Peer-reviewed studies from RAND Corporation and Harvard Medical School establish that financially incentivizing employees to choose lower-cost imaging generates significant, measurable savings — with no compromise in care quality. Those savings grow in direct proportion to how many employees engage. Pario's real-time interception is designed to maximize that engagement.
Research from RAND Corporation and Harvard Medical School found that financially rewarding employees for using lower-cost imaging generates real, durable savings — 25% per MRI for patients who switched — and does not compromise care quality in any measurable way. ACR-accredited outpatient centers perform the same scans, on equivalent equipment, read by the same radiologists, at a fraction of hospital prices.
Even with only 8% employee engagement, these programs saved $2.3 million across 29 employers — roughly $8 per enrolled person per year. That is not a small number. That is what the savings look like at 8% participation.
Engagement is the multiplier. Every percentage point of additional participation compounds the savings directly. Pario's real-time interception — reaching employees 28 minutes after the physician signs the order, before they've called anyone to schedule — is designed to drive engagement far beyond what passive opt-in programs can achieve. The employee receives one text, replies with one number, and a navigator books the appointment. No portal. No research. No remembering.
The research established the savings potential. Pario is built to realize it at scale.
Sources: Whaley et al., Health Affairs 2019; Whaley et al., Health Services Research 2022; Robinson, Whaley & Brown, Med Care 2016; RAND Corporation Hospital Price Transparency Study 2022
Whaley, Sood, Chernew, Metcalfe, and Mehrotra — researchers from RAND Corporation, USC, and Harvard Medical School — evaluated a rewards program deployed by 29 self-insured employers covering 269,875 eligible employees and dependents. For 131 elective services, employees who received care from designated lower-price providers received a check ranging from $25 to $500.
In the first twelve months, the program generated a 2.1% reduction in prices for targeted services — saving $2.3 million, or $8 per enrolled person per year. Nearly all savings came from MRI and ultrasound. That result came from only 8.2% of eligible employees engaging with the program at all. The savings are not a function of the program size — they are a function of how many employees act.
The research also confirmed no reduction in utilization. Employees didn't skip needed scans — they got the same scan at a better-priced facility. Clinical access was unaffected.
What Pario adds: The study's $8 figure reflects 8% participation in a passive, opt-in program. Pario reaches every enrolled employee at the moment of their imaging order — before they've made any scheduling decision. Higher engagement means proportionally higher savings. The research proves the mechanism; Pario is engineered to run it at full capacity.
A follow-on study by Whaley et al. in Health Services Research (2022) evaluated a larger cohort across 22 pilot employers. Overall program savings grew from 1.3% in year one to 3.7% in year two — not because the program changed, but because engagement increased and providers responded by lowering prices to retain volume.
For MRI specifically — the modality with the largest price gap between hospital and outpatient settings — 30% of patients engaged when proactively offered the program. MRI prices fell 3.7% in year one and 6.5% in year two. The relationship is direct: more engagement means lower prices, which means more savings per case, which compounds further as additional employees participate.
The study also confirmed no reduction in MRI utilization. Employees got the scans their physicians ordered — at a better price. Clinical access was completely unaffected.
The Pario implication: The Whaley study achieved 30% MRI engagement through passive opt-in. Pario intercepts every enrolled employee at the moment of their order — the highest-leverage point in the scheduling process. Greater engagement means the compounding effect the research documents starts from a much higher baseline, from the first year.
Robinson, Whaley, and Brown (Medical Care, 2016) evaluated reference pricing for advanced imaging tests deployed by Safeway through its employee health plan. Unlike opt-in rewards programs, reference pricing creates a structural cost-sharing incentive — employees who choose high-price facilities pay the difference themselves, which creates engagement at the point of scheduling.
Results: implementation of reference pricing was associated with a 12.5% reduction in CT scan prices and a 10.5% reduction in MRI prices by the end of year two. Employee out-of-pocket costs declined by 13.8%. Employees accounted for 45.5% of total savings, employers the remainder.
