Only Healthcare Podcast https://onlyhealthcarepodcast.com/ Breaking Down Cost, Care, & Access Tue, 23 Dec 2025 16:34:58 +0000 en-US hourly 1 https://wordpress.org/?v=6.9.4 https://i0.wp.com/onlyhealthcarepodcast.com/wp-content/uploads/2025/11/Only-Healthcare-Podcast-Cost-Care-Access-US-Icon.webp?fit=32%2C32&ssl=1 Only Healthcare Podcast https://onlyhealthcarepodcast.com/ 32 32 250577308 Trends and Issues for US Employer Insurance: Forecasting 2026-2030 Health Care Coverage https://onlyhealthcarepodcast.com/trends-and-issues-for-us-employer-insurance-forecasting-2026-2030-health-care-coverage/?utm_source=rss&utm_medium=rss&utm_campaign=trends-and-issues-for-us-employer-insurance-forecasting-2026-2030-health-care-coverage Mon, 01 Dec 2025 12:00:00 +0000 https://rst.bxq.mybluehost.me/website_cc17099b/?p=1286 J Clin Pathways. 2025;11(6):38-42.  INTRODUCTION In the health plan year 2025, health care stakeholders faced the lingering effects of the COVID-19 pandemic, a change in presidential and congressional party leadership, and artificial intelli­gence (AI)’s growing integration in health care. In addition, the rapid growth of the GLP-1 drug category overshadowed the im­pact of biologic-based products, especially cancer therapeutics. These market factors focused the attention of business leadership, human resource departments (HR), and company boardrooms beyond health care costs. Such dynamic changes in this marketplace—shifts in regulation or law and economic ramifications—require a more robust understanding of roles, responsibilities, and available time for all business sector leaders to sustain their business through 2025 into 2026. This column will review health care stakeholders’ final pri­orities for 2025 and the transition to a more complex business­-driven shift in risk mitigation for 2026 health care coverage. YEAR-END 2025 PRIORITIES In August, Law firm Fisher Phillips posted a to-do list for em­ployers regarding workplace law developments and upcoming compliance dates for the remainder of 2025.1 The listed items affect multiple C suite areas and business boards, including HR committees and operating executives. The firm notes that in general, all companies need to watch for major changes from the National Labor Relations Board. Key to-do items that all employers should be aware of according to the firm include: In a similar vein, Foley & Lardner LLP published “2025 Health Care & Life Sciences Top Trends,” highlighting the fol­lowing developments: With this list, the firm’s aim is to help businesses capitalize on opportunities and navigate potential pitfalls in an uncertain regulatory and litigation landscape.2 These risk management efforts can support a welcoming and thriving workplace that leads to a successful company. HEALTH CARE LANDSCAPE TRANSITIONS: ALTERNATIVE COVERAGE AND HR PRACTICES Employer of Record and Global Professional Employer Organizations In the current economic climate, companies have been increas­ingly tasked with reassessing their approach to business success. Despite global economic uncertainty, most business leaders pri­oritized growth and increasing their financial commitment to­ward hiring throughout 2024.3,4 However, this priority shifted in 2025 to leverage cost efficiency. More business leaders are adopting a “global growth mind­set.” Small- and medium-sized businesses alike are taking advantage of global expansion to navigate common challenges such as talent shortages.5 In addition, many companies are seek­ing an alternative to streamline HR functions such as hiring, recruiting, and compliance.6 Companies looking to quickly expand their workforce can try to partner with an employer of record (EOR) or a global professional employer organization (PEO) to effi­ciently manage HR needs while saving time and money.7 A PEO is a company that co-employs individuals with another company that already has its own registered entity. There are currently over 500 PEOs in the US alone.8 While a PEO only assists with employer responsibilities and certain HR tasks, an EOR handles all HR-related tasks to streamline day-to-­day operations.  Individual Coverage Health Reimbursement Arrangements and Alternative Funding Programs Employers are also looking at alternative coverage options to adapt to market changes. One option is Health Reimbursement Arrangements, which are “skinny plans” that offer mostly cata­strophic coverage. Individual Coverage Health Reimburse­ment Arrangements have also received much attention from pharmaceutical companies, their advisors, and vendors; how­ever, they lack an understanding of the employer marketplace perspective. The concept sounds great to those who don’t un­derstand insurance risk markets, but it represents a minority of businesses, mostly smaller employers. Alternative funding programs (AFPs) are increasingly be­ing discussed as another solution, particularly for higher cost biologic therapies, managing the costs of specialty medications, and for those without standard commercial insurance cover­age.9 However, AFPs, along with other emerging risk-based so­lutions or so-called direct to consumer web platforms, tend to be short-term band aids for pharma/biotech firms rather than solutions to root cause problems. In addition, premium costs and out-of-pocket (OOP) costs will likely go up for members (patients) as part of these programs. AFPs are often used by self-funded employer plans and involve a third party to manage high-cost specialty drugs.9 They may exclude these drugs from the plan and help employees ob­tain them through other means, like patient assistance pro­grams. However, there are concerns that AFPs can create barriers to accessing medications, increase patient costs, and di­vert funds. It is important to research any program thoroughly, understanding potential impacts on costs and access to neces­sary medications.10 Common types of AFPs include the following: IMPORTANT CONSIDERATIONS FOR 2026 Overall, the trends emerging for 2026 include market segment splitting, reducing or limiting access to care via commercial insurance, and minimizing plan risk (cost) to balance anticipated double-digit premium increases on employers. Government programs have also seen large increases in similar annual costs post-pandemic. Advocates, advocacy groups, and some individual employers have the following recommendations for navigating these trends: COMMERCIAL EMPLOYER PLANS FOR 2026 Public Sector Preliminary data shows double-digit increases in health plan renewals are impacting employers across the country. Public sector plans are getting hit especially hard. In New Jersey, for example, state and local government workers have faced rate hikes of more than 20% year over year—115% in the last five years alone—with little relief in sight.11,12 Massachusetts has also seen proposed rate hikes averaging greater than 13% for businesses with fewer than 50 employees. That renewal rate increase is double the 3.6% benchmark for health care costs set by the Massachusetts Health Policy Commission.13 For ACA marketplace plans, analyses of initial rate filings for 2026 indicate a median proposed premium increase of 18%, according to a report by Peterson-KFF Health System Tracker.14 Another analysis of preliminary filings from July 18 found a median premium increase of 15%.15 This means that many individuals and families who obtain health insurance through the ACA marketplace will likely experience double-digit premium increases for 2026 coverage. This would be the largest increase since 2018.  Private Sector In today’s challenging economic environment, private sector employers are facing double-digit percentage increases in their commercial health care insurance premiums upon renewal. This trend—as seen with ACA plans—is driven by several interconnected factors, creating a complex and ever-changing landscape for both employers and employees. These factors include the following: 

The post Trends and Issues for US Employer Insurance: Forecasting 2026-2030 Health Care Coverage appeared first on Only Healthcare Podcast.

