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Employers Taking Action on Healthcare Costs

A recent survey conducted by the National Alliance of Healthcare Purchaser Coalitions has shed light on a pivotal trend in the domain of healthcare management—employers who have full access to medical and pharmacy claims data are more proactive in their efforts to address hospital affordability, high-cost claims, and pharmacy benefit management (PBM) transparency.

The survey, known as the Pulse of the Purchaser, involved responses from 408 employers and highlights the ongoing challenges in the healthcare landscape. Most notably, it points to the significant correlation between claims data visibility and the subsequent actions employers are willing to take to mitigate escalating healthcare costs.

Key Survey Insights

1. Rising Wolves in the Healthcare Arena

The survey revealed that an overwhelming majority of employers recognize healthcare affordability as a critical issue that extends beyond mere benefits management. 97% of the employers identified attracting and retaining employees as crucial, with 98% acknowledging that health and wellbeing benefits play a vital role in this endeavor. However, 92% expressed concerns that rising healthcare costs hinder their competitiveness, with 83% indicating that these costs compromise wage and salary increases. Almost all, 93%, anticipate these costs to shift to employees, compelling employers to rethink their healthcare strategies.

2. Action Over Concern

Shawn Gremminger, the president and CEO of the National Alliance, encapsulated the sentiment by stating, "Healthcare affordability is no longer just a benefits issue; it is a business issue, a workforce issue, and a wage issue." The findings emphasize that while employers have genuine concerns, many lack the essential data and contractual authority needed for decisive action. When employers do gain access to comprehensive claims data, they are significantly more equipped to transition from concern to implementation.

3. Understanding Cost Drivers

The survey identified specific areas that pose significant challenges: 77% of employers pointed to drug prices, 75% to high-cost claims, and 68% to hospital pricing, highlighting the most pressing areas of concern. Employers predict an average 7.7% increase in healthcare costs before plan design modifications, with 33% of them preparing for a hike of 9% or more, further illustrating the growing financial pressure.

Strategic Shifts in Benefits Management

As employers grapple with these financial challenges, they are also reshaping their approach to benefits management. Those with comprehensive claims access reported an average of 11.9 high-value purchasing strategies, in contrast to 7.9 for those with limited access. It’s evident that more usable data fosters a more proactive stance toward healthcare costs.

4. The Need for PBM Transparency

Another area of focus is the push for transparency around Pharmacy Benefit Managers (PBMs). Findings reveal that nearly 87.6% of employers view PBM reform as a significant helper in alleviating costs, with 43% contemplating a PBM change within the next few years. This reflects a broader realization that practices in how medications are sourced and managed must be re-evaluated for efficiency and transparency.

5. Expanding to Other Policy Reforms

The survey also points to a greater emphasis on numerous critical policy reforms, with significant support shown for hospital price transparency (84.6%), hospital rate regulation (82.6%), and hospital antitrust enforcement (72.2%). This signals a notable focus on ensuring fair pricing across the healthcare system.

The Path Forward

As the 2026 midterm elections loom, rising healthcare costs remain a foremost concern. Employers are adapting their strategies, not just treating high costs as typical challenges, but as factors that require accountability from their healthcare vendors. The survey underscores the need for legislative engagement, which has noticeably climbed from 42.5% to 51.3% in just one year, particularly among those with complete pharmacy claims access.

In summary, the Pulse of the Purchaser survey illustrates a significant evolution in how employers are approaching healthcare affordability. With the right data, they can transition from merely identifying issues to implementing meaningful strategies that can lead to substantial changes in the healthcare landscape, ultimately creating a more sustainable model for both employers and employees alike.