High-Cost Claims
High-cost claims have become the single fastest growing issue for employers in the last several years and have been highlighted as the “most significant threat to employer-sponsored healthcare.” Since 2016, the number of health plan members with claims $3M+ has doubled, heightening sustainability concerns.
High-Cost Claims Resources
The Pulse of the Purchaser study gauges concerns and approaches of employers to address the workforce environment; whole person health, equity, women’s health, mental health and obesity management; fiduciary perspectives; pharmaceutical […]
This two-part Action Brief series (see links, below) covers the basics of the fast-growing field of life-changing, life-saving — and costly — cell and gene therapies (CGTs). Learn to navigate […]
As healthcare costs increase, employers and other plan sponsors continue to explore strategies to better manage pharmaceutical costs. Given that prescription drug spending accounts for 18% of all healthcare spending, […]
For decades the PBM industry has been plagued by misalignment, opacity, and consolidation. Rather than improving drug value and creating an efficient marketplace, the industry has fueled a flawed model […]
The private sector is bringing new expertise and momentum to an effort once thought impossible—the end of the HIV epidemic in the U.S. It’s going to take leaders across business […]
Even with significant efforts to improve care, medical errors in hospitals that harm patients still occur at alarming rates, causing substantial avoidable financial and human costs. Improving patient- and family-centered […]
Coalitions In Action
Membership in the National Alliance is a catalyst for state and regional coalitions and their employer/purchaser members to advance key initiatives. Together, they leverage their collective influence to drive health, equity and value.

Nevada Business Group on Health
The Nevada Business Group on Health plays a leading role nationally to keep healthcare expenses down and improve workforce health through better management of high-cost claims. More than 77% of US employers with 500 or more employees say helping these claimants manage their care was important or very important, according to an analysis by Mercer.

HealthCareTN (HCTN)
Advances in medical technology, including cell and gene therapies, along with ACA requirements that remove annual and lifetime maximums, have driven an increase in both the number of claimants exceeding traditional thresholds, and the amount spent for average high-cost cases. HCTN and its leading employers are focused on developing a framework for understanding, preventing and addressing high-cost claims.
Mitigating High-Cost Claims
Addressing a Rapidly Escalating Challenge
The management of high-costs claims is diverse and complex with various stakeholders increasingly conflicted and less motivated to work with self-insured plan sponsors. Market solutions exist in some areas but are unevenly deployed.
The National Alliance is amplifying the employer/purchaser voice through collective action and creating momentum through its high-cost claims initiative. It brings together coalitions and employers from across the country to address emerging issues and challenges.