]]> J Clin Pathways. 2025;11(6):38-42. 

INTRODUCTION

In the health plan year 2025, health care stakeholders faced the lingering effects of the COVID-19 pandemic, a change in presidential and congressional party leadership, and artificial intelli­gence (AI)’s growing integration in health care. In addition, the rapid growth of the GLP-1 drug category overshadowed the im­pact of biologic-based products, especially cancer therapeutics.

These market factors focused the attention of business leadership, human resource departments (HR), and company boardrooms beyond health care costs. Such dynamic changes in this marketplace—shifts in regulation or law and economic ramifications—require a more robust understanding of roles, responsibilities, and available time for all business sector leaders to sustain their business through 2025 into 2026.

This column will review health care stakeholders’ final pri­orities for 2025 and the transition to a more complex business­-driven shift in risk mitigation for 2026 health care coverage.

YEAR-END 2025 PRIORITIES

In August, Law firm Fisher Phillips posted a to-do list for em­ployers regarding workplace law developments and upcoming compliance dates for the remainder of 2025.1 The listed items affect multiple C suite areas and business boards, including HR committees and operating executives. The firm notes that in 
general, all companies need to watch for major changes from the National Labor Relations Board.

Key to-do items that all employers should be aware of according to the firm include:

  1. Take note of recent US Supreme Court (SCOTUS) decisions. For instance, SCOTUS allowed continued enforcement of the Affordable Care Acts’s (ACA) preventive-care mandates, aligning with the priorities of Make America Health Again and US Food and Drug Administration chronic disease efforts.
  2. Get familiar with “America’s AI Action Plan.” This is the White House’s strategy to “safeguard your business from AI hallucinations and how to align your AI governance practices with strong data minimization principles,” according to Congressman Jay Obernolte.
  3. Follow through with the revived Department of Labor program that rewards self-reporting from auditing the Fair Labor Standards Act and Family and Medical Leave Act compliance.
  4. Learn how the “Big Beautiful Bill” federal legislation may impact your workplace.
  5. Beware of deregulation as many bans or regulatory actions may not be fully eliminated, including any of President Donald Trump’s executive orders.

In a similar vein, Foley & Lardner LLP published “2025 Health Care & Life Sciences Top Trends,” highlighting the fol­lowing developments:

  • Government enforcement and health care litigation under the Trump Administration
  • The end of Chevron deference
  • Health technology trends, including telehealth and digital health policy
  • AI in health care and life sciences (eg, medical devices, pharmaceuticals, and the biopharmaceutical industries)
  • Medicare payment model trends and economic drivers

With this list, the firm’s aim is to help businesses capitalize on opportunities and navigate potential pitfalls in an uncertain regulatory and litigation landscape.2 These risk management efforts can support a welcoming and thriving workplace that leads to a successful company.

HEALTH CARE LANDSCAPE TRANSITIONS: ALTERNATIVE COVERAGE AND HR PRACTICES

Employer of Record and Global Professional Employer Organizations

In the current economic climate, companies have been increas­ingly tasked with reassessing their approach to business success. Despite global economic uncertainty, most business leaders pri­oritized growth and increasing their financial commitment to­ward hiring throughout 2024.3,4 However, this priority shifted 
in 2025 to leverage cost efficiency.

More business leaders are adopting a “global growth mind­set.” Small- and medium-sized businesses alike are taking advantage of global expansion to navigate common challenges such as talent shortages.5 In addition, many companies are seek­ing an alternative to streamline HR functions such as hiring, recruiting, and compliance.6

Companies looking to quickly expand their workforce can try to partner with an employer of record (EOR) or a global professional employer organization (PEO) to effi­ciently manage HR needs while saving time and money.7 A PEO is a company that co-employs individuals with another company that already has its own registered entity. There are currently over 500 PEOs in the US alone.8 While a PEO only assists with employer responsibilities and certain HR tasks, an EOR handles all HR-related tasks to streamline day-to-­day operations. 

Individual Coverage Health Reimbursement Arrangements and Alternative Funding Programs

Employers are also looking at alternative coverage options to adapt to market changes. One option is Health Reimbursement Arrangements, which are “skinny plans” that offer mostly cata­strophic coverage. Individual Coverage Health Reimburse­ment Arrangements have also received much attention from pharmaceutical companies, their advisors, and vendors; how­ever, they lack an understanding of the employer marketplace perspective. The concept sounds great to those who don’t un­derstand insurance risk markets, but it represents a minority of businesses, mostly smaller employers.

Alternative funding programs (AFPs) are increasingly be­ing discussed as another solution, particularly for higher cost biologic therapies, managing the costs of specialty medications, and for those without standard commercial insurance cover­age.9 However, AFPs, along with other emerging risk-based so­lutions or so-called direct to consumer web platforms, tend to be short-term band aids for pharma/biotech firms rather than solutions to root cause problems. In addition, premium costs and out-of-pocket (OOP) costs will likely go up for members (patients) as part of these programs.

AFPs are often used by self-funded employer plans and involve a third party to manage high-cost specialty drugs.9 They may exclude these drugs from the plan and help employees ob­tain them through other means, like patient assistance pro­grams. However, there are concerns that AFPs can create barriers to accessing medications, increase patient costs, and di­vert funds. It is important to research any program thoroughly, understanding potential impacts on costs and access to neces­sary medications.10

Common types of AFPs include the following:

  • Patient Assistance Programs: Sponsored by pharmaceutical companies or nonprofits, these programs provide free or discounted medications to those unable to afford them, often assisting uninsured or underinsured patients.
  • Copay Assistance Programs: Typically offered by drug manufacturers, these programs help patients cover OOP costs for prescriptions.
  • Foundations and Nonprofit Organizations: These groups may offer financial aid for medical treatments or expenses.
  • Government Assistance Programs: Programs such as Medicaid, Medicare, and the Children’s Health Insurance Program provide various but limited coverage or subsidies for income eligibility-based individuals and families.
  • Health Savings Accounts and Flexible Spending Accounts: These tax-advantage accounts allow pre-tax funds to be used for qualified medical expenses.
  • Medical Crowdfunding: Individuals can raise funds online from the public to help cover medical costs. 

