Affordability strategy blueprint for large employers
A total cost of care approach helps large employers coordinate the right affordability levers for their workforce and cost drivers.
- Larger self-funded employers face complex health care costs that no single affordability tactic can reliably address.
- A total cost of care approach looks beyond unit prices to coordinate multiple strategies — including data analysis, population health, specialty pharmacy management, site of care support and value-based care — tailored to the workforce's specific cost drivers.
- Rather than adding every available program, employers should use data to identify what's driving their spending and build a coordinated blueprint that balances cost, quality and outcomes.
Larger employers rarely manage just one health plan. They often oversee benefits across multiple geographies, employee populations and programs. And when those plans are self-funded, every utilization shift, high-cost claim, specialty pharmacy spend and provider cost hits the bottom line directly.
That complexity makes any single affordability strategy unreliable. A tactic that solves one organization's primary cost driver may barely move the needle for another. The better question isn't which cost management tools exist, but which combination fits a specific workforce, its utilization patterns and its underlying cost drivers.
A total cost of care approach broadens the view. It looks past the negotiated price of individual services to consider how often care is used, where it's delivered and how well it's managed. For large employers, that means coordinating multiple affordability levers rather than evaluating each in isolation.
Look beyond unit cost to understand what is driving trend
Unit costs matter, but they don't tell the whole story. Utilization shapes total spend too — clinical programs, site of care support, utilization management, provider relationships and claims accuracy all influence where health care dollars go.1 The same condition can cost very different amounts depending on where it's treated. Seen together, unit cost and utilization give employers, brokers and consultants a far more complete picture of plan performance.
The evidence backs this up. An analysis commissioned by UnitedHealthcare and conducted by Milliman found that UnitedHealthcare's total cost of care was more than 11% lower than national benchmarks — and up to 17% lower in certain regions.1 The study compared UnitedHealthcare medical claims and enrollment data against national benchmarks, adjusting for differences in health status, demographics and geography.
7 affordability levers larger employers can evaluate
There is no single formula for managing health care trend. Larger employers may have access to a wide range of strategies, but the appropriate mix will depend on where costs and utilization are concentrated.
1. Use data to identify where opportunity exists
Large employee populations can generate significant amounts of health care data. The challenge is turning that information into a clearer view of what is driving cost.
Population segmentation, utilization analysis, cost trend forecasting and performance benchmarking can help employers identify where health needs and spending are concentrated.
Those insights can help employers prioritize where additional clinical support, employee education or benefit strategies may be warranted. Data may also help employers and their advisors monitor whether strategies are changing utilization patterns over time rather than relying solely on aggregate annual spend.
2. Take a population health approach
Chronic and complex conditions can account for a substantial portion of health care spending, making population health an important part of a longer-term affordability strategy.
Depending on the needs of the workforce, employers may consider programs focused on chronic condition management, preventive care, behavioral health and employee engagement.
The goal is not simply to add more programs. It is to understand the health needs within a population and determine which resources may help employees access appropriate care, manage existing conditions and identify risks earlier when possible.
3. Support employees with complex health needs
As employee populations grow, employers may also face greater exposure to high-cost and complex claims. Cancer, maternity complications, cardiac conditions, musculoskeletal needs and other chronic and complex health events may require specialized support and coordination, for instance cancer treatment or cell, gene and molecular therapy.
Some high-cost claims may also be difficult to predict based on historic claims alone.2 Programs focused on complex conditions may help coordinate care, connect employees with specialized providers and identify opportunities for earlier intervention when appropriate.
4. Address specialty pharmacy across benefits
55%
of an employer's total prescription drug spend was driven by specialty medications in 2025, according to UnitedHealthcare data3
Specialty medications have become an increasingly important affordability consideration for employers.
According to the 2026 Health Trends Report from UnitedHealthcare, specialty medications drove approximately 55% of an employer's total drug spend in 2025.3 Some specialty medications may be covered through the pharmacy benefit, while others fall under the medical benefit, adding another layer of complexity.
