The role of consultants in the fight against health costs

Health costs are a major concern in the United States, 2025 providing for the most expensive year for the insurance sponsored by the employer. Employers are expected to cope with an increase of 8 to 9% of the costs of the health plan, according to the SHRM. A plan that previously cost employers $ 10,000 per member would now cost $ 10,800. For employees, this means paying more than $ 100 in bonuses, based on KFF data showing that the average employee contribution was $ 1,368 in 2024.

Think about it this way: almost five weeks of the annual salary of an average employee now takes place in medical coverage, and it is before a single visit or prescription from a doctor. Despite these arrow costs, many employers and employees do not see a corresponding improvement in the quality of care. More than 40% of employers plan to modify their health insurance companies over the next two years, according to a national business group on health.

In CBIZ, I support more than 1,000 employers directly and indirectly, helping them to sail in today’s health care complexities. A question that I often hear is: “I know that health care is expensive, but Why Is it so expensive? Here’s how I generally react and how I help companies act.

Broker vs Consultant: Understand the difference and select the right partner

While employers provide health care to their employees, management of the health plan is not their main expertise. This is why external support is essential. In the search for external advisers, there are two distinct archetypes: brokers and consultants.

Wikipedia defines a broker as an intermediary that sells, requests or negotiates insurance on behalf of a customer for compensation. Conversely, a consultant is defined as an advisor who helps individuals and companies to understand and choose appropriate policies, providing advice on risk assessment, complaints, compliance, etc. Consultants tend to provide continuous support beyond the initial purchase of policy.

A broker focuses on the identification and recommendation of good products and insurance plans. This general approach centered on the product can be a good choice for small businesses looking for a rationalized and simple approach, but for organizations faced with complex cost and profits challenges, consultants offer a higher level of strategic insight.

Consultants go beyond the product. Before recommending a path to follow, they plunge into the company to acquire an in -depth understanding of their customers’ unique challenges and problems. Consultants assess the use of complaint data, contractual language, risk tolerance, and even more – SO They offer tailor -made solutions designed to meet the customer’s unique needs. Many advisers are called consultants, but few really embody this advisory state of mind.

Understanding what separates the consultants from brokers is not only semantics – this is the difference between renewing an existing strategy and completely rethinking it. In the end, employers should look for an external advisor whose mission is to improve and enrich the employee health plan without Increase in deductibles or direct costs for members.

Cost management: a strategic approach

As a consultant, I see my role as that of a boxer. Managing a health plan is like entering a title fight at 12 laps. It is not only a brute force – it is calendar, strategy and remaining agile. The best employers know when to prevent me from making a blow (negotiate the costs), when dodging (avoid swollen networks) and when hitting with a daring new plan.

Containing the benefits of advantages requires an approach to punch and output. Employers waiting to adapt, stick to the same strategy year after year, often lack their opportunity to attenuate costs. For what? Because industry has already thwarted its cost design tactics when implementing.

To ensure effective cost attenuation, employers cannot wait for the market to adjust – they must first strike. My most successful clients are those who make daring movements and adopt innovation.

Edge Liénant vs Breaking Edge Innovation

When I meet customers, I explain both sides of health care innovation: bleeding edge and rupture edge. At the edge of bleeding, the risks often prevail over the rewards. However, the Breaking Edge is the place where innovation and data meet to produce proven results.

The leading alternative health plans incorporate cost control strategies that help employers proactively manage increases from year to year. While many of these strategies have been considered a bleeding edge 10 years ago, their efficiency has now been proven across the country. Large consultants will present advanced solutions, as alternative health plans, to companies where it makes sense.

Employers who take advantage of these decomposition solutions are ultimately able to make smart movements Before The costs are uncontrollable.

Use data power

Although innovation is essential to the attenuation of costs and the resolution of other key challenges in health care, it must be supported by data to be really effective.

By painting through mountains of data and countless plan analyzes, our team has determined that the data should be classified into three key buckets: usable, influenable and observable. Many advisers focus only on data in aggregate form, which often only fills the “observable” bucket, leaving the other two voids. By working with customers, I go beyond the surface and I search the data at the level of the members, by filling out each of the keys. This allows me to acquire a global understanding of the current customer strategy and provide recommendations based on data focused on their objectives, whether they are trying to maintain employee bonuses, reduce franchises or manage their overall expenses.

A strategic data analysis associated with innovation leads to measurable and impactful results.

The long -term path

The management of health care costs effectively requires more than decisions of the renewal season – it requires a thoughtful strategy rooted in data, motivated by adaptability and aligned with real results. By adopting proven innovations and working with a consultant who acts as a real partner, organizations can control costs while improving employee satisfaction and improving the performance of the plan.

To learn more about the implementation of data to stimulate the decision -making of the health plan, please visit: CBIZ Cost CONTINDINATION.

Cole Harris is President of Cbiz Benefits & Insurance of Tennessee, as well as the National Head of Practice for the Practice of CBIZ health innovations. With vast experience in the benefits and insurance sector, Cole has played an essential role in major business strategies, offering advisory services that include the assessment of current practices and the recommendation of complete and data solutions. Its expertise extends over a wide range of areas, including health care reform, compliance standards, management of pharmacy services, value -based purchases, benefits, etc.