Rising healthcare costs and underutilized benefits continue to challenge HR leaders and employers. Despite significant investment in health plans, many employees either don’t fully understand their benefits or struggle to navigate them efficiently—leading to unnecessary costs, underutilized programs, and wasted budgets.

At Fijoya, we’ve identified three key strategies that can help employers contain costs while improving benefits utilization:

1. Health Plan Steerage & Navigation

One of the most effective ways to cut unnecessary costs is by guiding employees toward the right care at the right time. Many employees unknowingly opt for high-cost medical services when more affordable and appropriate alternatives exist.

📌 Example: Avoidable ER Visits

• 66% of emergency room (ER) visits among privately insured individuals are avoidable¹.
• Treating primary-care conditions at the ER costs $2,032 per visit, compared to just $167 at a physician’s office or $193 at urgent care¹.
• Savings Potential: A company with 10,000 employees could save $2.1M annually by guiding employees toward appropriate care settings².

🚀 How Fijoya Helps:

• Our AI-powered assistant steers employees toward in-network, lower-cost providers for non-urgent care - whether through primary care, telehealth, or dedicated benefits programs.

📌 Example: In-Network vs. Out-of-Network Costs

Many employees unintentionally visit out-of-network providers, leading to significantly higher costs.

• 7 in 10 who received out-of-network bills didn’t know the provider was out of network³.
• 18.2% of psychotherapy visits are out-of-network, costing employers an additional cost of $150 per visit on average⁴ 
• Savings Potential: A 10,000-employee company could save ~$200K per year by directing employees toward in-network psychotherapy options⁴

🚀 How Fijoya Helps:

• Our AI assistant encourages employees to check in-network providers before scheduling an appointment.
• It provides expected cost estimates for out-of-network visits, helping employees make informed choices and reducing employer spend.

2. Reducing Point Solution Waste (PEPM Costs)

Many employers invest in point solutions (wellness programs, telehealth, mental health services) but face low utilization rates. The per-employee, per-month (PEPM) model often leads to wasted budgets when employees don’t take advantage of these offerings.

📌 Example: Low Utilization of Mental Health Benefits

• Traditional PEPM models result in low utilization (<10%), meaning most of the budget goes unused.

🚀 How Fijoya Helps:

• Our Marketplace model shifts from a fixed PEPM to a utilization-based approach, ensuring funds are only spent when employees engage with services.
• Savings Potential: A company with 10,000 employees spending $10 PEPM on wellness benefits could recover $240K per year by reallocating unused funds⁵.

3. Boosting HR & Employee Productivity

HR teams spend countless hours answering benefits-related questions, while employees waste time navigating complex benefits structures. This administrative burden affects both HR efficiency and employee productivity.

📌 Example: Time Lost on Benefits Navigation

• HR professionals spend 39% of their time handling benefits-related inquiries⁶.
• Employees spend 53% of time dealing with health insurance and administration while at work⁷.
• Savings Potential: A 10,000-employee company could save $1.5M in HR admin costs and employee time lost by streamlining benefits communication^7,8.

🚀 How Fijoya Helps:

• Our AI assistant reduces HR workload by answering benefits questions and guiding employees to the right resources.
• Our automated benefits navigation ensures employees find the right programs faster, reducing frustration and boosting engagement.

The Bottom Line: A Smarter Approach to Benefits Cost Containment

By addressing health plan navigation, in-network steerage, point solution waste, and administrative inefficiencies, employers can significantly reduce costs while improving employee benefits engagement.

📌 Summarized Savings Potential for a 10K-Employee Company annual savings:

• Health Plan Navigation Savings (ER only) - $2.1M
• In-Network Steerage Savings (psychology, primary care) - $400K
• Point Solution Savings - $240K
• HR & Employee Productivity Gains - $1.5M

Total Savings Potential: $4.25M

💡 Want to see how Fijoya can help your company cut costs while enhancing benefits engagement?
📩 Visit Fijoya.io or contact us at contact@fijoya.io to book a demo today!

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1. United Health
2. Calculated based on Health System Tracker Org
3. KFF org
4. Managed Healthcare Executive, The Health Affair
5. Fijoya analysis
6. Fijoya HR Professionals Survey, 2025
7. Academy of Management Discoveries 
8. Fijoya calculation based on Bureau of Labor Statistics

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