IMPORTANT CONSIDERATIONS FOR 2026

Overall, the trends emerging for 2026 include market segment splitting, reducing or limiting access to care via commercial insurance, and minimizing plan risk (cost) to balance anticipated double-digit premium increases on employers. Government programs have also seen large increases in similar annual costs post-pandemic.

Advocates, advocacy groups, and some individual employers have the following recommendations for navigating these trends:

  • Contract directly with high-value providers: Corporatization along with merger and acquisitions of health care service practices has hindered contracting efforts. Direct contracted care has delivered marginal results in geographic case studies due to the lack of large-scale use and real-world limitations in contracting with all providers in a given employer network. 
  • Design smarter plans that steer toward quality and value: Sustainable, long-term support for primary care that delivers on quality and value has remained elusive in the market due to various real-world ebb and flow market factors, including benefit plan strategy.
  • Support strong primary care to keep people healthy and costs predictable: In the rare cases where public or private employers have regained control, it hasn’t been luck—employers have been deliberate in how they purchase care. However, employer plans remain mostly status quo since the COVID pandemic.

COMMERCIAL EMPLOYER PLANS FOR 2026

Public Sector

Preliminary data shows double-digit increases in health plan renewals are impacting employers across the country. Public sector plans are getting hit especially hard. In New Jersey, for example, state and local government workers have faced rate hikes of more than 20% year over year—115% in the last five 
years alone—with little relief in sight.11,12

Massachusetts has also seen proposed rate hikes averaging greater than 13% for businesses with fewer than 50 employees. That renewal rate increase is double the 3.6% benchmark for health care costs set by the Massachusetts Health Policy Commission.13

For ACA marketplace plans, analyses of initial rate filings for 2026 indicate a median proposed premium increase of 18%, according to a report by Peterson-KFF Health System Tracker.14 Another analysis of preliminary filings from July 18 found a median premium increase of 15%.15 This means that many individuals and families who obtain health insurance through the ACA marketplace will likely experience double-digit premium increases for 2026 coverage. This would be the largest increase since 2018. 

Private Sector

In today’s challenging economic environment, private sector employers are facing double-digit percentage increases in their commercial health care insurance premiums upon renewal. This trend—as seen with ACA plans—is driven by several interconnected factors, creating a complex and ever-changing landscape for both employers and employees. These factors include the following: 

  • Rising health care costs: The underlying cost of health care, including increased prices for services such as hospitalizations, physician care, and prescription drugs, remains a primary driver of premium increases. Insurers commonly cite an 8% increase in underlying health care costs for 2026, similar to the previous year.
  • Expiration of enhanced premium tax credits: The enhanced premium tax credits for ACA are set to expire at the end of 2025. This is projected to increase OOP premium payments for many individuals by over 75% on average, according to a Peterson-KFF Health System Tracker analysis.14 Insurers anticipate this will lead healthier individuals to drop coverage, negatively impacting the risk pool and potentially driving up premiums further.
  • Tariffs: The potential impact of tariffs on the cost of pharmaceuticals, medical equipment, and supplies is another factor driving up premiums. Some insurers are building in modest upward adjustments to their trend assumptions, estimating a 3% increase in premiums due to tariffs.
  • Inflation and labor costs: Health care worker shortages and increased wage demands are driving up expenses for providers, which are ultimately reflected in premiums.
  • Demand for specialty medications: The growing demand and utilization of high-priced drugs, including GLP-1s like Ozempic and Wegovy and other specialty medications, are significantly impacting premium calculations.
  • Policy uncertainty: Uncertainty around federal policy changes and the implementation of new regulations have forced insurers to make assumptions when developing their rates, potentially leading to higher risk margins and larger rate increases.16 

For the fourth year, health plan actuaries surveyed annually by PwC said they anticipate medical cost trends for the group and individual markets to remain high. Based on these results, PwC is projecting next year’s cost trend to remain at 8.5% for the group market and 7.5% for the individual market. The pharmacy cost trend also saw an increase of 2.5 points higher than the medical trend, further highlighting the importance of managing pharmaceutical care.17 

PwC recommends that health plans put more emphasis on cost of care programs to bring the medical cost trend to a sustainable level, at least for the short term. For long-term solutions there needs to be “reallocation of healthcare spending to create a patient-centric ecosystem anchored by care that’s preventive, personalized, and predictive with flexible sites of are built around the patient.”17

According to a Mercer’s Survey on Health and Benefit Strategies for 2026, about 45% of employers are planning to shift more health care expenses to workers.18,19 For instance, they plan to institute higher deductibles or annual OOP maximums. 

However, the survey found that employers plan to increase certain benefits, including childcare, elder care services, and resources to support women’s reproductive health. More are also offering onsite Employee Assistance Program counseling services and providing more sessions. 

The Mercer survey also found that US employers are planning the following strategies for 2026:

  • Tackle high-cost growth by focusing on cost management. Some employers are choosing alternative medical plans that steer employees to higher-value providers, while some will stick to traditional plans.
  • Consider affordability when weighing health benefit cost management strategies. 
  • Support diverse workforce needs with inclusive benefits.

CONCLUSION

The transition from health plan year 2024 to 2025, and looking ahead to 2026 and beyond, reveals positive and negative trends that will continue to affect all health care stakeholders. Anticipating such mixed trends, which are sometimes counterintuitive to previous efforts or messaging, employers are making adjustments to protect their business interests. Centers for Medicare & Medicaid Services is also trying to manage short-term spending in their growing population of Medicare insurance products. These efforts are likely to negatively impact commercial insured populations due primarily to cost shifting 
by providers and therapy manufacturers shifting pricing structures worldwide. 

Clinical only guidelines or pathways utilized in managed care programs will be impacted by these numerous plan design changes or cost management programs. Non-clinical applications of clinical pathways can be expected to grow and change more quickly throughout 2026 to 2030. AI is likely to spur the expansion of uses in clinically effective programs that incorporate traditional pathways toward optimizing member patient care outcomes, including financial considerations.

