Healthcare costs aren’t just about price — quality matters

You should be done being quiet about healthcare costs — and quality 

This is one of those articles I read that I literally responded out loud to: “You should be done being quiet!” 

We all know that employer healthcare costs keep going up. One recent analysis points to a 5.8% increase for large employers in 2025, while another report projects a 10% rise in healthcare costs in 2026. The Business Group on Health even called the 2025 increase the “highest in more than a decade.” 

Employers are absolutely right to ask for price transparency in healthcare. But I really hope they don’t stop there — because price is only half the story. 
 

Why price alone doesn’t tell the whole healthcare story 

Think about it. You wouldn’t buy a car based on price alone. 

At least, I wouldn’t. I’d want to know:

• How safe is it?
• How many miles to the gallon does it get — or is it a hybrid?
• Does it have heated seats?
• And if you have kids: how many cup holders are there? 

Heck, as I’ve blogged before, I don’t even buy peanut butter based on price alone (Skippy, you are the one!). 

So why would we evaluate healthcare that way? 

Employers also need to ask: 

• What are we getting for that price? 
• What is the quality tied to that price? 
   

Healthcare quality directly impacts total cost of care 

A less expensive hospital visit doesn’t help if a patient ends up right back in the hospital within seven days. 

A lower premium doesn’t solve everything if a person’s health isn’t managed, and if no steps are taken to prevent avoidable hospital admissions or emergency department (ED) visits. 

This is where healthcare cost and quality intersect. Without quality, lower prices can actually drive higher costs over time.
 

Proof that quality-based models work 

The good news? Asking the quality question isn’t theoretical — it’s already happening. 

Value-based care in action 

Health plans across 15+ states are designing value-based reimbursement models that:

• Enable more accurate and equitable provider payment
• Reduce cost volatility
• Decrease preventable utilization

Through aligned reimbursement and shared savings programs, organizations have achieved:

• Fairer payments
• Improved quality outcomes
• Growing provider participation
• In some years, tens of millions of dollars in savings
• 8–11% reductions in hospital admissions, readmissions and ED visits 

Importantly, contributions to reducing the total cost of care are measured by focusing on potentially avoidable events, including ambulatory complications, admissions, readmissions, and ED visits. 

States are leaning into quality, too 

Texas Hospital Quality-Based Payment Program (HQBP) 

Texas links payment to quality and efficiency using outcomes measures such as comprehensive readmissions and complications, along with hospital-reported process measures. Under this program, up to 4.5% of inpatient payments are at risk, tying dollars directly to performance. 

Mississippi Quality Incentive Payment Program (QIPP) 

Mississippi’s QIPP — part of the Mississippi Hospital Access Program (MHAP) — allocates 60% of roughly $844 million in annual distributions based on quality outcomes. These include potentially avoidable inpatient and ambulatory complications, readmissions, and ED visits.
 

The bottom line: Employers, your voice matters 

Employers, please lend your voices to the debate over healthcare costs and quality. 

Employees — people like me — want lower costs and better quality, just like you do. But we won’t get there by looking at price alone. 

If we truly want to tackle rising healthcare costs, quality has to be part of the mix.

Megan Carr is the head of the regulatory and payer solutions team at Solventum.