--- title: Top 5 Healthcare Benefit Challenges and How To Solve Them description: Discover the top five healthcare benefit challenges and strategies employers and plan sponsors can employ to overcome them. image: https://blog.valenzhealth.com/hubfs/Blog/AdobeStock_218394966-1.jpeg --- [Skip to content](https://blog.valenzhealth.com/top-5-healthcare-benefit-challenges-and-how-to-solve-them#page-content) [![Valenz Health](https://blog.valenzhealth.com/hubfs/web/logo.svg)](https://www.valenzhealth.com/) - [Who We Serve](https://www.valenzhealth.com/who-we-serve/) - [Solutions](https://www.valenzhealth.com/solutions/member-experience/) - [About Us](https://www.valenzhealth.com/about-us/) - [Resources](https://www.valenzhealth.com/resources/) - [Contact](https://www.valenzhealth.com/contact/) ### [Patients](https://www.valenzhealth.com/who-we-serve/members/) ### Payers - [Employers](https://www.valenzhealth.com/who-we-serve/employers/) - [Taft-Hartley Funds](https://www.valenzhealth.com/who-we-serve/taft-hartley-funds/) ### Providers - [Healthcare Facilities and Providers](https://www.valenzhealth.com/who-we-serve/healthcare-facilities-and-providers/) ### Plans - [Health Plans](https://www.valenzhealth.com/who-we-serve/health-plans/) - [Third-Party Administrators](https://www.valenzhealth.com/who-we-serve/third-party-administrators-tpas/) - [Brokers and Consultants](https://www.valenzhealth.com/who-we-serve/brokers/) - [Stop Loss Producers](https://www.valenzhealth.com/who-we-serve/stop-loss-producers/) #### Partner with Us Discover how Vālenz Health® can simplify the healthcare experience with our innovative solutions. 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[Browse All Resources](https://www.valenzhealth.com/resources/) [![Valenz Health](https://blog.valenzhealth.com/hubfs/web/logo.svg)](https://www.valenzhealth.com/) - Who We Serve - Solutions - About Us - Resources - Contact Us - Login - Search Back ### Who We Serve - [Overview](https://www.valenzhealth.com/who-we-serve/) #### Patients - [Members](https://www.valenzhealth.com/who-we-serve/members/) #### Payers - [Employers](https://www.valenzhealth.com/who-we-serve/employers/) - [Taft-Hartley Funds](https://www.valenzhealth.com/who-we-serve/taft-hartley-funds/) #### Providers - [Healthcare Facilities and Providers](https://www.valenzhealth.com/who-we-serve/healthcare-facilities-and-providers/) #### Plans - [Health Plans](https://www.valenzhealth.com/who-we-serve/health-plans/) - [Third-Party Administrators](https://www.valenzhealth.com/who-we-serve/third-party-administrators-tpas/) - [Brokers and Consultants](https://www.valenzhealth.com/who-we-serve/brokers/) - [Stop Loss Producers](https://www.valenzhealth.com/who-we-serve/stop-loss-producers/) Back ### Solutions - [Overview](https://www.valenzhealth.com/solutions/) - [Member Experience](https://www.valenzhealth.com/solutions/member-experience/) - [Payment Integrity](https://www.valenzhealth.com/solutions/payment-integrity/) - [Provider Quality](https://www.valenzhealth.com/solutions/provider-quality/) - [Plan Performance](https://www.valenzhealth.com/solutions/plan-performance/) - [Platform](https://www.valenzhealth.com/solutions/integrated-platform/) Back ### About Us - [Overview](https://www.valenzhealth.com/about-us/) - [Careers](https://www.valenzhealth.com/about-us/careers/) Back ### Resources - [Overview](https://www.valenzhealth.com/resources/) - [The No Surprises Act (NSA)](https://www.valenzhealth.com/resources/no-surprises-act/) - [Transparency in Coverage (TiC)](https://www.valenzhealth.com/resources/transparency-in-coverage/) - [Office of Inspector General Compliance](https://www.valenzhealth.com/resources/oig-compliance/) - [Fighting Fraud, Waste, and Abuse (FWA)](https://www.valenzhealth.com/resources/fraud-waste-abuse/) - [Self-Funded Insurance](https://www.valenzhealth.com/resources/self-funded-health-insurance/) Back ### Payment Integrity - [Overview](https://www.valenzhealth.com/solutions/payment-integrity/) - [ABN Medical Necessity Validation](https://www.valenzhealth.com/solutions/payment-integrity/abn-medical-necessity-validation/) - [Clean Claim Verification](https://www.valenzhealth.com/solutions/payment-integrity/clean-claim-verification/) - [Bill Review](https://www.valenzhealth.com/solutions/payment-integrity/clinical-bill-review/) - [Curated Data