Cost containment in healthcare: How smarter systems help employers save
Rising healthcare costs continue to be one of the most pressing concerns for employers, straining both company resources and employee wellbeing. Traditional approaches to managing expenses, like shifting more costs to employees or narrowing networks, often fail to create sustainable value.
What’s changing the equation today is the strategic use of healthcare technology and smarter system design. By leveraging data-driven insights, predictive analytics, and integrated care management, employers have new opportunities to contain costs without sacrificing access or quality. For health plan decision makers, this shift isn’t just about efficiency; it’s about creating long-term savings and healthier outcomes through innovation.
“Solving big-picture challenges requires bold ambition, deep expertise, and powerful capabilities,” says Jeff Plante, President, Carelon Insights. “At Carelon, we have all three.”
The market challenge: Employer health insurance costs are rising
For employers, the urgency of containing costs is hard to overstate. U.S. employers expect health-benefit costs to climb another 6.5% in 2026 , following two years of approximate 6% increases; the steepest rise in more than 15 years, while family-plan premiums rose 7 % in 2024 . These trends are widening the gap between what employers pay and what employees can realistically shoulder, with more than half of large organizations exceeding their healthcare budgets in 2024 .
“Payment integrity started decades ago as a clean-up function,” says Aaron Browder, President, Carelon Payment Integrity Solutions. “It has evolved into a much broader capability which can address a wide range of medical claim payment errors such as inaccurate coding, duplicate payments, and contractual mistakes.”
This market environment has put reducing healthcare costs at the center of employer strategy. Traditional cost-shifting measures are proving insufficient, and decision makers are prioritizing more comprehensive healthcare cost management approaches. From value-based care models and smarter plan design to investments in healthcare technology, employers are looking for solutions that not only slow the pace of rising expenses but also deliver better long-term outcomes for employees.
What smarter healthcare technology systems look like
For employers, smarter systems aren’t just about digitizing processes, they’re about building a connected ecosystem where data flows across providers, payers, and patients. At the center of this is healthcare system integration: unifying claims, clinical data, pharmacy records, and population health insights into a single, actionable view. This makes it possible to spot high-cost trends earlier, coordinate care more effectively, and intervene before expenses escalate.
Integrated data also powers real-world solutions:
- Combining pharmacy and medical information to flag employees at risk of complications from conditions like diabetes, enabling proactive outreach that prevents avoidable claims.
- Using network analytics to direct employees to high-value specialists or lower-cost care settings, such as outpatient surgical centers instead of hospitals.
Together, these examples illustrate how smarter technology systems give employers clear ROI visibility and transform healthcare cost management from reactive budgeting to proactive, data-driven workforce health strategies. As these systems mature, they set the stage for even more innovative approaches, like precision care, that will continue to reshape employer-sponsored health plans.
Practical applications for reducing healthcare costs
Employers are moving from broad cost-containment measures to more targeted strategies that deliver measurable results. A major focus is addressing high-cost drivers such as chronic conditions, specialty drugs, and avoidable emergency room visits. With predictive analytics and early identification tools, organizations can intervene sooner, using condition management programs that connect rising-risk employees to coaching, remote monitoring, or case management before costs escalate.
Another important lever is plan design that steers employees toward smarter care delivery, including:
- Incentivizing high-value providers and lower-cost settings such as urgent care or outpatient surgery centers.
- Expanding telehealth, now a cornerstone of healthcare cost management, to improve access to primary and behavioral care while reducing reliance on costly in-person visits.
- Integrating pharmacy and medical data to ensure appropriate specialty drug use and better adherence.
These approaches show that reducing healthcare costs isn’t about cutting benefits; it’s about redesigning the system so that employees receive the right care, at the right time, in the most cost-effective way.
Improving claims accuracy with payment integrity
Inaccurate or inappropriate billing is a hidden but significant cost driver for employer health plans. Smarter payment integrity systems address this by detecting errors, duplicates, and improper charges before claims are paid. By combining advanced analytics with clinical and coding expertise, these tools improve accuracy, enhance transparency, and ensure that employers only pay for services actually delivered. Beyond immediate savings, payment integrity also frees up resources that can be redirected toward higher-value care initiatives, strengthening both cost management and employee health outcomes.
“The solution accomplishes in one eight-hour day what would take 12 full-time employees a month to process manually, and with fewer mistakes,” says Sherri Richardson Carelon, Strategy and Program Director, Payment Integrity.
Looking ahead at healthcare technology trends
“Carelon was born out of one of the nation's largest health plans,” says Jeff Plante. “We can develop end-to-end solutions based on hundreds of millions of claim payment transactions.”
Discover how Carelon’s payment integrity solutions can help to reduce costs and improve accuracy within employer health plans.
