Three key focus areas for smarter 2027 health benefits planning 

January 22, 2026

As we kick off strategic planning for 2027, employer health plan sponsors are already struggling with two forces that will continue to exert pressure next year – the fastest health benefits cost growth in 15 years, and a workforce burdened by financial stress. Sounds like a tall challenge, and it is — but as with any challenge, it’s less daunting if you break it down. Here are three areas to focus on as you start planning.

Top strategic priorities for employers, according to our survey, are focusing on high-cost claimants (90%) and measuring performance to ensure health programs provide value (77%). Put simply: To optimize value and reduce waste.

Evaluate high-cost claims. Start by assessing your risk tolerance for these claims and discussing the data with your CFO. According to the Sun Life Stop Loss Report, their highest claim in 2024 was over $12M (and to think, not long ago, we worried that $5M claim might wreck your budget). Look at the conditions associated with your top claims and the average cost by condition. This is where “get started early” comes in. Challenge your vendor partners on how they are using predictive analytics and proactive medical management to be more real-time and effective.

Measure performance and drive more value. You can always go out to bid for more competitive pricing and terms, but before you take that step, consider what more you could do to increase vendor accountability for driving value in your programs. Evaluate engagement, look at performance guarantees and continuous improvement metrics, and ensure industry standard quality protocols are in place and that they are being followed.

Rein in Rx costs. Pharmacy benefits have been driving up health plan costs for years, and as employers continue to add coverage for weight-loss GLP-1 drugs, it’s only getting worse. With so many options in the market, employers are looking at alternatives to traditional pharmacy benefit models and some are requiring PBM to disclose all enterprise revenue — rebate GPOs, biosimilar manufacturing, retail, mail order and specialty pharmacies, and so on. More transparency will provide competitive insights and cost management opportunities.

There is plenty of research showing that people delay care because of financial constraints. One recent survey  found that 6 in 10 patients have skipped or delayed medical care because of the cost. Delays in care can lead to more severe diagnoses and higher costs. How can you help encourage your people to get the care they need, especially when it’s simply not feasible to offer a plan with rich benefits and low contributions? Here are three strategies — within reach — that can boost employees’ confidence about seeking care.

Alternative medical plan options featuring curated provider networks — which may be narrow or even closed – will typically offer members both lower out-of-pocket costs and smaller paycheck deductions. Savings stem from members getting more of their care from high-quality, cost-effective providers.

People need an easier way to pay/afford medical bills. A common feature in variable co-pay plans is consolidated billing with the option to pay over time. Last year, in a Commonwealth survey of 2,000 low-to-moderate-income workers, 40% reported that they had medical debt. However, 84% of this group owed less than $5,000 and 62% owed less than $2,500, suggesting that repayment was not an insurmountable problem. Consolidated billing and payment plans are a great way to avoid or ease the financial burden, and stress, of medical debt.

Build employee confidence in asking for, and getting, help from their health plan. Plan sponsors pay for customer service at a minimum, and often for enhanced navigation and advocacy services. Yet many — probably most — employees don’t know or understand how the plan is supposed to support them, much less who to contact for help. Or even if they are aware of the service, they don’t trust that it will actually be of help. Make sure employees know how to access all the financial support and counseling that’s available to them. According to Mercer’s worker survey, Inside Employees’ Minds, half of employees with low to moderate income want more frequent benefits communication. This is your sign to communicate more!

It’s not enough for care to be affordable — it must also be available when needed. Timely access to care is key to employee health and productivity and to avoiding or minimizing the cost impact of delayed care.

Make access to low-cost primary care as easy as possible. You can do this with tele-health, an on-site or near-site clinic, a direct primary care plan in which plan members have easy, low-cost access to a clinic or physician practice for care, or, if possible, by waiving co-pays for primary care visits.

Assess access to care as a cost driver. When is the last time you evaluated network adequacy and waiting times for appointments? How long is the wait to see a PCP, OB/GYN, cardiologist, or urologist by geography for your population? Think about your own recent experience. Could some delays in care be caused by access?  Depending on your locations, you may be able to address access problems with navigators or curated networks. Also, digital tools have become an important ally, helping people navigate the healthcare system and enabling them to self-advocate and self-treat. According to a January report published by OpenAI that looked at anonymized ChatGPT message data, nearly 2 million messages per week in the US focus on health insurance — and, in underserved rural communities, users send an average of nearly 600,000 healthcare-related messages every week, signaling strong engagement with digital tools. How well are your vendor partners providing digital support to plan members?

Look at your data. Where is care happening? Do you find variations in cost based on the care setting or location? Are the variations big enough that you would consider strategies to steer care to more cost-efficient providers? There are a number of ways to do this through direct contracting or vendor solutions.

Rather than offering a strategic planning checklist, this post is an invitation to take a step back before you dive into planning and maybe think a little differently about your approach. It’s only January — we will have plenty more to say about the specific strategic challenges facing employers in 2027. Watch your in-box!