Sources](https://www.valenzhealth.com/solutions/payment-integrity/curated-data-sources/) - [In-Network Repricing](https://www.valenzhealth.com/solutions/payment-integrity/in-network-repricing/) - [Out-of-Network Repricing](https://www.valenzhealth.com/solutions/payment-integrity/out-of-network-repricing/) Back ### Provider Quality - [Overview](https://www.valenzhealth.com/solutions/provider-quality/) - [Credentialing](https://www.valenzhealth.com/solutions/provider-quality/credentialing/) - [Provider Staff Sanction Monitoring](https://www.valenzhealth.com/solutions/provider-quality/provider-staff-sanction-monitoring/) - [CareChex® Awards by Quantros](https://www.valenzhealth.com/solutions/provider-quality/carechex-awards-by-quantros/) - [Outcomes Analytics by Quantros](https://www.valenzhealth.com/solutions/provider-quality/outcomes-analytics/) Back ### Member Experience - [Overview](https://www.valenzhealth.com/solutions/member-experience/) - [Clinical Engagement](https://www.valenzhealth.com/solutions/member-experience/clinical-engagement/) - [Valenz Bluebook](https://www.valenzhealth.com/solutions/member-experience/valenz-bluebook/) - [• Bluebook Rx](https://www.valenzhealth.com/solutions/member-experience/bluebook-rx/) - [Precision Care](https://www.valenzhealth.com/solutions/member-experience/valenz-bluebook/#precision-care/) Back ### Plan Performance - [Overview](https://www.valenzhealth.com/solutions/plan-performance/) - [Stop Loss](https://www.valenzhealth.com/solutions/plan-performance/stop-loss/) - [Variable Copay](https://www.valenzhealth.com/solutions/plan-performance/variable-copay/) Back ### Search # Top 5 Healthcare Benefit Challenges and How To Solve Them By [Vālenz Health®](https://blog.valenzhealth.com/author/valenz-health) - June 20, 2022 [Healthcare Benefits Innovation](https://blog.valenzhealth.com/tag/healthcare-benefits-innovation) [Cost and Quality Transparency](https://blog.valenzhealth.com/tag/cost-and-quality-transparency) [Member Experience](https://blog.valenzhealth.com/tag/member-experience) Share ![A doctor sitting at a table and discussing healthcare options with her patient.](https://blog.valenzhealth.com/hs-fs/hubfs/Blog/AdobeStock_218394966-1.jpeg?width=485&height=485&name=AdobeStock_218394966-1.jpeg) Employers and health plan sponsors are always looking for ways to make healthcare easier, more affordable, and more effective. However, it’s not a simple process. Healthcare benefit challenges have increased in the past decade due to fluctuating prescription drug costs and federal price transparency mandates. It’s tough to meet your clients' needs, give them ways to engage with their healthcare benefits, and improve their overall experience. Vālenz Health® is committed to giving employers and plan sponsors new ways to make smart healthcare choices with solutions designed to help tackle your healthcare benefit challenges. Curious? Read on: ## Challenge:  Low-Value Care The U.S. has the highest healthcare costs in the world. In 2020, the U.S. spent about $4.1 trillion on healthcare — about $12,530 per person — [according to the Centers for Medicare & Medicaid Services](https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet). This is a 9.7% increase over the past year. And yet, we [trail behind other developed countries](https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022) on common health outcomes, including life expectancy, unmanaged diabetes, and infant mortality. Part of the problem is that there’s little to no visibility into the cost or quality of care until after that care is delivered. Valenz data shows that the quality and cost of a service are often unrelated. Unless patients shop for care, they may pay prices that vary as much as 600% for the same procedure among in-network facilities in the same market. Without an effective quality and cost transparency tool, patients may unwittingly choose a higher-price or lower-quality option. ### Solution: Objective Quality and Cost Navigation [Valenz Bluebook](https://www.valenzhealth.com/solutions/member-experience/valenz-bluebook/) is powered by the largest healthcare quality and cost dataset nationwide. We help employers, consumers, providers, and payers make more informed healthcare decisions using a simple, intuitive color-coded system (green, yellow, and red) to help people identify the