documented results

The Numbers Behind the Framework

These are not projections built on favorable assumptions. They are documented outcomes from employers who replaced their renewal cycle with a governed alternative.

$11,048.64 Per Employee Per Year.

The Industry Average Is $17,000.

The 2026 employer healthcare benchmark is $17,000 per employee per year, based on Aon's current projections. A recent client operating under Scott's Advanced Benefit Design framework reached their fourth-year renewal at $11,048.64 PEPY. The mechanism is not a better deal from the same carrier. It is the elimination of the embedded revenue layers that were driving the number in the first place.

128-Employee Group — Fourth-Year Renewal

A mid-market employer on a legacy fully insured plan engaged Scott's Advanced Benefit Design framework ahead of their renewal cycle. After four years of fiduciary-governed plan restructuring — including independent TPA selection, PBM reform, stop-loss optimization, and billing audit — the group reached fourth-year renewal at $11,048.64 per employee per year.

• Employees covered: 128
• PEPY at fourth-year renewal: $11,048.64
• 2026 industry average PEPY: $17,000 (Aon)
• Annual savings differential: $761,774
• Primary savings mechanisms: PBM reform, stop-loss restructuring, billing audit recovery, vendor economics restructuring

260-Employee Prospect — Cost Modeling Report Findings

Before a single plan change was implemented, the Cost Modeling Report produced for a 260-employee employer identified $3.4 million in recoverable spend over 36 months. The report used the employer's actual 24 months of claims data — not industry averages or actuarial estimates.

• Employees covered: 260
• Modeled savings over 36 months: $3.4 million
• Source: Cost Modeling Report, produced at the $6,000 engagement fee stage
• Status: Pre-implementation — savings modeled before any plan restructuring began

Global Call Center Services — Dallas, TX

A 1,230-employee multi-state employer under private equity ownership engaged Scott's Advanced Benefit Design framework with a mandate to reduce operational expense without compromising employee benefits. Leadership exited their existing fully insured plan eight months early to accelerate savings capture.

• Employees covered: 1,230
• Documented savings: $2.6 million
• Prior plan: Fully insured, conventional carrier
• Primary savings mechanisms: Vendor economics restructuring, embedded revenue layer elimination, independent plan redesign

Healthcare EHR Software & Services — Pittsburgh, PA

A 440-employee multi-state employer facing a specialty Rx cost crisis that traditional carrier solutions could not address. Leadership ruled out shifting costs to employees through benefit reductions or payroll contribution increases — the engagement was structured to find savings inside the plan, not transfer them to the workforce.

• Employees covered: 440
• Documented savings: $2.1 million
• Prior plan: Fully insured, conventional carrier
• Primary savings mechanisms: Specialty pharmacy cost containment, PBM reform, independent plan restructuring

Marketing & Software Solutions — Chicago, IL

A 450-employee multi-state employer whose leadership had reached the limit of price-blind buying — an outdated plan structure stacked against the employer's financial interest with no independent fiduciary oversight in place. The engagement goal was sustainably lower plan costs, elimination of conflicts of interest, and rational healthcare procurement going forward.

• Employees covered: 450
• Documented savings: $900,000
• Prior plan: Self-insured with conventional carrier administration
• Primary savings mechanisms: Conflict of interest elimination, independent vendor selection, governance restructuring

Automotive Retail Services — Tucson, AZ

An 850-employee employer growing through acquisitions needed a plan structure that could absorb organizational change without the added expense and loss of control that comes with fully insured carrier arrangements. The engagement was structured around growth synergies and a governance model that would scale with the business.

• Employees covered: 850
• Documented savings: $1.1 million
• Prior plan: Fully insured, conventional carrier
• Primary savings mechanisms: Fully insured cost elimination, independent plan design, governance framework built for acquisition growth

Claims Re-Adjudication — Individual Billing Recoveries

Healthcare billing audit and claims re-adjudication recover overpayments that accumulate silently inside every plan. Two recent examples from Scott's billing audit work:

• Knee replacement: Billed at approximately $58,000. Re-adjudicated to approximately $25,000. Overpayment identified: roughly $33,000 on a single claim.

• Hernia repair: Billed at approximately $60,000. Correctly priced at approximately $7,000. Overpayment identified: roughly $53,000 on a single claim.

Cost Modeling Report Snapshot — 105-Employee Group

• Total company savings: $948,645 (29% reduction)
• Company savings per employee: $7,972
• Gross employee savings: $15,142
• Medical and Rx claims savings: $810,000
• Trend flattening value: $138,645
• Sales equivalency: $11,858,057 — the revenue this company would need to generate to produce an equivalent bottom-line impact
• Company valuation increase: $15,178,313 — the projected increase in enterprise value attributable to the sustained reduction in healthcare spend
  

A Governance Outcome, Not Just a Financial One

The Fiduciary Risk Scoring Model™ gives the CFO a second number to bring to the board. A legacy fully insured plan typically enters engagement with a governance risk score of 4.2. A properly structured independent TPA self-funded plan under full fiduciary oversight scores 1.0. That movement is permanent — because the framework eliminates the misaligned vendor economics driving the score, not just the costs they produce. Fourth-year savings exceed first-year savings for the same reason. Structural changes compound. Discounts don't.