Findings in US commercial plans show the following cost trends:

  • Significant cost increases are occurring. Analysts and consulting firms are projecting an annual rise in employer health plan costs in the range of 6% to 8%. This trend is a continuation of several years of above-average cost growth.20
  • Rising per-employee costs are creating further financial pressures in an uncertain US economy. The average cost per employee for a comprehensive health benefits package is expected to reach an estimated $15 000 per year, up from the $13 000-$14 000 range in 2024.21
  • ACA affordability adjustments are impacting employers and employees. The affordability benchmark for employer-sponsored coverage under the ACA is increasing to 9.96% of an employee’s household income for the 2026 plan year. This is a notable rise from 9.02% in 2025, giving employers a higher ceiling for employee cost-sharing contributions while still meeting ACA requirements. 22

As a result, employers in the commercial insurance market are expected to do the following:

  1. Optimize plan design: Adjust health plan structures to encourage more cost-effective care without sacrificing current quality in care.
  2. Leverage technology and data: Utilize available tools for both cost management and employee well-being.
  3. Be proactive with wellness and pharmacy management: Invest in preventative care and improved pharmacy strategies to yield measurable 1-year short-term and 3-to-5-year long-term savings into 2030.
  4. Consider alternative funding and risk-pooling: Explore innovative collaboration or pooling arrangements with other employers as part of stronger risk mitigation planning into 2030.
  5. Promote employee engagement and education: Facilitate member understanding and engagement for the longer term in utilization of covered benefits for benefits strategy success. 

Whatever the final plan rates may ultimately cost any employer, there remains a shared friction in health care that has been mitigated and features ever-bigger middlemen negatively impacting employers, providers, and patients. 

Employers, as plan sponsors or purchasers, have little to no visibility into health care spending, which has been allowed to happen in self-funded plans, resulting in ever-rising health care cost trends. Manufacturer portfolios of new or novel therapies have ramped up the pricing schemes while disabling lower cost options, increasing the pressure on private or public sector plans and programs. Similar challenges to effectively, yet holistically, manage utilization patterns with guidelines or pathways have faced member patient pushback due to the lack of personalized care made available.

Providers deal with ever-growing delays, denials, and rising financial receivables for delivering health care services or products. Corporatization of provider care has seemed to only enhance battles over contracting as plans faced increased care cost claims from 2024 into 2025. 

Patients struggle to find or cannot afford care (combined premium and OOP costs) and face confusing rules from third-party medical or pharmacy administrators. Regrettably, 2026 will look a lot like 2024 and 2025, but with enhanced member patient risk for OOP costs in their plan. Calls for change, transformation, and innovation now reign across the marketplace. How and when such a change will happen remains unknown. 

REFERENCES

  1. Fisher Philips. Workplace law update: 10 essential items on your August 2025 to-do list. August 1, 2025. Accessed August 30, 2025. https://www.fisherphillips.com/en/news-insights/workplace-law-update-10-essential-items-august-2025.html
  2. Foley & Lardner LLP. Health care & life sciences top trends for 2025. 2025. Accessed September 5, 2025. https://www.foley.com/health-care-life-science-trends-2025 
  3. Globalization Partners. Report: global growth. Accessed October 27, 2025. https://www.globalization-partners.com/resources/report-global-growth/
  4. MIT Sloan Management Review. Hiring trends for 2024: optimism, online recruiting, and the rise of AI. December 7, 2025. Accessed October 27, 2025. https://sloanreview.mit.edu/sponsors-content/hiring-trends-for-2024-optimism-online-recruiting-andthe-rise-of-ai/
  5. Paulise L. 3 hiring trends for 2024: AI, optimism, and online recruiting. Forbes. December 19, 2023. Accessed October 27, 2025. https://www.forbes.com/sites/lucianapaulise/2023/12/19/3-hiring-trends-for-2024-ai-optimism-and-online-recruiting/?sh=2bc986bc4196
  6. Globalization Partners. Market entry steps: how to transition from startup to growth. February 6, 2024. Accessed October 27, 2025. https://www.globalization-partners.com/blog/4-new-market-entry-steps-from-exploration-to-roi/
  7. National Association of Professional Employer Organizations (NAPEO). Industry overview. 2025. Accessed October 27, 2025. https://napeo.org/intro-to-peos/industry-overview/
  8. National Association of Professional Employer Organizations (NAPEO). PEO industry footprint 2023. March 2025. Accessed October 27, 2025. https://napeo.org/wp-content/uploads/2025/03/peoindustryfootprint2023_finalweb.pdf
  9. Globalization Partners. What is an EOR? October 13, 2025. Accessed October 27, 2025. https://www.globalization-partners.com/blog/what-is-an-eor/
  10. PAN Foundation. How alternative funding programs prevent access to medications. 2025. Accessed October 27, 2025. https://www.panfoundation.org/how-alternative-funding-programs-prevent-access-to-medications
  11. American Medical Association. Issue brief: alternative funding programs. Accessed October 27, 2025. https://www.ama-assn.org/system/files/issue-brief-alternative-funding-programs.pdf
  12. Becker’s Payer Issues. New Jersey public employees face major premium rate increases in 2026. July 11, 2025. Accessed October 27, 2025. https://www.beckerspayer.com/payer/new-jersey-public-employees-face-major-premium-rate-increases-in-2026/
  13. Office of the Governor, State of New Jersey. Governor Murphy announces efforts to address premium rate increases. July 9, 2025. Accessed October 27, 2025. https://www.nj.gov/governor/news/news/562025/approved/20250709b.shtml
  14. Peterson-KFF Health System Tracker. How much and why ACA marketplace premiums are going up in 2026. August 6, 2025. Accessed October 27, 2025. https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2026
  15. Insurance NewsNet. Health plans seek double-digit rate increases. June 4, 2025. Accessed October 27, 2025. https://insurancenewsnet.com/oarticle/health-plans-seek-double-digit-rate-increases
  16. Peterson-KFF Health System Tracker. Individual market insurers requesting largest premium increases in more than 5 years. July 18, 2025. Accessed October 27, 2025. https://www.healthsystemtracker.org/brief/individual-market-insurers-requesting-largest-premium-increases-in-more-than-5-years/
  17. PwC Health Research Institute. Behind the numbers: medical cost trends. July 16, 2025. Accessed October 27, 2025. https://www.pwc.com/us/en/industries/healthindustries/library/behind-the-numbers.html
  18. CNN Business. Health care costs for employees to rise in 2026. July 16, 2025. Accessed October 27, 2025. https://www.cnn.com/2025/07/16/economy/health-care-costs-employees-2026
  19. Mercer. 2026 benefit strategies report. 2025. Accessed October 27, 2025. https://www.mercer.com/en-us/insights/total-rewards/employee-benefits-strategy/2026-benefit-strategies-report/
  20. Business Group on Health. Business Group on Health survey reveals almost 8% in projected health care trend for 2025. August 20, 2025. Accessed October 27, 2025. https://www.businessgrouphealth.org/newsroom/news-and-press-releases/press-releases/2025-employer-health-care-strategy-survey
  21. Mayer K. Employers project 8%-9% rise in health care costs for 2025. SHRM. August 22, 2024. Accessed October 27, 2025. https://www.shrm.org/topics-tools/news/benefits-compensation/employers-project-8–9–rise-in-health-care-costs-for-2025
  22. Smith DZ, Hughes C. 2026 affordability percentage for employer health coverage increases. July 22, 2025. Accessed October 27, 2025. https://www.mercer.com/insights/law-and-policy/2026-affordability-percentage-for-employer-health-coverage