highest-value care for their needs. ![valenz-bluebook-example](https://blog.valenzhealth.com/hs-fs/hubfs/Blog/Blog%20Graphics/valenz-bluebook-example.png?width=800&height=768&name=valenz-bluebook-example.png) Helping employees find the highest quality, most affordable healthcare providers near them is an employer’s best defense against rising costs and the most effective way to improve the overall quality of care for enrolled benefits members. Valenz Bluebook also offers a solution to help benefit brokers provide sound advice on healthcare options and generates deep analytics that enables brokers to pinpoint overspending and lapses in quality — information that informs their client benefit strategies. ## Challenge: Rising Prescription Drug Costs When you walk up to a pharmacy counter, you likely don’t know how much your prescription will cost. What happens if you can’t pay for it? [Recent research](https://www.usnews.com/news/health-news/articles/2021-09-22/18-million-americans-cant-pay-for-needed-meds) indicates that as many as 18 million Americans cannot afford their prescription medications, which is about 7% of America’s adult population. Prescription medications — especially specialty and brand-name drugs — have created an unsustainable cost situation for consumers and businesses. With prescription drug costs [outpacing inflation](https://www.aarp.org/content/dam/aarp/ppi/topics/health/prescription-drugs/prices-top-medicare-part-d-drugs-nearly-doubled-since-entering-market.doi.10.26419-2fppi.00352.001.pdf), some large employers shell out nearly a third of their total healthcare benefit spend to pharmacy. Plan sponsors also need support managing costs once new medications come to market. ### Solution: Valenz Bluebook Rx Pharmacy Savings Solution “Everyone should be concerned about the rising costs of brand-name specialty medications. A generic alternative can cost as much as 99% less than its brand-name counterpart,” said Samantha McMaster, PharmD, former senior director of Pharmacy Solutions at Valenz. Valenz Bluebook Rx gives plan sponsors and members an independent look at employers’ prescription drug spending. With [Valenz Bluebook Rx](https://www.valenzhealth.com/solutions/member-experience/bluebook-rx/), plan sponsors get an objective analysis of pharmacy spending that identifies the drugs and drug categories driving high costs. With that information, Valenz Bluebook Rx offers members personalized savings reports that suggest lower-cost, clinically effective alternatives that can save them and their employer money. Members can potentially save thousands of dollars in out-of-pocket costs, and companies can potentially cut costs by millions. ## Challenge: Navigating a Complex System When an employee needs a complex, high-cost medical procedure, finding, scheduling, and coordinating the right care can be overwhelming, especially without visibility into quality and costs. ### Solution: Concierge Member Support Our [Concierge](https://www.healthcarebluebook.com/explore-careconnect/) feature provides individuals with a member concierge who works with them to find and schedule the right care with a high-value provider, from the initial consultation to follow-up appointments. Members develop a trusting relationship with the concierge throughout their care journey. “When I needed surgery, the cost was overwhelming and I felt lost. But when I called \[Valenz Health\], a member advocate assured me they could help me,” said a member who saved $10,964. “They negotiated a package for the surgeon, hospital, and anesthesiologist.” ## Challenge: Meeting Federal Price Transparency Requirements The Departments of Health and Human Services (HHS), Labor, and the Treasury now enforce provisions of the [Transparency in Coverage](https://www.valenzhealth.com/resources/transparency-in-coverage/) rule and the [No Surprises Act](https://www.valenzhealth.com/resources/no-surprises-act/).  Today, insurers and plan sponsors are on the hook for compliance. They are required to disclose their negotiated in-network and out-of-network rates and offer members good-faith cost estimates before care (i.e., enhanced explanation of benefits \[EOB\]).  ### Solution: Valenz Bluebook Comply [Valenz Bluebook Comply](https://www.valenzhealth.com/solutions/member-experience/valenz-bluebook/) is a comprehensive compliance solution that addresses critical mandates, including the price comparison tool, Advanced EOBs, and machine-readable files. It's designed to help organizations not only meet the mandates but also deliver value far beyond the requirements. ## Challenge: Engaging Employees Although providing solutions to identify high-value care is important, it’s only one step in the process. You must also encourage good shopping behaviors so your employees make better choices. ### Solution: Engagement Rewards [Engagement rewards](https://www.valenzhealth.com/solutions/member-experience/valenz-bluebook/) create savings by changing employees’ healthcare shopping habits through targeted financial incentives that reward smarter, quality-driven, cost-effective healthcare choices. Employers who implement Valenz Bluebook’s engagement best practices — Educate, Remind, Reinforce — see as much as 20% monthly utilization with an ROI of up to 6:1. There are additional ways to drive employee engagement, including making it fun and adding incentives. “I did this yesterday and saw that the hospital where I had my kidney stone removed was one of the highest: $2,200 out of pocket! I found that I can get my second one done at a surgical center much cheaper — green light,” said a member after playing Valenz Bluebook’s pricing game. ## We’re Here to Help You are likely facing at least one of these healthcare benefit challenges. The good news is that you don’t have to find innovative solutions alone. The Valenz team is here to help you along the way, giving your team members or clients an engaging and successful healthcare benefit experience. Interested in how Valenz solves common healthcare benefit challenges facing today's self-funded employers? Contact us today to learn more about our solutions. ### Connect with Us to Learn More   ![Vālenz Health®](https://blog.valenzhealth.com/hs-fs/hubfs/Valenz%20Logo%20Signature.png?width=48&height=48&name=Valenz%20Logo%20Signature.png) [Vālenz Health®](https://blog.valenzhealth.com/author/valenz-health) Vālenz Health® empowers employers, brokers, payers, and providers to reduce costs, improve quality, and elevate the healthcare experience. Our solutions combine advanced technology, clinical expertise, and extensive cost, quality, and utilization datasets to execute across the entire healthcare journey — connecting insights and action for greater transparency, flexibility, and cost containment within a complex system. By helping our customers and members navigate healthcare with confidence, we support smarter care decisions, strengthen plan performance, and deliver better value for everyone we serve. ## Related Articles [![A doctor's stethoscope lying beside an emptied piggy bank.](https://blog.valenzhealth.com/hubfs/Blog/why-price-transparency-isnt-enough-featured-blog-image.png)](https://blog.valenzhealth.com/incentivizing-smarter-healthcare-choices) ### [Why Price Transparency Isn’t Enough: The Importance of Incentives in Driving Smarter Healthcare Decisions](https://blog.valenzhealth.com/incentivizing-smarter-healthcare-choices) [Christie LaGrange](https://blog.valenzhealth.com/author/christie-lagrange) October 21, 2026 [![](https://blog.valenzhealth.com/hubfs/Social/2026/October/hcbb-vbb-social.png)](https://blog.valenzhealth.com/valenz-bluebook-healthcare-bluebook) ### [From Healthcare Bluebook to Valenz Bluebook: Turning Navigation into Smarter Care Decisions](https://blog.valenzhealth.com/valenz-bluebook-healthcare-bluebook) Two years ago, Vālenz Health® welcomed a new member to our product family: Healthcare Bluebook. [Vālenz Health®](https://blog.valenzhealth.com/author/valenz-health) October 06, 2026 Share Ready to Simplify Self-Insurance? ## Your Journey Starts Here Connect with a Valenz team member to explore the difference our solutions can make for you. ![Vālenz Health](https://www.valenzhealth.com/wp-content/uploads/2025/05/logo.svg) [![Youtube](https://www.valenzhealth.com/wp-content/uploads/2025/06/Icon-Youtube.svg)](https://www.youtube.com/@valenzhealth) [![Linkedin](https://www.valenzhealth.com/wp-content/uploads/2025/06/Icon-Linkedin.svg)](https://www.linkedin.com/company/valenz/) [Login](https://www.valenzhealth.com/user-login/) [Help Center](https://support.valenzhealth.com/hc/en-us) [Trust Center](https://trust.valenzhealth.com/) [Privacy Policy](https://www.valenzhealth.com/privacy-policy/) Cookie