Employers are empowered to take affordability action through claims data transparency: Survey

Drivers of Healthcare Affordability Challenges

Key information about an employer’s health care spending and costs is more likely to spur action to address health care affordability and transparency of healthcare plans, a new survey has found.

For the annual Pulse of the Purchaser survey, the National Alliance of Healthcare Purchaser Coalitions sent out a survey to 408 employers, from small businesses to jumbo firms. It discovered that the leading sources of affordability challenges for these companies were drug prices (77%), high-cost claims (75%), and hospital prices (68%).

The companies with the data to use to solve these problems were more likely to have adopted high-value purchasing strategies, averaging 11.9 versus 7.9 for companies with more limited access to data. Direct contracting, centers of excellence, and site-of-care redirection are all approaches used.

In an interview, Alliance President and CEO Shawn Gremminger said that employers often have to go on the plans to get the data they need and that insurance carriers can present the data as they choose.

With open access to this information, employers can utilize the data in a manner appropriate to them. Some of the reasons include that there may be a high-risk population within a specific plan that these employers could handle better, or employees may have different needs based on their geographic location, Gremminger said.

That transparency also makes it easier to steer patients to sites of care that are the best value, with lower cost and quality outcomes, he said.

If you have a broad plan design, you can get involved in things where you would say, all right, let’s put in a tiered cost-sharing incentive to try to get people to higher value sites of care, lower cost, higher quality,” he said.

Strategies for PBM Reform and Pharmacy Spend

The other way that employers can go is they can just have more narrow networks, which I know is somewhat controversial, but I think can also be really impactful,” Gremminger said.

Having more transparency and insight into the pharmacy spend is also a critical priority, and 87.6% said PBM reform was very or somewhat beneficial. Nearly half (43%) of the employers surveyed said they are looking to switch to a new PBM in the next 3 years as costs in the pharmacy business continue to rise.

In 2026, the percentage of surveyed employers contracted by one of the industry’s Big Three companies (CVS Health’s Caremark, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx) fell from 63.4% in 2025 to 54.3% for 2026. There was more interest in switching among smaller employers (those with 1,000 or fewer employees), with 55.7% expressing interest in switching.

The survey also shows that although jumbo employers are slower to change, they are looking at new models, too.

Gremminger said that, in the past several years, the survey has revealed that employers were thinking about changing their approach, and this year’s poll indicates they are doing so. It is the larger companies that are not moving as quickly, as they have questions about whether an alternative PBM can handle their group, he said.

Addressing Hospital Costs Through Transparency and Direct Contracting

One of the things that we’ve been very focused on, and I think employers are getting their minds around, is moving away from thinking about rebate maximization, and moving to a lowest net cost paradigm,” Gremminger said.

In addition, employers are increasingly seeing hospital price transparency as a policy priority, the study found. The majority (84.6%) agree that hospital price transparency is a helpful reform, and 82.6% agree that hospital rate regulations are a helpful reform. In addition, 72.2% said greater enforcement of hospital antitrust is helpful.

Exploring direct contracting is another way they’re looking to get their arms around hospital costs, Gremminger said. That trickles back down, he said, because they can show up to a provider with all the information that they have.

That information will help the employer feel more confident doing a direct contract because, ‘I know where I am, I know where my starting point is, I know where I want to be,’ he said.

Healthcare Affordability and Claims Data Transparency

Healthcare Affordability is becoming a growing priority for employers as companies look for better ways to understand healthcare spending. Greater access to claims data can help employers identify cost trends and evaluate whether their healthcare benefits are delivering value.

A recent survey highlights how employers are increasingly interested in using transparent healthcare information to make more informed decisions around benefits and spending.

Healthcare Affordability Gives Employers More Visibility

Better claims data transparency can provide employers with clearer information about where healthcare dollars are being spent. For Healthcare Affordability, this visibility can help organizations identify high-cost services, utilization patterns, and opportunities for savings.

Employers can use this information to evaluate healthcare programs and make adjustments based on actual spending rather than relying solely on estimates.

Healthcare Affordability Requires Actionable Data

Although claims data can support Healthcare Affordability, simply having access to information is not enough. Employers need reliable data, strong analytics capabilities, privacy protections, and effective strategies for turning information into action. Data quality and integration are also essential because incomplete healthcare information can make it difficult to identify the real drivers of healthcare spending.

Healthcare Affordability and Employee Healthcare

Employers must balance Healthcare Affordability with employee healthcare needs. Cost reduction should not come at the expense of access to necessary services or quality care. By using claims data responsibly, employers can identify opportunities to improve healthcare value while supporting employees and maintaining appropriate access to healthcare services.

The Future of Healthcare Affordability

The increasing availability of claims data is making Healthcare Affordability more measurable and strategic. Employers can combine healthcare analytics, cost transparency, benefit data, and provider information to make better decisions about healthcare spending. As healthcare expenses continue to challenge businesses, Healthcare Affordability will remain an important part of employer benefit strategies and long-term healthcare planning.