Originally published in the Transformative Business Trends column at Journal of Clinical Pathways

The post Trends and Issues for US Employer Insurance: Forecasting 2026-2030 Health Care Coverage appeared first on Only Healthcare Podcast.

]]> 1286 Employers and Manufacturers: A Call to Action to Co-Lead the Future of Health Care https://onlyhealthcarepodcast.com/employers-and-manufacturers-a-call-to-action-to-co-lead-the-future-of-health-care/?utm_source=rss&utm_medium=rss&utm_campaign=employers-and-manufacturers-a-call-to-action-to-co-lead-the-future-of-health-care Wed, 01 Oct 2025 12:00:00 +0000 https://rst.bxq.mybluehost.me/website_cc17099b/?p=1311 F. Randy Vogenberg, PhD, FASHP J Clin Pathways. 2025;11(5):55-56. There is a path forward for employer plans and manufactur­ers despite the health care sector surging with costs from unprecedented medical and technological breakthroughs. From artificial intelligence (AI)-assisted diagnostics and real-time clinical data platforms to the emergence of cell and gene thera­pies (CGTs), biologics, and targeted medicines, we are on the cusp of an overdue medical transformation. Pathways, clinical guidelines, and other management tools can barely keep cur­rent. Yet, despite this acceleration, many patients—particularly those insured through employer-sponsored plans—still struggle to access these advancements due to outdated care or reimburse­ment models, payer silos, and rising treatment costs of care. It’s no longer just a health care issue. It’s a workforce issue. And it’s one employers and biopharmaceutical or device manu­facturers must solve together. The Real Problem: Innovation Without Access Innovation without access is a failure for manufacturers and employers. Clinical pathways, for example, are just one tool with multiple users, purposes, and developers. Simply focusing on clinical or cost control has not worked for members. For innovation to be sustainable, there must be a dynamic balance to member access. The following issues prevent members from receiving optimal care: According to McKinsey & Company, US employers are ex­pected to spend over $1.5 trillion on health care by 2030, with­out a guarantee of improved outcomes.1 American society in general now seeks a health care reboot through White House initiatives such as Make America Health Again, upending a long-time status quo ecosystem.2 Interestingly, commentary in and about that Report indicates the desire for commercial insurance to drive innovation at a faster pace than the government could achieve. Such a strategy would leverage faster continuous qual­ity improvement cycles of innovation that are more routinely utilized in the private sector. What Employers Can Do Differently and Why Manufacturers Should Join Them Challenged employers are stepping up—not just as plan spon­sors, but as architects of access to care using their own pathway sources. With more freedom or flexibility in being Employee Retirement Income Security Act (ERISA) plan sponsors, com­mercial-insured entities have a long history of unique offerings but minimal-to-no scaling. Building on the past successes, there is a renewed seeking of scaling solutions through collabora­tion with manufacturers and facilitative organizations such as Only Healthcare Consultants (OHC). They are supporting new models that prioritize member education, transparency, and actionable data that both employers and manufacturers have sought independently for decades. Different from prior direct contract efforts, Employer Em­powerment Models (EEM) reimagine health care engagement at the grassroots level, empowering employers to take the fol­lowing actions: This model isn’t just a theory. Like continuous quality im­provement models, EEMs have evolved toward a scalable ap­proach and are being validated by real-world employer-manufac­turer pilots with long-term potential for market transformation. Why This Moment Matters AI is holding health care accountable at a rapid pace, just as technologies continue to accelerate devices, drugs, and vaccines through the FDA approval pipeline. Employee expectations around benefits have also changed since the pandemic. And the next wave of therapies—from mRNA-based cancer vaccines to gene editing solutions for rare diseases—won’t succeed without broader consumer buy-in. Manufacturers can no longer rely solely on historically based top-down awareness or traditional television campaigns. Existing third-party intermediaries are not trusted. The path to sustainable member utilization runs through trust, and trust is built at the community level in workplaces, families, and households. The call to action today runs through a new kind of part­nership. An EEM that seeks to enable manufacturers to meet plan members where they are remains elusive. Collaborating purposely inside employer ecosystems, through data-driven strategy and culturally relevant engagement, is a strategic path forward. Such a strategy can enhance the effective utilization of clinical guidelines, pathways, or other care management tools that can be beneficial to all concerned. Much can be achieved together to ensure that innovation reaches the people who need it, when they need it. Because what good is technology or benefit innovation if no one member trusts it enough to use it, let alone fails in efforts to access it? Originally published in the Journal of Clinical Pathways.

The post Employers and Manufacturers: A Call to Action to Co-Lead the Future of Health Care appeared first on Only Healthcare Podcast.

]]> F. Randy Vogenberg, PhD, FASHP

J Clin Pathways. 2025;11(5):55-56.

There is a path forward for employer plans and manufactur­ers despite the health care sector surging with costs from unprecedented medical and technological breakthroughs. From artificial intelligence (AI)-assisted diagnostics and real-time clinical data platforms to the emergence of cell and gene thera­pies (CGTs), biologics, and targeted medicines, we are on the cusp of an overdue medical transformation. Pathways, clinical guidelines, and other management tools can barely keep cur­rent. Yet, despite this acceleration, many patients—particularly those insured through employer-sponsored plans—still struggle to access these advancements due to outdated care or reimburse­ment models, payer silos, and rising treatment costs of care.

It’s no longer just a health care issue. It’s a workforce issue. And it’s one employers and biopharmaceutical or device manu­facturers must solve together.

