Benefits design and administration have been part of my work throughout my entire career.
One theme I’ve seen over the years is that many employers view rising healthcare costs as something that simply happens to them. The renewal numbers arrive. Rates increase. Budgets tighten.
Many employers rely on their consultants throughout the year to help manage their benefits programs and provide options. But some have these conversations for the first time at renewal, when the discussion becomes primarily about what to cut or what to absorb.
I recently moderated a panel discussion with leaders in benefits strategy, pharmacy, and healthcare navigation, and there was a consistent message throughout the conversation.
Employers have far more influence over their health plans than many realize.
By asking more questions, using data, and making informed decisions throughout the year, employers can put that influence to work long before renewal season begins.
Here are some of the themes that came up during our discussion.
You’re the Steward of Your Health Plan
The employer is the steward of its health plan.
A steward doesn’t have all the answers. A steward asks better questions, understands the organization’s goals, knows the workforce and what employees need and value, reviews claims data, and brings together the right partners to make informed decisions.
Stewardship isn’t about doing everything yourself. A steward knows when to leverage experts – a benefits consultant to evaluate the market, a pharmacy advisor to understand drug spend, or a navigation partner to help employees make better decisions.
The employer’s role is to bring those perspectives together into one strategy.
Most importantly, stewardship happens year-round through reviewing data, understanding the workforce, strategizing with finance, measuring outcomes, and revisiting assumptions.
Your Claims Data Is One of Your Most Valuable Assets
One of the strongest themes throughout our discussion was the importance of data, access, and action.
Claims data is key to understanding your population’s healthcare spending. What is driving pharmacy costs? How is your workforce actually using the plan you built for them?
Take the MRI example discussed during the panel. The cost of the same MRI can vary by thousands of dollars within a relatively small geographic area. Without visibility into those differences, both employees and the plan may end up paying more than necessary.
Self-funded employers have access to more claims data than ever before. Access is the starting point. Reviewing the data regularly and using it to guide decisions is where opportunities begin to emerge.
Benefits Decisions Should Start With Your Workforce
The best health plan isn’t necessarily the richest one. It’s the one that meets the needs of your workforce.
Understanding employee demographics, utilization patterns, and feedback helps organizations make decisions based on evidence rather than assumptions. Sometimes what employees value most isn’t what leadership expects.
I’ve spent most of my career in consulting, but I also had a stint leading benefits and HRIS inside a company. During that time, I conducted a workforce survey and learned that a large portion of our employees were still covered under their parents’ plans. I also learned that mental health, not physical health, was their top priority.
That is the type of insight employers gain by asking rather than assuming.
Healthcare Costs Require More Than One Solution
There isn’t a silver bullet.
Our conversation covered pharmacy strategy, healthcare navigation, transparency, incentives, and employee engagement. Even a topic as specific as GLP-1 coverage demonstrated the importance of looking beyond a single decision.
Simply covering or excluding medications for one condition does not necessarily address the employer’s total exposure. Employers need to understand how the medications may be used across different diagnoses and evaluate the broader coverage and clinical-management strategy.
Employers should understand the options and determine which approaches align with the workforce and the organization’s business goals.
Your Partners Matter
No employer should have to navigate these decisions alone. The right broker, consultant, pharmacy advisor, and solution providers can each bring valuable expertise.
But employers still need to lead the strategy. The strongest partnerships happen when everyone works toward the same goals with transparency, data, and shared accountability.
Fully Insured Doesn’t Necessarily Mean Flying Blind
Employers with fully insured plans may still be able to obtain meaningful information about their plan and workforce.
The level of detail available depends on factors such as group size, carrier practices, state requirements, and privacy considerations. Employers should work with their broker or consultant to understand what claims reports, utilization information, benchmarking, and other data may be available.
Many carriers already have reporting capabilities. Sometimes gaining greater visibility begins simply by asking what information can be provided.
Healthcare costs may continue to rise. But employers have more influence than many realize.
The organizations that achieve the strongest outcomes aren’t necessarily the ones with the biggest budgets. They are the ones that embrace their role as stewards, ask better questions, and use data and expert guidance to make informed decisions throughout the year.
