Insights
By: Brandon Batiste (Morgan Health) and Kyle Natichioni (Merative)
August 5, 2026
Employers are making higher-stakes benefit decisions faster than ever, against the backdrop of severe cost pressure and rising care complexity and fragmentation. This landscape is changing how employers are evaluating their purchasing patterns.
A simple explanation of renewal increases is no longer enough. Employers want to understand:
There’s one clear opportunity to differentiate in today’s market: offer better data visibility, paired with timely, actionable analytics. By doing so, health plans can more effectively empower employers to identify cost and quality variation, anticipate high-cost events and present more attractive choices to employees.
There are three key opportunities for true differentiation and innovation:
Employers, especially small and mid-sized groups, are asking for flexibility without added complexity. They’re exploring narrower networks, alternative plan designs, and other network types to stabilize trends while maintaining access and employee satisfaction. For plans, these models can be game changers, but only if they can offset rising premium costs without sacrificing quality.
Today, premium inflation has become more than a pricing challenge – it’s an account retention and growth risk. Employers increasingly expect plans to show how different designs perform across cost, utilization, and experience. They must then tailor recommendations based on the employer’s industry, demographics and utilization patterns.
The market opportunity is clear. Plans can lead with value-forward coverage models, but scale depends on the ability to:
Truven, a division of Merative, enables plans to turn alternative designs into measurable, reportable value. With Truven’s Account Group Insights, plans can deliver account-level reporting and benchmarking across cost, utilization, quality, and outcomes, enhanced with peer and industry comparisons for added context. These insights resonate with employer purchasers by going beyond trend reporting to clearly explain why costs are changing – and more importantly, what to do next, such as optimizing disease management programs, targeting high-impact intervention opportunities, and evaluating alternative network designs.
Truven’s Account Group Insights was utilized by a large employer seeking to address drug waste and misuse. They uncovered $4.2M in annual savings – based on inflated prices from high-cost providers. The employer was then able to work with their health plan to develop a preferred provider network for specialty drug administration, which remains a major cost driver for employers today.
Specialty drugs, including cell and gene therapies, are rapidly increasing spend and volatility, particularly for employer-sponsored populations. Employers don’t just see a higher pharmacy line. They experience unpredictability and potential volatility. For employees who might need these life-changing therapies, they face financial anxiety and uncertainty. Health plans sit in the middle, accountable for cost management and clinical stewardship at the same time.
Plans that integrate clinical oversight, utilization controls, and alternative financing can manage volatility while maintaining trust. But the real value-add is evidence. Employers want to understand the total cost impact beyond the drug itself, including specialist visits, administration, ancillary care, follow-ups and side effects. They also want to know where variation exists: prescribing patterns, site of care, biosimilar adoption, and population prevalence.
Truven equips plans with analytics and benchmarking to bring clarity to specialty pharmacy strategy. Longitudinal claims analysis links specialty utilization to medical outcomes and total cost of care at the episode level. Additionally, MarketScan® benchmarking datasets support large-scale analysis of utilization, outcomes, and cost variation across comparable populations. Through these tools, plans can identify high-variation therapies, providers, and sites of care to inform formulary strategy, site-of-care optimization and utilization management. And critically, they can produce employer-ready reporting that explains specialty spend, what’s driving it, and what value clinical management strategies are delivering. This enablesa more productive conversation guiding what actions to take next.
Recently, MarketScan was deployed by a mid-sized employer seeking to optimize the cost and quality of specialty drug administration. Through the data, the employer was able to identify more cost-effective sites of care – without sacrificing quality or delaying care. Directing members to these sites helped achieve $6M in annual savings accounting for 18% of total medical specialty spend.
Employees increasingly expect real-time, personalized guidance. In fact, many already rely on digital tools and AI-enabled experiences to make care decisions. Plans that don’t meet this expectation risk low engagement, care leakage, avoidable utilization and dissatisfaction – outcomes that erode employer trust in plan performance.
There’s a real opportunity to more proactively guide members to high-quality, affordable care through digital front doors and benefit designs that make the “right” choice easier.
Truven provides the analytic backbone to measure navigation impact over time using comprehensive MarketScan longitudinal closed claims data – revealing how guidance influences downstream utilization, outcomes and total cost of care. Plans can identify high-impact steerage opportunities (in high-impact areas like imaging, surgeries, and specialty referrals) and where employees diverge from optimal pathways. Doing so helps measure behavioral change and ROI at all levels (plan, employer, and population level). On the employee side, tools like Benefits Mentor, which helps members select the most appropriate benefit plan, offer greater visibility into out-of-pocket costs and benefit design – empowering consumer decision-making and tradeoffs.
The bottom line: employers are asking for speed, clarity, and accountability. Health plans that pair innovative offerings with transparent analytics – delivered in time to influence decisions – can become a trusted partner employers need now, not just the vendor they renegotiate each year.