The Real Problem: Innovation Without Access

Innovation without access is a failure for manufacturers and employers. Clinical pathways, for example, are just one tool with multiple users, purposes, and developers. Simply focusing on clinical or cost control has not worked for members. For innovation to be sustainable, there must be a dynamic balance to member access. The following issues prevent members from receiving optimal care:

  • Formulary hurdles and utilization barriers continue to block even US Food and Drug Administration (FDA)- approved, evidence-based therapies from reaching patients who need them most.
  • Misinformation and apathy fueled by public distrust, political narratives, and inconsistent communication have significantly eroded the credibility of preventive care, especially vaccines.
  • Employers are absorbing higher care costs year after year, while employee members face steeper deductibles or co-insurance, narrowed provider networks (medical and pharmacy benefits), and fewer meaningful access options.

According to McKinsey & Company, US employers are ex­pected to spend over $1.5 trillion on health care by 2030, with­out a guarantee of improved outcomes.1 American society in general now seeks a health care reboot through White House initiatives such as Make America Health Again, upending a long-time status quo ecosystem.2 Interestingly, commentary in and about that Report indicates the desire for commercial insurance to drive innovation at a faster pace than the government could achieve. Such a strategy would leverage faster continuous qual­ity improvement cycles of innovation that are more routinely utilized in the private sector.

What Employers Can Do Differently and Why Manufacturers Should Join Them

Challenged employers are stepping up—not just as plan spon­sors, but as architects of access to care using their own pathway sources. With more freedom or flexibility in being Employee Retirement Income Security Act (ERISA) plan sponsors, com­mercial-insured entities have a long history of unique offerings but minimal-to-no scaling. Building on the past successes, there is a renewed seeking of scaling solutions through collabora­tion with manufacturers and facilitative organizations such as Only Healthcare Consultants (OHC). They are supporting new models that prioritize member education, transparency, and actionable data that both employers and manufacturers have sought independently for decades.

Different from prior direct contract efforts, Employer Em­powerment Models (EEM) reimagine health care engagement at the grassroots level, empowering employers to take the fol­lowing actions:

  • Understand behavioral barriers like manufacturer mistrust through real-time employee feedback;
  • Collaborate directly with manufacturers to co-design localized educational campaigns; and
  • Pilot programs that deliver predictable access to novel therapies and preventative care that are beneficial to members and plan sponsors.

This model isn’t just a theory. Like continuous quality im­provement models, EEMs have evolved toward a scalable ap­proach and are being validated by real-world employer-manufac­turer pilots with long-term potential for market transformation.

Why This Moment Matters

AI is holding health care accountable at a rapid pace, just as technologies continue to accelerate devices, drugs, and vaccines through the FDA approval pipeline. Employee expectations around benefits have also changed since the pandemic. And the next wave of therapies—from mRNA-based cancer vaccines to gene editing solutions for rare diseases—won’t succeed without broader consumer buy-in.

Manufacturers can no longer rely solely on historically based top-down awareness or traditional television campaigns. Existing third-party intermediaries are not trusted. The path to sustainable member utilization runs through trust, and trust is built at the community level in workplaces, families, and households.

The call to action today runs through a new kind of part­nership. An EEM that seeks to enable manufacturers to meet plan members where they are remains elusive. Collaborating purposely inside employer ecosystems, through data-driven strategy and culturally relevant engagement, is a strategic path forward. Such a strategy can enhance the effective utilization of clinical guidelines, pathways, or other care management tools that can be beneficial to all concerned.

Much can be achieved together to ensure that innovation reaches the people who need it, when they need it. Because what good is technology or benefit innovation if no one member trusts it enough to use it, let alone fails in efforts to access it?

Originally published in the Journal of Clinical Pathways.

The post Employers and Manufacturers: A Call to Action to Co-Lead the Future of Health Care appeared first on Only Healthcare Podcast.

