Report

Maximize primary care's impact on specialty care

Discover how advanced primary care reduces unnecessary specialty referrals, improves care coordination, and drives measurable savings.

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Smarter primary care, lower specialty spend: Marathon Health provider supports care coordination and care navigation through a patient blood pressure check in an exam room

Specialty care referrals directly shape member health outcomes and drive significant organizational spend—yet most primary care settings lack the tools to make value-driven decisions. The result: unnecessary referrals, fragmented care, and a rising specialty care spend. Advanced primary care offers a proven framework to address this problem at its source.

Advanced primary care physician uses a stethoscope to examine a patient, supporting specialty care referral management, care coordination, and care navigation at a Marathon Health clinic

BEHIND THE FINDINGS

A proven framework for better specialty care outcomes

What we set out to answer

Specialty referrals represent one of the most consequential decisions in the care continuum—yet they are too often made without the data or coordination needed to drive value. This report examines how advanced primary care (APC) can transform specialty care referral management, from reducing unnecessary referrals to steering members to high-value providers.

Scope and methodology

Drawing on Marathon Health's book-of-business data along with outcomes analyses from partner integrations with RubiconMD, Garner Health, and Lantern, this report presents a four-part framework: prevent, avoid, steer, and connect. The findings quantify the clinical and financial impact of each pillar—giving plan sponsors a clear picture of what value-driven specialty care navigation can deliver.

A SYSTEM UNDER STRAIN

Specialty care spend is rising—advanced primary care changes that

Too many referrals, too little coordination

Between 30-50% of outpatient specialty referrals are never completed—yet they still generate costs and fragment care. Without cost and quality data at the point of referral, providers default to familiar networks, leaving members without guidance and plan sponsors absorbing avoidable specialty care spend.

Fragmented care leaves members navigating alone

65% of Americans say coordinating their own healthcare is overwhelming. When primary care lacks the time and tools to guide members, they self-refer, disengage, or fall through the gaps—driving up downstream costs and reducing the effectiveness of existing benefits.

Point solutions add complexity, not coordination

More than 40% of plan sponsors support eight or more digital health vendors—yet fragmentation persists. The challenge isn't a shortage of solutions; it's the absence of a coordinating layer. Advanced primary care fills that gap, integrating benefits and guiding members to the right resources.

Marathon Health provider draws blood from a patient in a welcoming exam room, supporting care coordination.

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fewer specialty care claims among engaged Marathon Health members vs. unengaged counterparts

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average savings per completed referral through value-driven specialty care navigation

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of specialist referrals and testing are avoided with eConsults

Better coordination across our existing benefits ecosystem partners can help more members access the right care, improve adherence, and create measurable value.

JOE DEBA

Director with CEBT’s Trust Administrator, Colorado Employer Benefits Trust (CEBT)

GET THE REPORT

See how advanced primary care transforms specialty care outcomes

Unnecessary specialty referrals, fragmented care coordination, and rising employer costs are problems that advanced primary care is built to solve. This report breaks down the clinical and financial evidence behind a four-part framework—prevent, avoid, steer, and connect—that helps plan sponsors take control of specialty care quality and spend.

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