- INSIGHTS
2025 Healthcare Trends: What Employers need to know about Benefits
Employers face a 13-year high in health insurance costs for 2025. Learn the healthcare trends reshaping the market and your role as a trusted adviser.
Employers are conditioned to annual increases in healthcare costs, but 2025 brings the highest in the last 13 years.
This isn’t just inflation. It’s the ripple effect of chronic conditions, high-cost treatments, and outdated insurance models.
So, employers face tough choices, often passing costs to employees. And employees are pushing back. They demand affordable, meaningful coverage that prioritizes their well-being.
The result? A talent war. Employers who can’t meet these expectations risk losing their best people to those who can.
So where does that leave you? At the center of these conversations.
You’re not selling health plans, you’re helping employers navigate one of their biggest challenges: mitigating costs and improving benefits.
And in a market where volatility is the norm, your role is more important than ever.
This blog will explore the top healthcare trends shaping 2025 and how you can position yourself as a trusted adviser, driving solutions that benefit employers and their employees.
Let’s dive in.
Main Trends
Trend #1: Rising healthcare cost demand smarter strategies
Trend #2: Preventing “Bad Years” with better risk management
Trend #3: The Employee-Centric approach to benefits
Trend #4: The future of Healthcare in data-driven decisions
Trend #1: Rising Healthcare Costs Demand Smarter Strategies for Employers
According to the latest PWC report, in 2025, medical cost growth will rise to the highest level in 13 years.
The average per-person per-year (PEPY) cost is now $31,000 annually for a family of 4, a number fueled by inflation, chronic conditions like obesity, and high-cost claims such as cancer treatments and specialty drugs.
Employers can no longer rely on health insurance plans without cost control or transparency. These plans drive up premiums, leaving employers to shoulder the burden.
Often, these costs are passed down to employees. The result? Higher out-of-pocket expenses for employees, leading to dissatisfaction and challenges in retaining talent.
Instead, progressive employers are turning to self-funding solutions. 65% of US workers are now covered by self-funded health plans, according to Statista.
Self-funded plans, especially those leveraging private pools, and group purchasing models, provide the predictability and control employers look for in volatile times.
What to do:
- Educate Employers: Help them understand the market dynamics and cost drivers like inflation, demographic risks, and claim trends.
- Leverage Data and AI: Use advanced underwriting tools to present a clear picture of risk and potential cost containment strategies.
- Promote Long-Term Solutions: Encourage a shift away from short-term, volatile insurance policies to stable, long-term risk-sharing models.
Trend #2: Preventing "Bad Years" With Better Risk Management
Sun Life reports a 50% rise in million-dollar claims over four years, driven by longer hospital stays, comorbidities, complex surgeries, and high-cost drugs.
Claims exceeding $3 million have doubled since 2018, with $2–$3 million claims growing fastest at 44%.
Cancer, newborn care, and hemophilia drive these costs, and 25% of million-dollar claims come from members under age 2.
Today, 1 in 5 employers now face claims exceeding $1 million.
This volatility spikes stop-loss premiums overnight and wipes out years of savings.
In these conditions, risk financing becomes non-negotiable.
Because challenging years are marked by increased claim frequency and severity. So, It’s not if a group will face a bad year, but when.
In 2025, more employers will turn to risk-sharing models.
Unlike traditional stop-loss, which leaves employers vulnerable to unpredictable costs, coverage gaps, and limited control over claims; a specialized risk management model stabilizes premiums by pooling together multiple employers to share risk and manage costs.
That’s why you need to ensure the program aligns with the employer’s risk tolerance and long-term financial goals.
Traditional stop-loss may suit larger groups, but for mid-sized employers, it’s a bumpy ride they can’t afford.
Trend #3: The Employee-Centric Approach to Benefits
Today’s workforce demands more from their healthcare benefits. They expect affordable coverage that prioritizes their well-being, from zero-dollar copays for primary care to mental health resources.
According to the latest Kaiser survey, 48% of large employers increased mental health resources, reflecting a growing commitment to employee well-being.
One of our employers built an $800,000 surplus in two years, reinvesting it into benefits like free primary care, $0 copays for outpatient procedures, physical therapy, and imaging services. Employees now access high-quality care without extra costs, something their former traditional health plans couldn’t deliver.
Employers who fail to deliver risk losing top talent, so they look for solutions to offer enhanced benefits without breaking the bank.
By controlling million-dollar claims and optimizing plan designs, mid-sized employers can reinvest savings into richer benefits that attract, and retain talent and compete with Fortune 500 companies.
Trend #4: The Future of Healthcare Lies in Data-Driven Decisions
Progressive employers are shifting from reactive to proactive healthcare strategies.
Winning in healthcare in 2025 comes down to one thing: control over the health plan.
Data-driven decision-making isn’t a trend, it’s the foundation for controlling costs, improving care, and managing risk.
Fully insured plans offer zero control and transparency, leaving employers at the mercy of carriers. Self-funding, on the other hand, empowers employers with actionable insights.
With data analysis, employers identify and manage high-dollar claims, often driven by a few members of the plan. Controlling these high-dollar claims is key to controlling healthcare costs.
Properly structured cost-containment strategies, leverage proactive tools like trigger reports, flagging high-cost conditions (e.g., cancer) early.
This allows quick intervention, whether sourcing lower-cost, high-quality medications or redirecting care to cost-effective, high-quality providers.
In fully insured plans, high-cost claims only surface at renewal, when it’s too late to act.
In self-funding, data leads to better savings and better care.
How Virtue Health Keeps Employers Ahead of Healthcare Trends
Our private stop-loss consortium empowers employers to control high-dollar claims, reduce volatility, and achieve long-term cost stability through group purchasing power and mandatory cost-containment measures.
Here’s how it works:
- Group purchasing: By pooling resources, employers reduce volatility, secure better pricing, mitigate risk, and stabilize renewals.
- AI and Data-Driven Underwriting Tools: We use advanced tools for underwriting to offer more accurate claims predictions.
- High-dollar claim control: We maintain the integrity of our Private Pool with cost-containment requirements.
- Eliminating plan abuse: No carrier administrators, no Big 3 PBMs, and no “buying business” practices.
- Flexibility: Employers can join or renew at any time of the year and select their preferred TPA/PBM.
Reinvent Employee Benefits with Virtue Health
By leveraging a private stop-loss consortium like Virtue Health’s, you’ll help your clients control high-dollar claims, stabilize premiums, and reinvest savings into meaningful benefits that attract and retain employees.
Ready to redefine healthcare with data-driven strategies and proactive risk management?
Let’s collaborate to secure your clients’ future in an unpredictable market. Reach out today to explore how Virtue Health’s consortium model can transform your approach.
John W. Sbrocco
@johnwsbrocco
IF YOU’RE A BROKER READY TO…
Elevate your clients’ healthcare strategy with a long-term, stable solution, it’s time to consider self-funding.
