In today’s complex benefits landscape, employers face mounting challenges in managing healthcare costs, designing effective plans, and engaging employees. With healthcare costs projected to rise 8% in 2025—the highest increase in over a decade—many organizations are turning to data analytics to transform their approach to benefits management.
Today’s Employee Benefits Challenges
Employers and benefit advisors struggle with several key issues:
- Data complexity: Either too much information to extract meaningful insights or insufficient data to drive informed decisions
- Fragmented data: Siloed medical, pharmacy, wellness and point solution data from multiple vendors preventing a comprehensive view of plan performance
- Limited visibility: Insufficient access to member-specific insights needed to refine plan design
- Surface-level reporting: Many analytics tools focus on descriptive rather than actionable, prescriptive insights
- Seasonal usage: Benefits data often only examined during renewal season rather than supporting year-round strategic decision-making
A Data-Driven Approach to Benefits Management
Leading organizations are addressing these challenges by following a three-step framework:
Step 1: Assess
Evaluate health plan expense drivers and benefits utilization based on both absolute cost metrics and meaningful benchmarks. This approach enables strategies targeting your largest issues while uncovering opportunities to better serve all members.
Case Example: Insurance Office of America (IOA)
IOA uses comprehensive analytics to generate turnkey monthly financial and clinical reports for employers, allowing their teams to focus on higher-value activities like deeper dives and creative solutions for group-specific elements.
Dominic Marzolino, National Analytic Consultant at IOA , notes that often platforms overlook or oversimplify the fixed portion of a self-funded plan in favor of a hyper-fixation on the clinical elements. “When doing so, you omit a very significant part of the conversation. The group isn’t only seeing the claim elements of their spend, they also must account for the administrative fees, stop loss premiums. Any point solution fees that may come into consideration. You need more than 70% of the story.”
“The benefits landscape is specialized and you see a lot of stagnation in platforms,” says Marzolino . “What has impressed me most is the baseline understanding of concerns I bring to their attention, and their willingness to expand their knowledge base. When practical application doesn’t line up with design purpose, they continuously refine the platform to meet my needs.”
Key outcomes include:
- Self-service ad-hoc data querying
- “What-if” scenario modeling for plans with less reliance on actuaries
- Streamlined information access for decision-making
Step 2: Optimize
Transform insights into action by closing care gaps and driving adoption of existing programs throughout the plan year. Define comprehensive renewal strategies by analyzing ROI of current programs alongside cost drivers and utilization patterns.
Case Example: North American Affiliate of International Corporation
This company leveraged in-depth data analysis to identify several key intervention opportunities:
- High ER spend: After analytics highlighted increasing ER visit rates, they educated employees on different care options and price points, resulting in an 11% decrease in non-emergent ER use year-over-year.
- Cancer screening compliance: Dashboard insights revealed screening improvement opportunities. Targeted campaigns during national cancer awareness days yielded increases in compliance: +6% for colorectal, +2% for breast, and +2% for cervical cancer screening.
- MSK condition costs: Predictive risk modeling identified the 5% of members most critical for proactive intervention. A prevention-based model directing employees to non-surgical resources first generated $100K in direct annual savings while improving quality of life.
“Maybe you don’t know you have a problem, but the dashboards will tell you – they highlight things to focus on,” notes their Head of U.S. Well-being & Digital Health. “It helps you be proactive versus reactive. We have multiple health plans with annual reports for each. Another benefit is having one place to look at everything across all plans, with one report.”
Step 3: Sustain
Stay on top of data and integrate insights into operational workflows; as employee populations change and evolve, it is important that workflows and interventions do the same. Advance health plan innovation to ensure stakeholder confidence and maximize employee benefits utilization, health outcomes, and productivity.
Case Example: Global Medical Services Company
This organization identified cancer as one of their top cost drivers and developed “ScreenStrong,” an ongoing campaign around 24 cancer screenings that highlights real employee stories through diagnosis and treatment journeys.
They also introduced a free ColoFIT kit program addressing social determinants of health, as many employees work lab and facility shifts spanning 24 hours, making traditional appointments difficult. Within five weeks, over 5,000 employees requested kits, with a 3-4% positive test rate. Among members with positive tests from April-September 2024, 72% saw a doctor after their test date.
“If we only have one person that shows up positive, and they go get a colonoscopy and find colon cancer early, we’ve just potentially saved a life,” explains their Health and Wellness Executive. “That is what this is all about. When we do that, we’re going to positively affect our business.”
The company is also proactively monitoring GLP-1 medication usage for weight loss, treating obesity as a chronic condition similar to diabetes. They’re tracking one-time utilizers, waste, drug effectiveness, and program utilization on member outcomes including weight loss, blood pressure, cholesterol, and other associated chronic conditions.
Finding New Opportunities with Data Analytics
Organizations leveraging data analytics are discovering creative ways to transform their benefits programs:
Regional Brokerage Firm Examples:
- On-site clinic ROI evaluation: Analyzing primary care costs and potential referral pattern changes helps employers determine if on-site clinics are worth the investment.
- Fee transparency: Data analytics uncovered $100K in overpayments for one employer, resulting in a refund and new transparency policies with carriers.
- Reference-based pricing analysis: Analytics helped a public school system understand the risks of their RBP plan, including steerage, service line access, and utilization issues.
The Future of Benefits Analytics
As data analytics platforms like BenInsights® continue to evolve, employers and brokers are gaining unprecedented visibility into healthcare spend, enabling proactive collaboration and smarter decisions. The impact includes significant cost savings, improved care access and utilization, better wellness interventions, more personalized benefits, and stronger fiduciary defensibility.
Organizations using data analytics for benefit design save an average of 7.2% on healthcare costs while building programs that truly meet employee needs. By continuously monitoring and analyzing benefits data, employers can anticipate risks, identify intervention opportunities, and develop strategic programs that improve health outcomes while controlling costs. In today’s challenging economic environment, data analytics isn’t just a nice-to-have tool—it’s becoming essential for organizations seeking to balance cost management with delivering high-quality benefits that attract and retain talent.