Your Company Spends a Lot on Healthcare. Who Is Looking Out for Your Interests?
Employer-sponsored family health coverage cost an average of $26,993 in 2025. Workers paid $6,850 of that amount, with employers funding the balance. [1] At that price, healthcare deserves the same management scrutiny as any other major business expense.
Yet many employers manage healthcare through a collection of separate relationships. Brokers, insurers, administrators, pharmacy benefit managers, provider networks, and specialty vendors each perform a defined role. None is necessarily responsible for determining whether the entire arrangement works for the employer and its employees.
Employers can outsource administration. They cannot outsource the judgment required to decide whether their healthcare spending is producing value.
The missing expertise may be healthcare, not insurance
Insurance expertise helps an employer understand coverage, premiums, funding arrangements, and plan design. Value-based care expertise addresses a different set of questions. What is the healthcare system being paid to do? Is it producing the results the employer needs? Those questions require looking beyond claims totals.
For example, an increase in primary care spending may be worthwhile if employees obtain care sooner and avoid more expensive services later. A network discount may appear favorable while the underlying total cost remains high. A vendor may report strong engagement without demonstrating a meaningful effect on access, quality, or total cost.
A value-based care expert can help an employer:
Connect spending patterns to how employees obtain care
Evaluate whether provider and vendor incentives support the employer’s objectives
Distinguish lower unit prices from better overall value
Assess primary care access and opportunities for direct or enhanced primary care
Identify fragmentation across vendors and care settings
Develop meaningful measures for access, quality, employee experience, and total cost
Evaluate payment models, shared-savings arrangements, and performance guarantees
Determine whether a proposed solution changes care delivery or merely adds another service
These are practical employer questions. In 2025, 30% of surveyed employers with at least 50 workers reported contracting for virtual primary care beyond what their health plan network provided. Another 7% contracted directly with a primary care organization. [2]
Those arrangements may create value, but their existence proves very little by itself. The real questions are whether they address an identified problem, reach the employees who need them, improve care, and produce results worth the additional expense.
My work in payment reform taught me to examine not only what a program promises, but how its incentives operate, how performance is measured, and what clinicians and employees experience in practice. That perspective can help employers move from purchasing benefits to managing healthcare performance.
The available options depend on how the plan is funded
A self-funded employer pays its employees’ healthcare claims rather than transferring the full financial risk to an insurer. This gives the employer more direct exposure to healthcare spending and potentially more control over plan design, vendor relationships, provider arrangements, and performance expectations.
Self-funding is not a niche concern. Among group health plans required to file a Form 5500 in 2023, 81% of participants were covered through plans with at least some self-insured component. [3]
For a self-funded employer, value-based care expertise can support decisions about provider networks, primary care arrangements, payment incentives, quality measures, shared-savings opportunities, and the relationship between clinical performance and total cost.
It can also help the employer examine whether its contracts create real accountability. A performance guarantee has limited value if it measures an activity unrelated to the employer’s objectives. A shared-savings arrangement deserves scrutiny if the baseline, attribution method, quality requirements, or calculation of savings is unclear. A new vendor may solve a problem, duplicate an existing service, or introduce another disconnected point of entry for employees.
Fully insured employers have less direct control over claims payment and provider contracting. They still have important decisions to make.
A fully insured employer can examine whether the available network meets employee needs, whether access problems are creating unnecessary cost and disruption, whether renewal proposals are adequately explained, and whether its broker and carrier provide useful performance information. It can also evaluate employee communication, primary care access, alternative plan options, and whether remaining fully insured continues to fit the organization.
The available levers differ. The need for informed judgment does not.
More information is not the same as more insight
Employers have access to more healthcare information than ever. Federal transparency rules require most group health plans and insurers to publish negotiated rates and other pricing information. Availability of information does not guarantee its usefulness.
The federal agencies responsible for the transparency rules have acknowledged that enormous file sizes, ambiguous data, and missing context make the information difficult to use. [4] The same problem can occur with claims reports, utilization dashboards, vendor presentations, and renewal materials. An employer can receive a great deal of information without gaining a clear basis for action.
A useful review should help leadership answer questions such as:
What problems are we trying to solve?
Which costs can we realistically influence?
Are employees able to obtain appropriate care when they need it?
Do provider and vendor incentives support our objectives?
How is performance measured and against what baseline?
Does the proposed solution improve care or simply add another service?
Who is accountable if the expected results do not occur?
These questions shift the conversation from purchasing products to managing performance.
Employers do not need to become healthcare organizations
They do need to manage healthcare as a major business function.
That means understanding how insurance, payment, access, provider performance, and employee experience fit together. It means asking more of available information and testing whether proposed solutions address the company’s actual needs.
Brokers, insurers, administrators, and vendors remain important partners. Independent healthcare expertise adds something different. It gives leadership a way to examine the full arrangement, connect business objectives to healthcare performance, and decide what should happen next.
Looking out for the company’s interests begins by refusing to treat an annual renewal as a healthcare strategy.
Sources
[1] Kaiser Family Foundation (KFF), 2025 Employer Health Benefits Survey, Summary of Findings, October 22, 2025.
[2] KFF, 2025 Employer Health Benefits Survey, section addressing employer practices, employee concerns, provider networks, and primary care, 2025.
[3] U.S. Department of Labor, Employee Benefits Security Administration, 2026 Report to Congress: Annual Report on Self-Insured Group Health Plans, Executive Summary and Table 1, based on statistical year 2023 Form 5500 filings.
[4] Centers for Medicare & Medicaid Services, Transparency in Coverage Proposed Rule (CMS-9882-P), fact sheet, December 19, 2025.
Thinking about your company’s healthcare strategy?
Raynes Healthcare Resources helps employers independently evaluate healthcare spending, vendor relationships, benefit strategy, and the decisions surrounding them.