]]> 1311 Employer-Driven Health Care: Opportunities for Change https://onlyhealthcarepodcast.com/employer-driven-health-care-opportunities-for-change/?utm_source=rss&utm_medium=rss&utm_campaign=employer-driven-health-care-opportunities-for-change Wed, 01 Oct 2025 12:00:00 +0000 https://rst.bxq.mybluehost.me/website_cc17099b/?p=1314 F. Randy Vogenberg, PhD, FASHP J Clin Pathways. 2025;11(5):52-54. Stakeholder Positioning Across the Commercial and Government Health Insurance Landscape During the annual budget debate, Congress and state legislatures continued their advocacy and lobbying efforts to advance health care reform. Employers, manufacturers, providers, and consum­er advocates descended upon statehouses and Congress to draw attention to problems in US health care economics. In response to such advocacy and proposed governmental program inter­ventions emanating from new budgets, commercially insured populations have discussed potential strategies with government officials to address these issues. Despite these efforts, reform outcomes have been uneven, and common issues remain, including the following: employ­ers do not have complete access to claims data from their plan; pricing and claim cost transparency remain mired in supply chain opacity behind multiple contracted entities; and manu­facturers are not collaborating or partnering with employers on insurance solutions for novel therapies. All parties need to get involved with health care reform, as the government has become engaged in market change. Gov­ernment actions and related market-based cost shifting have created barriers or operational issues for other commercial plan stakeholders. For example, the Health Insurance Portability and Accountability Act (HIPAA) has member data sharing bar­riers to hide the value of medication therapies. In addition, the Affordable Care Act created a fiscal problem for commercial employer plans by removing lifetime health care benefits. Oth­er legislation of government programs impacting health care include Medicaid best price regulation, 340B pricing discounts, prior approvals (PAs) for coverage or formulary procedures, and state regulations that limit individual utilization data and create barriers for member patients to access drugs. Manufacturers and employers express a desire to learn from each other, yet both fail to understand the other’s operation­al position in the market. For example, personal bankruptcy trends show how employers are confronting medical plan-re­lated or business bankruptcies. The commercial trend of not covering drug therapies is likely to continue, as most employers wait until they are hit with a catastrophic claim to come up with a solution—akin to a deer in headlights. Commercial employer insurance plans will require a lot of education. Established business groups have been active in education with their members, but that is a small percentage of plans. In January, the National Pharmaceutical Council pro­duced the open-source publication Patient & Caregiver Odys­sey1 to illustrate challenges patients face in therapeutic care for cell and gene therapy (CAGT). Care guidelines and pathways, while informative clinically, can go awry with the presence of multiple financial adaptations in the market. These adaptations, used by both government and commercial plan administrators, often conflict, ultimately preventing optimal care for a patient. The Evolution of Commercial Health Insurance As novel therapies and CAGTs grow in number in the market, there are key issues to address for multistakeholders. These in­clude plan and patient affordability; the role of drug therapy re­bates vs no-rebates models; the strategic use of PAs vs current PA practices that yield few denials; and patient assistance programs (PAPs) funded by manufacturers. To date, manufacturers have shown an inability to work toward change in a market landscape without rebates. In addition, hospitals and large specialty medi­cal groups tend to be combative, rather than collaborative, re­garding 340B program changes during federal or state legislative sessions. Lost in many public conversations among health care stake­holders is the total cost of care and what that means for the employer-sponsored plan or patient. The original purpose of commercial health insurance was primarily to provide a safety net for workers by protecting against income loss due to ill­ness, particularly hospital-based care.2 While its initial focus was not on making health care cheaper, as the US business landscape changed, insurance gradually evolved to encompass medical and pharmacy expense coverage, along with cost-con­tainment processes. These included recruiting new employees, retaining existing employees, and being seen as an employee-friendly workplace. At its core, commercial insurance is a form of private health insurance coverage that pays for individual patients’ medical and surgical expenses. Unlike government-sponsored insur­ance, commercial insurance is often offered through an em­ployer’s benefit package.3 It provides employees the option of obtaining coverage at a potentially lower cost than purchasing it independently. In addition, out-of-pocket employee costs may be lower or waived, depending on benefit coverage or spe­cific plan details provided by the employer. In 2024, the year-over-year (YoY) cost of plans increased and is projected to continue rising at double-digit rates into 2025, with the same expected for 2026.4,5 Health insurance costs today are increasing rapidly due to several factors. These include the rising cost of medical services, an aging workforce, medical inflation, insurance market consolidation, coverage strategies by employers, and residual effects of the COVID-19 pandemic. Additional factors that employers face in the con­tinuing cost trend dilemma include the overall economy, tar­iffs, government spending reductions through the Centers for Medicare & Medicaid Services (CMS), and cost-shifting to the employer market. Ellen Kelsay, president and CEO of Business Group on Health (BGH), said that broad-based and sustained cost reduc­tion “must fundamentally come from the delivery system itself and is not isolated only to the commercial/employer market.”6 To do so will require changes and approaches that would em­power commercial employer plans over a sustainable, long-term period. The following are some current approaches to curb costs: Where Do Pathways and Algorithms Fit Pathways and algorithms are integral to the evolving land­scape of health care delivery, serving as valuable tools to en­hance efficiency, accuracy, and patient outcomes. Pathways for clinical care stemming from physicians, surgeons, and ad­vanced practice providers help create and manage a patient’s treatment plan. Such tools or platforms aim to standardize care processes by translating clinical practice guideline recommendations into actionable steps for delivering patient care. Ultimately, these efforts can assist in maximizing patient safety and clinical ef­ficiency to achieve optimal patient outcomes. Studies suggest that using clinical pathways can lead to improved clinical and economic outcomes, such as decreased length of hospital stay, fewer in-hospital complications, and improved professional services documentation.7 In the context of health care delivery, algorithms are com­putational processes designed to analyze data and support

The post Employer-Driven Health Care: Opportunities for Change appeared first on Only Healthcare Podcast.

]]> F. Randy Vogenberg, PhD, FASHP

J Clin Pathways. 2025;11(5):52-54.

Stakeholder Positioning Across the Commercial and Government Health Insurance Landscape

During the annual budget debate, Congress and state legislatures continued their advocacy and lobbying efforts to advance health care reform. Employers, manufacturers, providers, and consum­er advocates descended upon statehouses and Congress to draw attention to problems in US health care economics. In response to such advocacy and proposed governmental program inter­ventions emanating from new budgets, commercially insured populations have discussed potential strategies with government officials to address these issues.

Despite these efforts, reform outcomes have been uneven, and common issues remain, including the following: employ­ers do not have complete access to claims data from their plan; pricing and claim cost transparency remain mired in supply chain opacity behind multiple contracted entities; and manu­facturers are not collaborating or partnering with employers on insurance solutions for novel therapies.

All parties need to get involved with health care reform, as the government has become engaged in market change. Gov­ernment actions and related market-based cost shifting have created barriers or operational issues for other commercial plan stakeholders. For example, the Health Insurance Portability and Accountability Act (HIPAA) has member data sharing bar­riers to hide the value of medication therapies. In addition, the Affordable Care Act created a fiscal problem for commercial employer plans by removing lifetime health care benefits. Oth­er legislation of government programs impacting health care include Medicaid best price regulation, 340B pricing discounts, prior approvals (PAs) for coverage or formulary procedures, and state regulations that limit individual utilization data and create barriers for member patients to access drugs.

Manufacturers and employers express a desire to learn from each other, yet both fail to understand the other’s operation­al position in the market. For example, personal bankruptcy trends show how employers are confronting medical plan-re­lated or business bankruptcies. The commercial trend of not covering drug therapies is likely to continue, as most employers wait until they are hit with a catastrophic claim to come up with a solution—akin to a deer in headlights.

Commercial employer insurance plans will require a lot of education. Established business groups have been active in education with their members, but that is a small percentage of plans. In January, the National Pharmaceutical Council pro­duced the open-source publication Patient & Caregiver Odys­sey1 to illustrate challenges patients face in therapeutic care for cell and gene therapy (CAGT). Care guidelines and pathways, while informative clinically, can go awry with the presence of multiple financial adaptations in the market. These adaptations, used by both government and commercial plan administrators, often conflict, ultimately preventing optimal care for a patient.

The Evolution of Commercial Health Insurance

As novel therapies and CAGTs grow in number in the market, there are key issues to address for multistakeholders. These in­clude plan and patient affordability; the role of drug therapy re­bates vs no-rebates models; the strategic use of PAs vs current PA practices that yield few denials; and patient assistance programs (PAPs) funded by manufacturers. To date, manufacturers have shown an inability to work toward change in a market landscape without rebates. In addition, hospitals and large specialty medi­cal groups tend to be combative, rather than collaborative, re­garding 340B program changes during federal or state legislative sessions.

