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
Insights from the National Alliance 2025 high-cost claims coalition workshops, along with the latest research, highlight the urgent need for employers to embrace data-driven, collaborative, prevention-focused strategies to address cardiometabolic […]
Biosimilars are the future of specialty drug therapy, costing, on average, 50% less than their biological reference products, with some exceeding 90%. While adoption has been hindered by barriers such […]
Biosimilars are the future of specialty drug therapy, costing, on average, 50% less than their biological reference products, with some exceeding 90%. While adoption has been hindered by barriers such […]
Pulse of the Purchaser, a national survey of employers, was conducted with member coalitions from July-August 2025 with 324 responses from private and public employers and purchasers across the country. […]
Action-oriented recommendations for coalitions, employers and other plan sponsors, and healthcare and benefits professionals.
- Case Study, Employee Resources, Final Report, Guidebook, Issue Brief, Placemat, Playbook, Toolkit, Vendor Engagement Template, Video
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.