Beyond Standard Cost Cutting: How Employers Can Change Healthcare Decisions

For years, employers have been searching for ways to reduce healthcare costs.

Many have adjusted deductibles, raised copays, and made changes to their benefit designs in hopes that employees would naturally make lower-cost healthcare choices. But as one panel at The Alliance’s 2026 Spring Symposium with Jake Nolin, Vice President of Human Resources at Rice Lake Weighing Systems and Melanie Schoenemann, Vice President, Business Growth & Member Strategy at The Alliance made clear, reducing healthcare spend isn’t just about changing plan design. It’s about changing behavior.

Learning how to change behavior starts with understanding what’s really preventing change.

Sometimes We Focus on the Wrong Problem

During World War II, the U.S. government faced a major challenge: how to preserve valuable meat supplies for soldiers overseas.

At the time, Europe was being ravaged by war, so food was in short supply. Meat on the homefront was rationed to ensure soldiers received the best cuts of meat. To help with the effort, the U.S. government launched an education and advertising campaign with posters, pamphlets, and lectures about nutrition and the benefits of eating organ meat. Homemakers listened but continued cooking the same meats they always had.

Despite clear reasoning, most people resisted.

Then policymakers tried something different. They brought in social psychologist Kurt Lewin who asked a different question, “What’s stopping them?” And that simple question changed everything.

He started by conducting interviews and observations, then created a new plan that focused on removing the barriers.

Removing the Barriers to Change

When you identify and reduce the barriers preventing change, people are more likely to make desired behavior choices.

Kurt Lewin identified five key barriers to behavior change:

• Telling people what to do doesn’t work. When people are pushed to do something, they push back.
• People are comfortable with the status quo. In this case, they enjoyed their steaks and didn’t want to give them up.
• The size of the ask was too large. Asking people to stop eating steak and instead eat brains or kidneys several times a week was too big of a change all at once.
• There was uncertainty. Homemakers didn’t know how to cook organ meats and were afraid of making a mistake.
• For some, it was a matter of status. Some felt organ meats were beneath them. They felt this type of meat was for lower-income families, not for them.

Once Kurt Lewin knew the barriers to change, he was able to address them by:

• Reducing uncertainty by making organ meat easier to find and providing cooking tips where the meats were sold.
• Decreasing the size of the ask by encouraging people to try organ meat occasionally. He suggested they incorporate it into familiar dishes, like a filler in meatloaf and sausage.
• Reducing attachment to the status quo. Instead of saying organ meat was good, he showed how sticking with old habits at home was hurting the troops abroad. This inspired people to do the desired behavior.
• Stopping lectures. He replaced “expert talks” with small group discussions. He asked homemakers for their opinions about how they could overcome the obstacles to cooking organ meat. Hearing how their peers solved similar problems provided evidence and normalized the change.

Applying this Framework to Healthcare Consumerism

This same approach can be applied to getting employees to choose high-value healthcare options.

Employees often:

• Feel pushed when employers tell them what to do, or where to get care
• Like to stick with the same doctors they’ve always used
• Resist big changes all at once
• Feel uncertain about going to a new provider
• Worry that lower cost means lower quality

They’re not being irrational; they’re just being human.

Employers can encourage behavior change by:

• Reducing uncertainty. Provide care navigation tools to make finding Preferred-Value Providers easier with detailed information, so people know what to expect.
• Decreasing the size of the ask. Ask employees to try one new provider for one service, not to change everything at once.
• Reducing attachment to the status quo. In healthcare, this means helping employees see how much staying with the same way of purchasing healthcare is quietly costing them, without blaming or shaming them.
• Stopping lectures. If you rely only on presentations, emails, and open enrollment meetings, employees may feel pushed and resist change. But if you set up open office hours to address questions and allow for employee discussion in meetings, they can hear how their peers navigated a new provider, tried a different option or worked through the same concerns. People are more likely to act when they feel ownership over the decision, rather than feeling dictated to.

Inertia is a Barrier to Behavior Change

Many employers think that if employees know a provider will save them money, they’ll make the switch. But behavior doesn’t work that way.

People often stick with the status quo, not because it’s the best option, but because it feels easier, safer, and more familiar. Roughly 70% of patients rely on physician referrals or prior habits rather than price or quality data when choosing specialists or hospitals.

This concept, often called status quo bias, is one of the biggest hidden cost drivers in healthcare.

Employees may continue using:

• The same doctor they’ve always seen
• The nearest hospital, regardless of cost
• A specialist recommended years ago
• A higher-cost provider they assume is “better”

Even when lower-cost, high-quality alternatives exist.

Why? Because changing providers can feel risky. Familiarity feels comfortable, even when it comes at a cost.

Rice Lake Weighing Systems: A Real-World Example of Behavior Change

Rice Lake Weighing Systems shared how they approached this challenge by focusing on workforce engagement, not just benefit plan design.

Rather than relying solely on cost-saving initiatives, Rice Lake worked to build understanding and buy-in among employees.

Their strategy centered on:

• Creating awareness: Helping employees understand the “why” behind healthcare decisions.
• Building trust: Demonstrating that lower-cost options can also mean high-quality care.
• Making better choices easier: Complexity is a barrier. Choices should take one to two steps to complete.
• Simplifying navigation: Providing guidance, navigation, and support at the point of care, so employees don’t have to figure out complex decisions alone.
• Asking, not telling: They framed conversations around options, not directives.
• Encouraging ownership: Instead of telling employees what to do, they created an environment where employees could actively participate in choosing high-value healthcare.
• Making savings visible: Rice Lake showed employees how much staying with their current providers was costing them and what they could personally save by switching.

This approach helped shift behavior because employees weren’t just being told what to do; they were becoming part of the solution.

Behavior Change Is the Real Opportunity

The WWII meat conservation story is a reminder that behavior rarely changes by telling people it should.

Whether encouraging wartime preservation or choosing high-value healthcare, the principle is the same: people support what they help create.

For employers, this means the path to lower healthcare costs isn’t just about building better benefit plans.

It’s about helping employees feel informed, empowered, and invested in making better decisions.

Ready to move beyond standard cost cutting? Schedule a consultation to learn how The Alliance can help you drive smarter healthcare decisions and connect your employees to high-value healthcare.