Understanding the Disconnect: Employers and Brokers in Health Plan Evaluation

The latest 2026 Phia Group Broker Survey conducted among 124 brokers and advisors unveils a concerning disconnect between the health plan discussions initiated by employers and the critical issues raised by brokers regarding fiduciary responsibilities, plan performance transparency, and vendor oversight.

As employers gear up for the upcoming health plan renewal cycle, their focus primarily revolves around familiar challenges such as escalating costs, increasing pharmacy spending, and overall plan design. However, the survey findings suggest that some pressing matters are not receiving the level of inquiry they warrant.

Key Discrepancies in Health Plan Discussions

According to the survey, 12% of brokers expressed confidence in their clients' fiduciary processes, yet only 22% mentioned fiduciary oversight as a frequent topic of discussion among their clients. A staggering 78% of brokers revealed they lack working visibility into their clients' No Surprises Act (NSA) and Independent Dispute Resolution (IDR) performance. Additionally, 62% reported that their clients have limited insights into subrogation and recovery – a critical component of effective health plan management.

As health plans become increasingly complex and self-funded options expand, brokers emphasize that the traditional conversation surrounding renewals is no longer adequate. Adam V. Russo, Co-Founder and CEO of The Phia Group, remarked, "It's not just about healthcare costs rising; it's about employers making informed decisions while often lacking the necessary data to oversee and justify those choices."

The Role of Brokers in Navigating Health Plans

The survey results point out that brokers view fiduciary preparedness as a key area of concern, but these issues are frequently sidelined in discussions with employers. Over half of the brokers surveyed (54%) believe that having a fiduciary oversight checklist would enhance their ability to advise their clients effectively. This disconnect indicates a need for greater dialogue regarding fiduciary processes, documentation, and plan oversight.

Furthermore, the visibility gaps identified in the survey can significantly impact health plan performance. Without a clear view of how each component of the plan is functioning, employers risk mismanaging their health plans and financial resources. Russo cautioned, “If you lack visibility into parts of the plan, evaluating its success becomes unattainable. Employers need to place expectations on vendors and service providers to deliver not just services but quantifiable results.”

The Complexity of Health Plan Management

Cost pressures remain substantial as most brokers (70%) report that clients are either facing or anticipating double-digit increases for the 2026 renewals. Meanwhile, 76% noted a shift in their clientele toward self-funded plans within the last year. While self-funding can grant more control over financial management of health plans, it also heightens the necessity of understanding plan performance and vendor oversight.

Pharmacy management emerges as an increasingly complex issue. Reports indicate that 27% of brokers are fielding questions from employers regarding transparency and rebates related to Pharmacy Benefit Managers (PBMs), while 18% cite pharmacy and specialty drug expenses as the most pressing challenges they face. This demonstrates an evolution in employer concerns, moving beyond just the costs of medications to how those expenditures are managed and understood.

Evolving Broker Responsibilities

As the landscape of health insurance changes, the role of brokers is also transforming. The survey findings highlight a growing demand for more practical tools that could assist brokers in navigating these intricate health plan matters. These include checklists for fiduciary oversight, analysis of claims and cost drivers, transparent reporting from vendors and third-party administrators (TPAs), benchmark data, and educational resources that brokers can provide to their clients.

Russo concluded, "The broker's role must evolve from merely communicating rising costs to facilitating discussions that help clients understand what drives those costs, what can be seen in their plans, vendor performance metrics, required decisions, and potential areas for improvement."

The 2026 Phia Group Broker Survey provides valuable insights into the factors that are shaping employer health plans today. These insights underline the necessity for both employers and brokers to bridge the gap in their communications and effectively manage the complexities associated with health plan decisions. Interested parties can access the full report by visiting Phiagroup.com.

By enhancing their collaboration, employers and brokers can better navigate the challenges of health insurance and ensure optimal outcomes for all stakeholders involved.