Settings [Cookie Policy](https://www.valenzhealth.com/cookie-policy/) [California Privacy Rights Notice](https://www.valenzhealth.com/california-privacy-rights-notice/) [Terms and Conditions](https://www.valenzhealth.com/terms-and-conditions/) 1717 McKinney Ave, Suite 1000, Dallas, TX 75202, USA | [(866) 762-4455](tel:+18667624455) © 2026 Vālenz Health® ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ { "@type" : "Thing", "name" : "Healthcare Benefits Innovation" }, { "@type" : "Thing", "name" : "Cost and Quality Transparency" }, { "@type" : "Thing", "name" : "Member Experience" } ], "articleBody" : "Employers and health plan sponsors are always looking for ways to make healthcare easier, more affordable, and more effective. However, it’s not a simple process. Healthcare benefit challenges have increased in the past decade due to fluctuating prescription drug costs and federal price transparency mandates. It’s tough to meet your clients' needs, give them ways to engage with their healthcare benefits, and improve their overall experience. Vālenz Health® is committed to giving employers and plan sponsors new ways to make smart healthcare choices with solutions designed to help tackle your healthcare benefit challenges. Curious? Read on: Challenge: Low-Value Care The U.S. has the highest healthcare costs in the world. In 2020, the U.S. spent about $4.1 trillion on healthcare — about $12,530 per person — according to the Centers for Medicare & Medicaid Services. This is a 9.7% increase over the past year. And yet, we trail behind other developed countries on common health outcomes, including life expectancy, unmanaged diabetes, and infant mortality. Part of the problem is that there’s little to no visibility into the cost or quality of care until after that care is delivered. Valenz data shows that the quality and cost of a service are often unrelated. Unless patients shop for care, they may pay prices that vary as much as 600% for the same procedure among in-network facilities in the same market. Without an effective quality and cost transparency tool, patients may unwittingly choose a higher-price or lower-quality option. Solution: Objective Quality and Cost Navigation Valenz Bluebook is powered by the largest healthcare quality and cost dataset nationwide. We help employers, consumers, providers, and payers make more informed healthcare decisions using a simple, intuitive color-coded system (green, yellow, and red) to help people identify the highest-value care for their needs. Helping employees find the highest quality, most affordable healthcare providers near them is an employer’s best defense against rising costs and the most effective way to improve the overall quality of care for enrolled benefits members. Valenz Bluebook also offers a solution to help benefit brokers provide sound advice on healthcare options and generates deep analytics that enables brokers to pinpoint overspending and lapses in quality — information that informs their client benefit strategies. Challenge: Rising Prescription Drug Costs When you walk up to a pharmacy counter, you likely don’t know how much your prescription will cost. What happens if you can’t pay for it? Recent research indicates that as many as 18 million Americans cannot afford their prescription medications, which is about 7% of America’s adult population. Prescription medications — especially specialty and brand-name drugs — have created an unsustainable cost situation for consumers and businesses. With prescription drug costs outpacing inflation, some large employers shell out nearly a third of their total healthcare benefit spend to pharmacy. Plan sponsors also need support managing costs once new medications come to market. Solution: Valenz Bluebook Rx Pharmacy Savings Solution “Everyone should be concerned about the rising costs of brand-name specialty medications. A generic alternative can cost as much as 99% less than its brand-name counterpart,” said Samantha McMaster, PharmD, former senior director of Pharmacy Solutions at Valenz. Valenz Bluebook Rx gives plan sponsors and members an independent look at employers’ prescription drug spending. With Valenz Bluebook Rx, plan sponsors get an objective analysis of pharmacy spending that identifies the drugs and drug categories driving high costs. With that