Cutting Through Costs: Proven Cost-Containment Strategies Still Matter

Controlling medical claim costs has never been more complex. Rising claim severity, specialty drugs, private equity-backed providers and increasing regulatory scrutiny have made it harder for payors, brokers and TPAs to protect plans without creating friction or risk.

In this environment, cost containment isn't about chasing the newest tool. It's about applying the right expertise at the right moment.

That was the focus of a recent episode of The Granite List.Live, where HHC Group leaders joined the conversation to discuss what still works in cost containment and why human oversight remains essential.

On the episode, Bruce D. Roffé, President and CEO of H.H.C. Group and Bob Serber, Vice President, sat down with host Sally Pace to reflect on more than three decades of helping organizations manage high-cost medical claims.

Rather than focusing on theory, the discussion centered on practical lessons learned from thousands of negotiated claims and reviews. The takeaway was clear. While the healthcare landscape has changed, the fundamentals of fair, defensible cost containment have not.

One theme that surfaced repeatedly was assumption risk. Many organizations rely heavily on automation, PPO discounts or downstream dispute processes to catch problems after the fact. In reality, once a claim is paid, leverage is limited and savings opportunities are often gone.

The podcast highlighted why early intervention matters. High-dollar claims frequently contain billing practices that are technically compliant but still exceed what is fair or reasonable. Without experienced review, those charges move forward unchallenged and become permanent.

Cost containment works best when claims are reviewed proactively, not reactively.

During the conversation, Bruce and Bob discussed several strategies that continue to drive measurable savings when applied correctly.

Attorney-led negotiation remains critical for complex, high-dollar claims, especially when providers are sophisticated and well-resourced. Reference-based pricing provides a defensible structure when traditional discounts fall short. Independent Reviews support sound clinical decision-making and help reduce downstream risk.

Most importantly, these tools work best when guided by real people who understand billing, clinical context, contracts and negotiation dynamics. Technology supports the process but it does not replace judgment.

For H.H.C. Group, cost containment has never been about volume or shortcuts. It's about looking at claims closely, challenging assumptions and ensuring every payment is accurate, fair and defensible.

That approach has helped payors, brokers and TPAs protect plans through changing regulations, evolving provider behavior and rising claim severity. The podcast reinforces why that human-led model remains relevant today.

The strategies discussed on The Granite List.Live reinforce a simple truth. Cost containment works best when expertise is applied early, assumptions are challenged and real people drive the process.

If your current approach relies too heavily on automation, standard discounts or after-the-fact remedies, it may be time to take a closer look.

Listen to the episode to hear how experienced, human-led oversight continues to deliver measurable savings. Then consider whether your claims are being reviewed with the level of scrutiny today's environment demands.

Contact HHC Group today to discuss your high-cost claims strategy and share how proactive review and negotiation can help protect your clients and prevent missed savings.