Separately, CalPERS reference pricing for colonoscopy showed a 21% reduction in spending, and arthroscopy showed 17.6% — consistently confirming that the savings are real and durable when patients are structurally incentivized to act.
What this confirms for Pario: Structural engagement — reaching employees at a defined moment when the choice is still open — reliably produces 10–21% price reductions. Reference pricing achieves this through cost-sharing pressure. Pario achieves it through proactive outreach before scheduling. Same engagement effect, delivered without burdening employees with financial risk.
RAND Corporation's hospital price transparency research — covering $56 billion in claims across 3,112 hospitals — found that commercial health plans pay hospitals an average of 254% of Medicare rates for the same outpatient procedures. Independent outpatient imaging centers, by contrast, typically price within 130–160% of Medicare rates for the same services.
This is not a quality premium. The RAND research, along with Whaley's broader body of work, consistently finds weak or no relationship between hospital prices and care quality. The premium exists because of market concentration, facility fee structures, and the absence of price-sensitive patients at the scheduling decision — not because hospital-based imaging produces better images.
The practical consequence for a self-insured employer: the average commercial MRI at a hospital-based outpatient department costs $2,400. The same scan at an ACR-accredited independent outpatient center costs $420. The gap is $1,980 per case. For a 500-person employer generating seven steerable imaging cases per month, that is $11,200 in recoverable savings every single month.
Why this is Pario's foundation: The gap is large enough that a small HSA reward — typically $150–$300 — moves the employee, covers the plan's program cost, and still delivers $1,600+ in net savings to the employer per case. The math only works because the underlying price differential is this extreme.
Desai, Hatfield, Hicks, Chernew, Mehrotra, and Sinaiko — Harvard Medical School researchers — modeled the potential savings from steering commercial plan members to the median-priced provider in their market across three shoppable outpatient services. For imaging, they found that routing patients to the market median would save 45% of total imaging spend, representing 11% of all outpatient spending.
This is a ceiling estimate — not every patient can be steered, not every market has adequate supply of lower-cost alternatives. But the underlying price variation is large enough that even partial steerage generates material savings. The study used California commercial claims for 697,381 enrollees and found that roughly half of all imaging services were billed by providers with above-median prices in their market.
For self-insured employers, the implication is direct: a substantial fraction of every dollar spent on imaging is recoverable without any compromise in clinical quality, purely by changing where the scan happens.
Multiple studies in Whaley's body of work examine the relationship between provider price and care quality. The consistent finding: high-price and low-price providers do not differ significantly on care quality or efficiency for standardized outpatient services including imaging. This holds across imaging types, surgical procedures, and laboratory services.
ACR accreditation — the American College of Radiology's program for imaging facilities — is the operational mechanism that makes this equivalence usable. ACR accreditation certifies that a facility meets defined standards for equipment performance, personnel qualifications, quality control programs, and radiation dose management. These are the same standards applied to hospital-based imaging departments.
Pario requires ACR accreditation from every facility in our network. This is not a marketing claim — it is a contractual requirement verified monthly. When an employee receives a Pario offer, both options presented meet the same clinical standards as the hospital facility they would otherwise have chosen.
The quality argument, closed: Same machine. Same imaging protocols. Same ACR accreditation. Same radiologist read quality. The only difference is the facility fee structure — a billing category that reflects hospital overhead, not imaging quality.
As Pario accumulates program data across employer partners, this section will publish our own outcomes: steerage conversion rates, average savings per case, net plan savings by employer size, and employee satisfaction with the navigation experience. We will not publish outcomes data until we have statistically meaningful sample sizes. Anticipated: Q3 2026.
Every citation on this page links to its primary source. The research is published, peer-reviewed, and reproducible. Pario's approach — real-time interception at the moment of the physician's order — is designed specifically to maximize the engagement that the evidence shows drives savings. If you'd like to discuss the research directly or see how our projected engagement rates translate to your specific workforce, we're available.
For investor or integration-specific diligence requests, email contact@getpario.com