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A Midwest state university had to resolve a benefits and financial dilemma. Funding from the state was decreasing each year while health care costs were continuing to rise, making the university’s health plan’s more expensive for faculty and staff and impacting retention and recruitment. After several years of reducing administrative spending and negotiating favorable fees with the claims administrators and health care providers, the university could do little more to tighten spending for the health plans. Other than cutting back on benefits and increasing employees’ costs, the university’s remaining option was to reduce the cost of health claims.