With the new year just around the corner, plan sponsors, health care brokers, and plan participants alike want to prepare. Custom Design Benefits President and CEO Julie Mueller shares some of her expectations about the year ahead along with tips for managing costs and more in this informative Q&A.
Q: What trends do you expect to see in health care benefits for 2025?
A: This year, we saw a lot of buzz around GLP-1s, which I expect to continue in 2025 and beyond. Another hot topic is AI, and I expect to see more exploration of AI integration into health care aimed at improving provider and payer efficiency and patient outcomes.
We’re also seeing the beginning of a shift toward value-based care as health care providers seek to diversify payment models. Centers of Excellence are a great example of value-based care that I think we’ll see more of.
Telehealth and virtual care offerings may expand in an effort to make care more convenient and accessible. I think we’ll also see a continued emphasis on mental health/wellbeing care, especially as new mental health parity rules go into effect in 2025.
Another interesting development set to take off in 2025 is a collaboration between digital health disruptors and traditional providers. Amazon One Medical, for example, is joining together with Cleveland Clinic to open primary care offices that deliver in-person visits as well as virtual care via an app.
Q: What changes can we expect in health care as a new administration moves into the White House?
A: We don’t know exactly what is coming, but we can look at what happened in the previous Trump administration: efforts to repeal and reshape the Affordable Care Act (ACA), expansion of state-level flexibility through Medicare waivers, and introduction of the “Most Favored Nation” rule that aimed to lower prescription drug costs.
Q: What do brokers need to know to best serve their clients in the year ahead?
A: Brokers need to focus on long-term solutions and partnerships rather than year-to-year spreadsheeting rituals. Pay attention to the details, especially in stop-loss contracts. We offer our brokers a second set of eyes to review stop-loss proposals and have discovered many gaps in coverage that would have exposed the broker and client to additional risk. It’s always good to take advantage of a second set of eyes.
Q: Health care costs have been steadily rising in recent years. Do you expect this trend to continue?
A: Unfortunately, yes. One significant driver is high-cost specialty medication. Broader factors such as inflation mean plan sponsors will face the familiar pressure of providing access to quality care while containing costs. Nothing new there!
Q: Are there steps that companies can take now to help manage rising health care costs?
Absolutely. Preventative care is essential, and instituting wellness programs can help encourage healthy habits. Plus, you want to make sure you’re optimizing pharmacy benefits and asking for price transparency.
And if you’re not already, consider reference-based pricing plans as an alternative to PPO plans – we see organizations save hundreds of thousands of dollars annually by switching to reference-based pricing.
Q: Do you have any advice for plan sponsors who want to ensure they can continue to provide high-quality health care benefits at the best cost?
A: One of the best things sponsors can do is engage employees to take full advantage of available preventative care and wellness programs. The more you talk about available options, the more likely your team is to use them.
You can also embrace options like telehealth, direct primary care, and near-site clinics that have the flexibility to meet employee needs without necessarily driving up costs.
And, of course, partner with administrators and brokers who understand the intricacies of your business needs to help you make the best decisions. Select partners with a long-term relationship in mind. Avoid switching carriers year after year, which has a very negative impact on your most valuable asset: your employees and their families.