information, Valenz Bluebook Rx offers members personalized savings reports that suggest lower-cost, clinically effective alternatives that can save them and their employer money. Members can potentially save thousands of dollars in out-of-pocket costs, and companies can potentially cut costs by millions. Challenge: Navigating a Complex System When an employee needs a complex, high-cost medical procedure, finding, scheduling, and coordinating the right care can be overwhelming, especially without visibility into quality and costs. Solution: Concierge Member Support Our Concierge feature provides individuals with a member concierge who works with them to find and schedule the right care with a high-value provider, from the initial consultation to follow-up appointments. Members develop a trusting relationship with the concierge throughout their care journey. “When I needed surgery, the cost was overwhelming and I felt lost. But when I called [Valenz Health], a member advocate assured me they could help me,” said a member who saved $10,964. “They negotiated a package for the surgeon, hospital, and anesthesiologist.” Challenge: Meeting Federal Price Transparency Requirements The Departments of Health and Human Services (HHS), Labor, and the Treasury now enforce provisions of the Transparency in Coverage rule and the No Surprises Act. Today, insurers and plan sponsors are on the hook for compliance. They are required to disclose their negotiated in-network and out-of-network rates and offer members good-faith cost estimates before care (i.e., enhanced explanation of benefits [EOB]). Solution: Valenz Bluebook Comply Valenz Bluebook Comply is a comprehensive compliance solution that addresses critical mandates, including the price comparison tool, Advanced EOBs, and machine-readable files. It's designed to help organizations not only meet the mandates but also deliver value far beyond the requirements. Challenge: Engaging Employees Although providing solutions to identify high-value care is important, it’s only one step in the process. You must also encourage good shopping behaviors so your employees make better choices. Solution: Engagement Rewards Engagement rewards create savings by changing employees’ healthcare shopping habits through targeted financial incentives that reward smarter, quality-driven, cost-effective healthcare choices. Employers who implement Valenz Bluebook’s engagement best practices — Educate, Remind, Reinforce — see as much as 20% monthly utilization with an ROI of up to 6:1. There are additional ways to drive employee engagement, including making it fun and adding incentives. “I did this yesterday and saw that the hospital where I had my kidney stone removed was one of the highest: $2,200 out of pocket! I found that I can get my second one done at a surgical center much cheaper — green light,” said a member after playing Valenz Bluebook’s pricing game. We’re Here to Help You are likely facing at least one of these healthcare benefit challenges. The good news is that you don’t have to find innovative solutions alone. The Valenz team is here to help you along the way, giving your team members or clients an engaging and successful healthcare benefit experience. Interested in how Valenz solves common healthcare benefit challenges facing today's self-funded employers? Contact us today to learn more about our solutions. Connect with Us to Learn More", "articleSection" : [ "Challenge: Low-Value Care", "Solution: Objective Quality and Cost Navigation", "Challenge: Rising Prescription Drug Costs", "Solution: Valenz Bluebook Rx Pharmacy Savings Solution", "Challenge: Navigating a Complex System", "Solution: Concierge Member Support", "Challenge: Meeting Federal Price Transparency Requirements", "Solution: Valenz Bluebook Comply", "Challenge: Engaging Employees", "Solution: Engagement Rewards", "We’re Here to Help" ], "author" : { "@id" : "https://blog.valenzhealth.com/author/valenz-health", "@type" : "Person", "name" : "Vālenz Health®", "url" : "https://blog.valenzhealth.com/author/valenz-health" }, "dateModified" : "2025-12-18T11:49:33-05:00", "datePublished" : "2022-06-20T13:50:00-04:00", "description" : "Discover the top five healthcare benefit challenges and strategies employers and plan sponsors can employ to overcome them. 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