Marcy Tatsch , 2025-05-02 13:49:00
Businesses are struggling with the high cost of healthcare benefits for their employees. As companies prioritize their employees’ well-being, healthcare benefits are often their largest expense, second only to the cost of goods and services they provide. Costs of employer-sponsored healthcare are expected to rise 9% in 2025.
Large employers can use data-driven strategies to help reduce the cost of healthcare. Here are three areas employers can address to make healthcare more affordable for themselves and their employees without sacrificing quality.
1) Measure GLP-1 outcomes
GLP-1s are a hot topic. This class of drugs has been around for almost 20 years to treat diabetes, but utilization has grown exponentially to address obesity over the last few years.
A recent KFF Health Tracking Poll found that about one in eight American adults say they have taken a GLP-1. The drug class continues to expand with label expansions to reduce the risk of cardiovascular death, heart attack, and stroke, as well as dozens of clinical trials in progress to bring GLP-1 medications to market.
GLP-1s will be a significant part of the medication landscape for the foreseeable future. Employers must understand the financial cost and the clinical outcomes they are achieving. However, measuring the success of GLP-1s requires data sophistication.
Employers must combine drug, medical, biometric, lab, and other data to monitor utilization and results. They must also understand how weight management and diabetes programs affect outcomes and know if they’re getting a good return on investment (ROI). Beyond healthcare utilization, disability and absence data can help employers understand ROI from a productivity perspective.
Understanding the cost of GLP-1s and their impact on health can help a company determine how to manage these prescriptions over time.
2) Target mental health and well-being
One in five US adults experience mental illness each year, and less than half of them receive treatment. Employers are increasingly focusing on mental health to support their employees’ well-being. Many companies now proactively provide tools and services, such as private sessions with mental health professionals or bringing in external speakers to talk about mental health topics.
To make a real difference, companies must connect people with the services they need. Several barriers can prevent people from getting the help they need — financial concerns, pessimism about treatments, lack of support from loved ones, stigma, or just the perception that they can handle it on their own.
Data can help improve well-being, especially when companies combine their data with socio-demographic data to get a fuller picture of their population. Understanding more about their communities and their education level or ethnic background can help employers tailor their approach to engage them with mental health services.
These evaluations are especially important for companies that use vendors for wellness and mental health services. With data, companies can hold their vendors accountable for results. For example, data can show how vendors reach members and whether they reach those who need help most.
3) Negotiate pricing with better information
Reimbursement strategies are of utmost importance. Negotiating better pricing upfront will have significant implications for member affordability, population health, growth, and profitability.
There are four aspects to pricing analysis that every employer should consider before negotiating health plan benefit contracts:
- Medicare repricing is the gold standard discount baseline. It’s an important data point because it is the common language that payers, providers, and consultants use.
- Machine Readable Files (MRFs) —The Transparency in Coverage final rule requires these files to make healthcare pricing information more accessible. Note that the massive size of these files can be difficult to work with, and health plans and providers can use different formats, which makes it hard to compare them. However, they offer great promise and should be essential in any pricing analysis.
- Reimbursement benchmarks – Market-level benchmarks that use paid claims are the best resource to tell employers what happened. This real-world data is a good option to assess the accuracy of MRFs.
- Advanced analytic reporting – Employers must be able to pull all information into an environment where they can model it. Here, they can compare utilization and current spending against competitive data points or evaluate how their contracts are set up.
If an employer knows which Diagnostic-Related Groups (DRGs) are driving costs, that is powerful information when negotiating pricing. These facts — together with admissions and claims — enable a more complete picture and the ability to monitor changes over time.
Data sophistication is essential to lowering costs
In all three areas, one or two data sources are not enough to meet the challenge of soaring health benefits costs. Companies should discover trends affecting their members using a robust set of curated, aggregated data sources. Data-driven strategies will require a higher level of data sophistication than ever before, but the cost savings and protection of high-quality care are worth the effort and investment.
Photo: lerbank, Getty Images
Marcy Tatsch is Executive Vice President and General Manager of Truven, a platform that includes Health Insights (healthcare analytics) and MarketScan (real-world evidence) solutions. Previously at Merative, she also led Cúram, our global solution to help government agencies transform the delivery of benefits. Before joining Merative, she served in various senior leadership positions at McKesson and Change Healthcare, leading businesses that served hospitals and pharmacies with platform, financial, and analytic solutions.
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