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How Do Employers Control Healthcare Costs Without Hurting Employees?

How Do Employers Control Healthcare Costs Without Hurting Employees?

February 16, 2026

For many employers today, especially small to mid-sized companies with 100-500 employees, providing healthcare for its employee base has become one of the most difficult expenses to manage. Each year brings another renewal with higher premiums, and typical solutions offered often involve increasing annual deductibles, raising employee contributions, or reducing benefits.

While those strategies may temporarily reduce the employer’s cost, they often shift the burden to employees. Over time, that can create frustration, reduce morale, and even discourage employees from seeking necessary care, ultimately having a direct effect on the overall health & well-being of your employee population, potentially affecting employee production.

This leads many employers to ask an important question:

How can we control healthcare costs without hurting employees?

The answer begins with rethinking how an employer’s healthcare is purchased and managed.

Shifting From Cost Shifting to Cost Management


Historically, many companies addressed rising healthcare costs by shifting more expenses to employees. As mentioned, higher deductibles and increased premium contributions have become the common responses to rising insurance premiums,

However, this approach rarely solves the underlying problem. It simply redistributes the cost.

More employers are now exploring ways to manage healthcare spending more strategically, focusing on improving the efficiency and value of the care employees receive. This type of healthcare accountability and employee guidance is readily available but not highly utilized by many employers’ current healthcare purchasing model.

Improving Access to the Right Care


One of the biggest drivers of unnecessary healthcare spending is employees accessing care in the wrong setting.

For example, emergency room visits for non-emergency conditions can cost several times more than care delivered in an urgent care clinic or primary care office. When employees have clear guidance on where to seek care, costs can often be reduced without limiting access to treatment.

Providing employees tools such as care navigation services or prescription drug sourcing options can help them find appropriate care quickly, or more affordable costs for the same prescriptions, while also lowering overall employer spending.

Addressing the Biggest Cost Drivers


In most employer health plans, a relatively small number of medical conditions account for a large percentage of total employer healthcare spending. Chronic conditions such as diabetes, heart disease, musculoskeletal issues, and certain specialty medication often represent a significant share of the claims.

Employers can actually focus on these conditions by having access to their available healthcare data, allowing them to first identify & then more effectively manage these claims. A common myth is that the data is not available but all employers, especially those with over 100 employees, should have access to their healthcare data–it is THEIR DATA. Once employers learn they can have access & control over this data, and subsequently much of their healthcare spend, they discover that this refocusing provides much needed help for these employees to better manage these conditions, through preventive care, coaching programs, or early intervention, realistically improving health outcomes while controlling the long-term costs for both employee and employer.

Improving Transparency in Healthcare Pricing


Healthcare pricing is often difficult to understand, and the same service can vary drastically in cost depending on where it is delivered.

Employers are increasingly looking for ways to have access to their own healthcare data that can improve price transparency and guide employees toward high-quality providers that deliver care more efficiently. When employees have access to clearer information about healthcare cost and quality, they can make better decisions about where to receive care.

Evaluating Vendor Performance


Many employer health plans rely on multiple vendors, including insurance carriers, pharmacy benefit managers, and third-party administrators. Over time, these relationships can become complex, and employers may not always have the important and clear visibility into how well those vendors are performing.

Regularly reviewing vendor contracts, fees, and performance metrics can help ensure that these vendors are not only being held to higher accountability standards but that the employer’s organization is receiving appropriate, high quality and cost-effective value from its healthcare partners.

Focusing on Long-Term Value


Controlling healthcare costs does not necessarily mean reducing benefits. In many cases, the attainable goal is to deliver better care in a more efficient way.

Employers that approach healthcare with the same level of strategic oversight they apply to other areas of their business often discover opportunities to improve both employee experience and financial sustainability for their organization.

A More Balanced Approach


Healthcare costs will likely continue to rise, but employers are not without options. By focusing on smarter purchasing decisions, better access to care, and improved transparency through often overlooked access to their own healthcare data, organizations can begin to manage costs more effectively without shifting the burden onto employees.

Ultimately, the goal is not simply to spend less on healthcare–it is to ensure employees receive the right care at the right time in the right place, while maintaining a sustainable cost structure for the employer’s organization.

 

If you have any questions on this or other strategic benefits thinking, please contact us at 714.716.4060 or mike@my-EBP.com, or provide info here.


Final Rule Implements Ban on Surprise Billing Medical Billing

Final Rule Implements Ban on Surprise Medical Billing

August 26, 2022

On Aug. 19, 2022, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) jointly released a final rule implementing the ban on surprise medical billing under the No Surprises Act (NSA), which was enacted as part of the Consolidated Appropriations Act, 2021 (CAA). This rule finalizes two interim final rules released in July 2021 and September 2021, with certain changes related to the independent dispute resolution (IDR) process that has been the subject of ongoing litigation.

 

The Departments also released FAQs on NSA implementation in conjunction with the final rule that provide more detail on the surprise medical billing ban.

Surprise Medical Bills


Surprise medical bills occur when patients unexpectedly receive care from out-of-network providers (for example, treatment at an in-network hospital involving an out-of-network doctor). Patients often cannot determine the network status of providers during treatment to avoid additional charges and, in many cases, are not involved in the choice of provider at all.

Overview of the Final Rules


The final rule is generally intended to make certain medical claims payment processes more transparent and clarify the process for providers and health insurers to resolve their disputes. It:

  • Implements certain disclosure requirements related to information that group health plans and health insurance issuers offering group or individual health coverage must share about the qualifying payment amount (QPA) (generally, the health plan’s median contract rate for the item or service in the geographic area);
  • Finalizes certain changes related to the federal independent dispute review (IDR) process in light of ongoing litigation; and
  • Requires plans and issuers to disclose additional information in situations where they change a healthcare provider’s billing code to one of lesser value (lowering the payment to the healthcare provider).

Important Dates


July 1, 2021, and Sept. 30, 2021

Interim final rules to implement provisions of the No Surprise Act (NSA) related to surprise billing were released.

 

Aug. 19, 2022

Rules implementing the ban on surprise billing are finalized.

 

 Jan. 1, 2022

The No Surprise Act (NSA) generally applies to plan or policy yers beginning on or after Jan. 1, 2022.


The final rules generally require healthcare providers to agree with health plans and issuers on a payment amount instead of billing patients for unpaid balances.


For a copy of this overview, click below:

Final Rule Implements Ban on Surprise Medical Billing

 

If you have any questions on this or other benefits-related legislation, please contact us at 714.716.4060 or mike@my-EBP.com, or provide info here .