Healthcare Costs Soar: Employers Brace for Disruptive Changes & Turn to AI for Solutions
Employers are facing a critical juncture in healthcare benefits management. A recent survey from Willis towers Watson (WTW) paints a stark picture: healthcare costs are not only exceeding budgets but are projected to continue their upward climb, forcing organizations to explore increasingly innovative – adn sometimes disruptive – strategies.
Beyond Budget: The Reality of Rising Costs
The WTW survey, encompassing responses from 417 employers (81% self-insured, 19% fully-insured) with over 100 employees, revealed that in 2024, over half experienced healthcare costs exceeding their budgets by an average of 4.5 percentage points. This isn’t a temporary blip. employers anticipate a 9.1% cost increase in 2026 before plan adjustments,following projected increases of 8.1% in 2025 and 7% in 2024. Even after implementing plan changes, anticipated increases remain ample at 8%, 7%, and 6% respectively.
Key Cost Drivers: Pharmacy, High-Cost Claims, and Chronic Conditions
The primary culprits behind these escalating costs are well-defined:
* Pharmacy Costs: Specifically, the rising expense of specialty drugs and GLP-1 medications (like those used for weight management and diabetes) are significantly impacting budgets.
* High-Cost Claimants: A small percentage of individuals with complex medical needs account for a disproportionately large share of healthcare spending.
* Chronic Conditions: The prevalence of chronic illnesses continues to drive up overall healthcare utilization and costs.
Shifting Strategies: From Cost-Shifting to Disruptive Innovation
Historically, employers have relied on a combination of strategies to manage healthcare expenses. though, the WTW data indicates a shift in approach.While cost-shifting to employees (increasing premiums, deductibles, and co-pays) remains a tactic – utilized or planned by 47% of employers - there’s a growing reluctance to lean too heavily on this method.
“Fewer employers are absorbing rising costs because it’s becoming unsustainable,” explains Tim Stawicki, Chief Actuary of Health & Benefits at WTW. ”They’re also recognizing that aggressive cost-shifting can negatively impact employee health, satisfaction, and retention. Instead,we’re seeing a move towards bolder,more disruptive changes that aim to control costs and improve employee health outcomes – a more lasting path forward.”
Hear’s a breakdown of employer strategies, comparing current implementation to future plans:
| Strategy | Currently Implemented (%) | Planned/Considered (%) |
|---|---|---|
| Broader Cost-Saving Actions | 59 | – |
| Increased cost-Shifting | 47 | – |
| Absorbing Costs | 32 | – |
| Choice Plan Designs | 41 | 46 |
| Vendor Performance Evaluation | 46 | – |
| Medical Plan Bidding | 36 | 50 |
Holding Vendors Accountable & Exploring Alternative Plan Designs
Employers are actively taking steps to increase accountability and explore new plan structures:
* Vendor Scrutiny: 46% of companies are currently evaluating vendor performance, with an additional 36% actively seeking bids for medical plans and 50% considering it.
* Alternative Plan Designs: A growing number (41% currently, 46% planning to) are adopting alternative plan designs that may include:
* narrow Networks: Limiting access to specific providers to negotiate lower rates.
* Transparency Tools: Providing employees with clear information about healthcare costs and quality.
* Care Navigation: Offering support to help employees make informed healthcare decisions.
Pharmacy Benefit Manager (PBM) Under the Microscope
Dissatisfaction with Pharmacy Benefit Managers (PBMs) is widespread. A meaningful 75% of employers have either taken their PBM out to bid or plan to do so. Furthermore, 49% are utilizing transparent contract structures and 58% are conducting audits of their pharmacy benefits to ensure fair pricing and appropriate utilization.
managing GLP-1 Costs: A Focused Approach
The surge in demand and cost of GLP-1 medications requires specific management strategies. Employers are implementing measures such as:
* Lifestyle Management Programs: Requiring participation in wellness programs before accessing these medications.
* Fill Limits:
