Driven by ongoing inflation, catastrophic medical claims, and increased demand for specialty and GLP-1 prescription medications, overall healthcare spending growth is projected to increase by 8% year over year for the group health market in 2025 — the highest percentage in 13 years.
But, where others see challenges, Vālenz Health® sees a unique opportunity: one in which healthcare leaders can rethink outdated models, embrace smarter solutions, and build stronger, more resilient systems that benefit all parties involved.
And, in this blog series, we’ll present three important strategies that can help make it all possible.
Every quarter, Valenz and our dedicated iThrive Customer Council meet to discuss the changing industry and opportunities to advance smarter, better, faster healthcare for everyone. This year, we’ve identified three key priorities for leaders to consider in 2025 as we work collaboratively to optimize the utilization of high-value healthcare:
In this blog post, we’ll cover the first priority: what it means, why it’s important, and how to make it a reality.
You can also read the 2025 iThrive Customer Council priorities report in full on our website at any time.
As we consider ways to mitigate rising costs and improve member experience in healthcare, optimizing plan design is an important first step.
Health insurance plan design touches every party in the healthcare system, from patients to payers to plan issuers to providers. When plans are not built specifically to those stakeholders’ needs, the impacts quickly snowball, leading to ever-growing amounts of wasted cost, time, and energy.
With current plan designs, employees frequently misunderstand and under-utilize their benefits. In fact, 75% of workers wish for support in choosing the right benefits package for their needs, highlighting a literacy disconnect between those who design healthcare plans and those who actually use them.
When employees don’t understand their benefits packages, they’re less likely to use them properly, if at all. Research indicates that as much as $3 trillion in employer benefits spend is wasted each year, representing a huge opportunity cost. It’s no wonder, then, that public satisfaction with healthcare quality in the U.S. has consistently trended downward over the past decade.
For these reasons and more, optimizing plan design is a crucial priority for iThrive Council members in 2025.
With a detailed, humbling look under the hood, plan designers can identify and resolve any miscommunications and inefficiencies leading to wasted spend — in turn, providing higher-quality benefits and services to employees that help improve overall plan efficiency and effectiveness.
The good news? Thanks to innovation over the past decade, there are plenty of smart, efficient ways to optimize health plan designs and reduce costs without compromising access to high-quality care.
Perhaps the most effective strategy we’re exploring this year is fully integrated healthcare plans. By consolidating services and offerings across the Claim Cost Arc℠, we can help maximize solution efficiency, while simultaneously minimizing administrative burden for all stakeholders in the healthcare value chain, including the patient, payer, plan, and provider.
By bridging the existing divide between providers and networks, fully integrated healthcare plans support more comprehensive data transparency, in turn allowing for more informed decisions by employers and employees.
And, when plan designers have access to this utilization and quality data, they can better optimize plans for the unique needs of members and payers — reducing the waste caused by redundant or irrelevant offerings and offering benefits that employees are more likely to utilize.
Plans can also be optimized for better performance with the following features:
Transparency in quality and pricing data isn’t just good practice for healthcare plan designers; it’s required by federal law.
Per the Transparency in Coverage ruling, health plans members are entitled to clear, easily accessible information about not only their insurance coverage but also anticipated pricing for providers and facilities. Health plans that make this information available via digital tools (such as the Valenz Bluebook) empower members to utilize lower-cost, higher-quality providers — reducing out-of-pocket costs for patients and plan expenses for payers.
With Valenz Bluebook, we go a step further, using a “green-yellow-red" quality ranking system to highlight procedures, providers, and facilities that provide the highest-value care at an affordable price.
By incorporating these tools and features into plan design, healthcare leaders not only minimize spend; they also encourage a higher usage rate of healthcare benefits, creating a feedback loop of data that allows for better plan optimization over time.
To further support members’ usage of their benefits, health plans can also be optimized with helpful care navigation features.
These programs combine insightful usage data with customer service support to improve care and lower costs for plan members. By using high-touch member onboarding, member education, and intuitive navigation systems, these services can steer employees toward high-quality, affordable (even no-cost) providers that meet their unique needs.
The result: Reduced out-of-pocket expenses and increased member satisfaction.
At Valenz, we layer case and disease management into our care navigation services, proactively identifying and supporting members with complex, chronic conditions to avoid expensive claims in the future. With personalized, intuitive member guidance, we help maximize members’ usage of their health plan benefits — a key objective of optimizing overall plan design.
Health plan designs can also be optimized with the payer in mind. Stop-loss insurance should be included in every self-insurance plan design as a protection against high-cost claims and skyrocketing healthcare costs.
But, in the spirit of optimization, not just any stop-loss policy will do. Stop-loss underwriters who use insights gleaned from cost-saving tools will be better at designing policies that minimize risk from the start — in turn, offering lower stop-loss premiums to employers who must foot the bill for their self-insurance plans.
With more than 350 years of combined experience in the stop-loss industry, the Valenz team is adept at transparently structuring stop-loss coverage for the most unique and challenging of plan designs. Learn more about our services today.
When it comes to optimizing the utilization of high-value healthcare for everyone, plan design cannot be overlooked.
The way a healthcare plan is built has a huge impact on all the stakeholders involved. And, given the innovations made within the past few years, settling for “one-size-fits-all" designs is no longer necessary.
With options like fully integrated plans, cost and quality data transparency, care navigation services, and more, today’s plans can be customized to the unique needs of each stakeholder, without compromising high-quality care or cost containment.
In short, by prioritizing data-driven plan design in 2025, the healthcare industry can significantly eliminate inefficiencies, reduce waste, and improve outcomes — a key step in achieving smarter, better, faster healthcare for all.