Mayo Clinic has proven that the center-of-excellence model is a solution to this expensive problem. Its center of excellence—the Mayo Clinic Complex Care Program—provides a coordinated, multidisciplinary evaluation for patients with undiagnosed or complex conditions. Through collaboration among employers, payers, and brokers, high-risk individuals are identified, and the employer agrees to offer typical centers-of-excellence benefits such as travel and lodging support and waiving out-of-pocket costs when possible. (Based on federal tax rules, high-deductible health plans generally may not pay benefits until the minimum deductible is satisfied.) Members get answers and effective care, employers realize lower total costs, and local providers receive clear, evidence-based care plans to guide long-term management of these patients.

Quantifying the Impact

Lockton Companies’ clinical consulting practice, part of one of the world’s largest insurance brokerage and advisory firms, works directly with employer health plans to identify members with complex conditions who may benefit from subspecialized evaluations through the Mayo Clinic Complex Care Program. Lockton’s clinical team uses a rigorous methodology that combines claims analytics, medical history review, and clinical judgment to flag high-risk individuals. Importantly, the process is unique in that it is not passive; it involves proactive outreach, employer collaboration, and member engagement to ensure appropriate referrals.

This model ensures care is transitioned back to the patient’s home community, supporting long-term outcomes while minimizing disruption and cost. The model also fosters collaboration between Mayo Clinic specialists and community clinicians—a shared-care approach that benefits both patients and employers.

An analysis of three years of claims data from 12 employer clients that Lockton performed found that the approach saved an average of $98,571 per patient in Year 1 for 25 patients; $202,381 in Year 2 for 15 patients, and $100,437 in Year 3 for nine patients.

The analysis compared total claims from the patients six months before and after a Mayo Clinic evaluation (excluding the cost of visits to Mayo Clinic). The savings were driven by improved diagnostic accuracy, optimized treatment plans, and the elimination of unnecessary procedures. The most significant savings opportunities were observed in musculoskeletal, nervous system, immune, and endocrine conditions—areas where Lockton data shows misdiagnosis and overtreatment are common. The evaluation itself typically costs between $2,000 and $10,000, depending on the number of specialty consults and diagnostic tests required. Even after accounting for these program costs, the net savings remained substantial across all three years studied.

In one example, a 42-year-old employee experienced two years of escalating gastrointestinal symptoms, multiple emergency department visits, and five hospitalizations. Despite seeing seven specialists and undergoing extensive testing and surgical interventions, her condition remained undiagnosed. In 2023, when her condition was undiagnosed but she had no complications yet, her claims totaled $86,000. In the first 10 months of 2024, when she suffered increasing complications, her claims totaled $99,000. She reached out to her employer for help, which connected her to Lockton, and she was referred to the Mayo Clinic Complex Care Program. There she received a definitive diagnosis during her initial visit. Within five months of visiting Mayo, she had a targeted treatment plan and a surgical intervention that stabilized her condition and restored her quality of life. Lockton projects that the annual savings in this case alone (assuming her disease remains under control from the surgical intervention ) are up to $120,000. These findings indicate that when the correct diagnosis is made early in the patient’s journey, spending shifts away from ineffective or redundant care and toward interventions that create value for both employee and employer.

Leifheit’s Answers

Let’s return to Monte Leifheit, the patient we discussed at the beginning of this article. In late 2019, almost a year after he began seeking care for the swelling in his eye, he still didn’t have answers, and the steroids prescribed to reduce the swelling resulted in significant side effects. This included elevated blood sugar levels and a diabetes diagnosis, along with significant weight gain, worsening acid reflux and elevated blood pressure, leading to even more prescribed medications to manage those symptoms. A 3M occupational health nurse advised Leifheit of an employee benefit that would help him get care through the Mayo Clinic Complex Care Program. The program provided Leifheit with expedited scheduling at Mayo Clinic in Rochester, Minnesota, and 3M paid for his travel and lodging. A multidisciplinary team—which included specialists in general internal medicine, pulmonary medicine, rheumatology, ophthalmology, and hematology—coordinated his care.

A pathology review at Mayo Clinic revealed the culprit: sarcoidosis, a somewhat rare inflammatory disease often mistaken for other conditions. With the right diagnosis, Leifheit began tapering off the 15 medications he had relied on and adopted a new regimen of targeted therapy and lifestyle changes. Today, he has intentionally lost 40 pounds and takes far fewer medications.

“I feel better than I did before sarcoidosis,” says Leifheit. “This is now my life. I feel like I can do almost anything.”

Clear benefits for 3M and Other Employers

Since 2018, 3M, a self-insured employer, has offered the Mayo Clinic Complex Care Program to support its 50,000 U.S. employees and their dependents. In 2024:

62% of members referred to the Mayo Clinic Complex Care Program had a change in diagnosis
80% had a change made to their treatment plan
65% had a treatment plan that included a change in medication

3M employees in the program during the same timeframe saw an average of 3.5 specialists during evaluations at Mayo Clinic campuses in Arizona, Florida, or Minnesota. Two employees were spared unnecessary surgeries when Mayo Clinic specialists recommended alternative therapies.

Beyond 3M, a review of 4,409 Mayo Clinic Complex Care Program patients (2015–2024) by the Mayo Clinic’s Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery found that 51% received a change in diagnosis and 69% had substantive treatment modifications. In many cases, these changes in diagnosis and treatment translated directly into avoided procedures, reduced ER visits, and fewer hospitalizations.

For employers, the benefits of offering a center-of-excellence program focused on diagnostic accuracy for complex members are multidimensional:

Reduced healthcare spending by stopping waste
Better health outcomes and experiences for the most vulnerable employees
A differentiated benefit that drives employee retention, productivity, and equity in care access

While it may seem counterintuitive for a benefits strategy to focus on a small population, the impacts outlined here can be significant. A center-of-excellence program focused on high-cost claimants who receive the right expertise at the right time reflects a scalable, data-driven strategy for transforming care for a health plan’s complex members. As healthcare costs rise and more employers look to innovate in the benefits space, this unique diagnostic-focused, center-of-excellence model offers a compelling blueprint for improving outcomes while managing costs.

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