Lost in many public conversations among health care stake­holders is the total cost of care and what that means for the employer-sponsored plan or patient. The original purpose of commercial health insurance was primarily to provide a safety net for workers by protecting against income loss due to ill­ness, particularly hospital-based care.2 While its initial focus was not on making health care cheaper, as the US business landscape changed, insurance gradually evolved to encompass medical and pharmacy expense coverage, along with cost-con­tainment processes. These included recruiting new employees, retaining existing employees, and being seen as an employee-friendly workplace.

At its core, commercial insurance is a form of private health insurance coverage that pays for individual patients’ medical and surgical expenses. Unlike government-sponsored insur­ance, commercial insurance is often offered through an em­ployer’s benefit package.3 It provides employees the option of obtaining coverage at a potentially lower cost than purchasing it independently. In addition, out-of-pocket employee costs may be lower or waived, depending on benefit coverage or spe­cific plan details provided by the employer.

In 2024, the year-over-year (YoY) cost of plans increased and is projected to continue rising at double-digit rates into 2025, with the same expected for 2026.4,5 Health insurance costs today are increasing rapidly due to several factors. These include the rising cost of medical services, an aging workforce, medical inflation, insurance market consolidation, coverage strategies by employers, and residual effects of the COVID-19 pandemic. Additional factors that employers face in the con­tinuing cost trend dilemma include the overall economy, tar­iffs, government spending reductions through the Centers for Medicare & Medicaid Services (CMS), and cost-shifting to the employer market.

Ellen Kelsay, president and CEO of Business Group on Health (BGH), said that broad-based and sustained cost reduc­tion “must fundamentally come from the delivery system itself and is not isolated only to the commercial/employer market.”6

To do so will require changes and approaches that would em­power commercial employer plans over a sustainable, long-term period. The following are some current approaches to curb costs:

  • Move toward value-based models that reward preventive care, ensuring long-term sustainability. Examples have varied widely—such as an employer vs commercial managed care third-party entity—and some models have evolved differently based on the perspective taken by the model. This area continues to evolve as cost concerns have escalated in 2025 for 2026 and beyond.
  • Leverage artificial intelligence (AI). This early stage of predictive analytics requires significant program effort, costly data storage or analytic services, and has been limited in scope to highly controlled practices or specific rare diseases. Uncertainty in inputs within com­plex models or the lack of holistic pathways can limit AI’s decision-making value for preventative strategies, along with underwriting determinations or actuarial premium setting.
  • Reduce catastrophic claims. This is another early-stage aspect of AI-based predictive analytics that is still limited in scope to highly controlled practices or specific rare diseases. Uncertainty in inputs within complex models or the lack of holistic pathways can limit decision-making value for preventative strategies and tactics.
  • Improve the ability to track patients longitudinally over more than a single plan year or multiple employer plans. This will require overcoming challenges related to legal or regulatory compliance issues, such as HIPAA, the Health Information Technology for Economic and Clinical Health (HITECH) Act), and the Employee Retirement Income Security Act (ERISA), to name a few.
  • Determine who takes on financial risk flows and responsibility for patient-insured or reinsured monies over longer time periods. For example, who has contract or plan risk in a product warranty? Employer centric entities need to advocate with manufacturers and/ or collaborate in the risk hub of patient-centered care.

Where Do Pathways and Algorithms Fit

Pathways and algorithms are integral to the evolving land­scape of health care delivery, serving as valuable tools to en­hance efficiency, accuracy, and patient outcomes. Pathways for clinical care stemming from physicians, surgeons, and ad­vanced practice providers help create and manage a patient’s treatment plan.

Such tools or platforms aim to standardize care processes by translating clinical practice guideline recommendations into actionable steps for delivering patient care. Ultimately, these efforts can assist in maximizing patient safety and clinical ef­ficiency to achieve optimal patient outcomes. Studies suggest that using clinical pathways can lead to improved clinical and economic outcomes, such as decreased length of hospital stay, fewer in-hospital complications, and improved professional services documentation.7

In the context of health care delivery, algorithms are com­putational processes designed to analyze data and support de­cision-making. They can range from simple decision trees to complex machine-learning models. Algorithms can be used at various stages of the patient journey.8

A pilot survey report published by the Journal of Clinical Pathways in October 2024 discussed real-world findings on who uses pathways and other platforms containing algorithms for patient care management.9 The results revealed that multiple clinicians, administrators, and other organizations responsible for benefits administration outside of direct clinical care utilize these tools. As such, there are many different uses, and there­fore value, for clinical pathways.

Nonetheless, clinical pathway tools need to evolve beyond their current limitations or areas of focus. Insights gained across the patient journey for holistic financial and optimal outcomes can deliver improved plan performance solutions that employ­ers, as plan sponsors, are seeking. By expanding the developer pool, health professionals can better document the use and po­tential of care pathways to deliver on the promise of enhanced patient outcomes.

As pathway developers move into real-world and real-time applications, they should find a more welcoming market re­sponse due to current health insurance underwriting trends. As a result, the marketplace could achieve the desired balance in executing clinically effective plan designs. Parallel and col­laborative efforts by stakeholders can help accelerate both the improvement and implementation of such effective tools or platforms across all health care market settings.

Summary

Balancing economic and clinical elements of a commercial health plan through a clinical effectiveness strategy for personalized medicine remains elusive and difficult to execute. There is a lack of alignment, collaboration, and shared goals among stakehold­ers in the US market.

Commercial insurance plans will continue to face a rising tide of double-digit claim cost trends, along with employee de­mands for better plan coverage. The unpredictability of claim occurrence, cost, and volume hampers commercial or second­ary insurance underwriting, further contributing to higher premiums and patient out-of-pocket outlays.

Whether employers will follow the Medicare coverage change is not certain. There also may be unintended adverse impact(s) from the Medicare pricing model for negotiated ther­apies proposed by the White House.

The question isn’t if or why employers will make chang­es to coverage for novel therapies, it’s who, how many, and how fast. Innovation in medical technologies and therapeutics is happening at an increasingly faster pace, followed by increasingly rapid marketing approvals by the US Food and Drug Administration (FDA).

If they act now, stakeholders who work with commercial employer plans will gain a competitive advantage in the evolv­ing commercial health care benefit plan landscape. The devel­opment and application of pathways or algorithm-driven tools will continue to expand and support coverage changes. Robust commercial employer plans, and a viable commercial, private-sector health care market, could perhaps influence government programs to follow the commercial lead in operating balanced, clinical effectiveness-driven programs.

The post Employer-Driven Health Care: Opportunities for Change appeared first on Only Healthcare Podcast.

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