How Taft-Hartley funds can manage surging high-cost claims
Catastrophic medical claims are climbing. Discover 6 ways trustees can safeguard reserves and keep benefits strong for members.
High-cost medical claims are rising sharply — and for Taft-Hartley funds, the financial impact lands directly on reserves and contribution rates. Million-dollar-plus claims have increased 46% in frequency from 2022 to 2026, driven by comorbid conditions, long inpatient hospitalizations and injectable drugs.1 At a broader threshold, claims of $100,000 or more rose 12.9% from 2024 to 2025, according to the UnitedHealthcare data within its 2026 Health Trends Report.2
These claims can be difficult to plan for. About half of UnitedHealthcare high-cost claimants had no previous indicators, and only 5% showed elevated risk in the prior reporting period.3 For trustees and the consultants who advise them, that unpredictability makes proactive strategies essential to protecting fund sustainability.
What's driving high-cost claims
Three forces converge behind the top cost driver, cancer: more frequent diagnoses, higher treatment costs driven by specialty medications and longer treatment durations as survival rates improve.
Specialty medications now represent approximately 55% of pharmacy benefit spend for UnitedHealthcare clients, despite accounting for less than 2% of utilization.2 And according to another report, those aged 20 to 40 now account for 10% of high-cost claimants, partly due to treatment advances and improved cancer survival rates.4
6 strategies for funds and trustees
1. Encourage members to seek preventive care
Funds can encourage members to engage with their primary care provider (PCP) for annual wellness exams, which monitor biometric measurements and may reveal early indicators of chronic disease. Regular cancer screenings and on-site workforce wellness screenings further support early detection. Preventive health programs deliver a 3.6x ROI for plan sponsors, with engaged members contributing an average of $359 in combined savings per year.5
2. Choose a carrier that uses predictive analytics to identify risk earlier
A carrier that uses data and analytics to enable earlier intervention — including real-time hospital admission alerts detailing condition, location and severity — can help prevent high-cost claims through timely outreach. Approaches using admission, discharge and transfer (ADT) data and other predictive signals can trigger or automate faster referrals, while predictive cost modeling surfaces possible high-cost episodes earlier.
3. Encourage use of proven Centers of Excellence
Centers of Excellence (COEs) help identify the best available care where treatment protocols are evolving rapidly. UnitedHealthcare COEs deliver value-driven pricing and stringent quality measurement for chronic or complex conditions, and they have been shown to result in contracted discount savings of 20–61%.6
4. Ensure access to clinical management programs
Since cancer is the leading driver of catastrophic claims, aligning providers, pharmaceutical companies and other stakeholders throughout a member's cancer journey is critical. The UnitedHealthcare Cancer Support Program provides evidence-based treatment decision support and helps streamline prior authorization. The program has demonstrated a $437 per member per month (PMPM) reduction in spend for unplanned admissions.7
5. Safeguard member support throughout the health care journey
Members need access to support when and where they need it — especially those who are hardest to reach and most at risk. A nurse-led engagement model proactively reaches out to under-engaged, high-risk members, guiding them into appropriate clinical programs and addressing complex needs before they escalate. This approach has delivered a 42% predicted lift in clinical program enrollment versus a control group, suggesting it could offer a more scalable way to manage complex, high-cost claims while ensuring members get the right support at the right time.8
6. Explore stop loss insurance options
Stop loss insurance sets an out-of-pocket limit for funds, helping protect against significant financial losses from high-dollar claims by transferring part of the risk to the carrier. When integrated under a single carrier — combining stop loss with a health plan — funds may benefit from a shared network, established risk-management practices and more connected systems delivering affordability, consistency and administrative ease.
The bottom line for fund strategy
For labor consultants advising Taft-Hartley trustees, the message is clear: High-cost claims are rising in both frequency and severity, often without warning. Strategies that emphasize preventive care, predictive analytics, clinical management and member engagement can help funds protect reserves, stabilize contribution rates and sustain benefit quality for the members they serve.
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