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Navigating Healthcare Costs: The Impact of Claims Data Access on Employer Strategies

In a pivotal survey by the National Alliance of Healthcare Purchaser Coalitions, it has been found that employers who have complete access to their healthcare claims data are significantly more engaged in adopting cost-reducing strategies. The survey, which surveyed 324 employers, reveals noteworthy trends in healthcare management, particularly in addressing rising costs in drug and hospital services and the implementation of innovative approaches to pharmacy benefits management.

The Alarming Rise of Healthcare Costs

The survey underscores an alarming trend: the percentage of employers who agree that rising healthcare costs affect their competitiveness has surged from 35% in 2022 to 53% in 2025. A staggering 99% of employers indicated that high drug prices, hospital costs, and expensive claims pose a serious threat to their financial viability. As costs escalate, the ability to access complete claims data has become an essential tool for employers seeking ways to effectively manage these expenses.

Despite the rising costs, many employers struggle to gain access to their claims data. Approximately a third of employers reported they still do not have complete transparency regarding their claims information, with 40% stating that their vendors refuse to grant access. Understanding and utilizing this data can empower employers to make more informed decisions and create strategies that enhance their health offerings.

Embracing Transparency in Pharmacy Benefit Management

One of the significant findings from the survey indicates a dramatic shift towards more transparent pharmacy benefit managers (PBMs). Nearly two-thirds of employers (61%) reported either changing their PBM vendors from the Big Three or contemplating a change in the next one to three years. Those employing transparent PBMs observed notably lower premiums, making them more attractive options for cost-conscious employers.

In the past year, the share of employers utilizing transparent PBMs has more than doubled from 12% to 31%. This shift away from traditional PBMs highlights a growing recognition of the importance of having clear and accountable systems in place for managing drug costs and ensuring fair pricing.

Hospital Pricing: The Push for Fairness

The survey revealed employers' skepticism regarding hospital pricing practices, particularly in light of market consolidation. Six out of ten employers expressed doubts that consolidation has improved costs or quality. Adoption of strategies focused on hospital fair pricing is growing, particularly among larger companies. For example, 65% of large-scale employers now engage with centers of excellence for healthcare, compared to just 22% of smaller employers.

Direct contracting with high-value hospitals has also shown significant adoption among larger organizations, emphasizing the need for employers to seek out more equitable healthcare solutions.

Policy Reforms Taking Center Stage

In terms of policy, employers’ opinions highlighted significant reforms needed in the healthcare sector. The most favored reforms included changes to PBM practices and drug price regulation, with both garnering 56% support among respondents. This calls for a collective push from employers towards advocating changes that not only benefit their organizations but also the healthcare landscape at large.

A Growing Focus on Obesity Management and Emerging Needs

Despite a slight decrease in obesity management drug coverage—with 65% of employers offering coverage for branded GLP-1s, down from 67% in 2024—there is an evident evolution in program design. A strong emphasis now exists on primarily managing access through innovative point-solution vendors, indicating a shift towards more strategic and flexible healthcare options.

Conclusion: Shifting Paradigms in Employer Healthcare Management

The findings of the National Alliance survey resonate as a clarion call for employers to rethink their approach to healthcare management. Access to claims data is proving to be an essential element in effective cost management and strategic planning. As employers navigate these challenges, collaboration and transparency in healthcare practices will be key to fostering a healthier, more equitable system.

For those interested in delving deeper into these strategies, the National Alliance will host a webinar on September 22 to discuss key findings and potential solutions to benefit challenges faced by employers today. This event promises to illuminate pathways towards innovative health management strategies for a sustainable future.