Employers may want to evaluate utilization management, clinical oversight, biosimilar strategies as well as encouraging use of clinically similar, lower-cost options, sites of care and integrating medical and pharmacy benefits. A more coordinated view across benefits may help identify opportunities that can be missed when medical and pharmacy strategies operate separately.
5. Evaluate where care is delivered
Where employees receive care may also have a significant effect on total cost.
Site of care strategies can help navigate employees toward appropriate, cost-efficient settings when clinically appropriate. Depending on the service, this may include evaluating inpatient versus outpatient care, emergency department utilization or the setting in which certain medications and procedures are administered. For instance, Centers of Excellence (COEs) help members access the right care the first time, helping control costs for employers and members.
For employers, the opportunity is not simply to direct employees to the least expensive setting. Cost should be considered alongside quality, clinical appropriateness and access.
6. Consider value-based care and alternative payment approaches
Traditional fee-for-service arrangements generally reimburse providers based on the volume of services delivered. Value-based models seek to create greater accountability for quality, outcomes and cost. These approaches may include Accountable Care Organizations (ACOs), bundled payment arrangements and provider performance incentives.
Employers may want to consider alternative approaches of how to fund the various programs they offer employees, and whether there are more flexible approaches like a Lifestyle Spending Account (LSA). For example, 66% of employers are looking at LSAs,4 and there is also growing interest in the idea of defined contribution models which let employers set a fixed per-employee budget that staff can allocate across a broad range of eligible categories, giving employees more choice while allowing the company to forecast and control costs.
For employers, these models offer another way to consider cost and quality together. Their impact may vary based on the market, employee population, provider relationships and plan design.
7. Integrate medical benefits with specialty and behavioral benefits
When employers bundle specialty benefits with medical and behavioral health benefits, the combined data enables a more holistic view of employees' health and well-being — supporting an enhanced administrative and clinical experience that may lead to better outcomes and lower costs. UnitedHealthcare demonstrates this value in practice every day, using integrated medical and specialty data to drive financial value and better health outcomes in a tangible, hassle-free way.
Beyond employer strategy: The work happening across the health system
Many affordability conversations focus on decisions employers can make directly: plan design, pharmacy strategy, network selection and clinical programs. Those choices matter, but they represent only part of the total cost of care picture.
Affordability is also influenced by work taking place across the care and claims lifecycle, including:
- Provider contracting
- Payment integrity
- Fraud, waste and abuse prevention
- Clinical review and care management
- Value-based provider relationships
- Site of care education and support
- Claims management
For example, payment integrity processes are designed to help ensure claims are accurate and that employers and employees pay appropriately for eligible care and services rendered. Provider contracting, clinical review and care management can also influence how care is accessed, delivered and paid for.
For employers and their advisors, a total cost of care approach means considering both the levers the organization can choose and the capabilities its health plan uses to manage cost across the system.
What success may look like
The impact of an affordability strategy should not be judged by a single savings figure. For larger employers, progress may show up across several dimensions:
- Lower trend growth: Employers can monitor whether medical and pharmacy cost trends moderate over time as strategies become more targeted to the organization’s primary cost drivers
- Better management of high-cost claims: Clinical support and care coordination may help employers and employees navigate complex health needs more effectively, even when high-cost events cannot be predicted or prevented
- Improved care quality: Network, clinical and value-based care strategies may help support care that balances cost, outcomes and member experience
- More efficient use of health care resources: Employers may see changes in utilization patterns, site of care, program participation or other measures that indicate employees are accessing more appropriate care settings
The specific measures will vary by organization. Employers may also monitor provider performance, chronic condition trends, employee engagement and total cost of care relative to appropriate benchmarks.
The goal is to identify metrics that reflect the organization’s most important cost drivers and business priorities, then evaluate whether the coordinated strategy is changing those patterns over time.
A blueprint, not a checklist
There is no one-size-fits-all affordability strategy.
A large national employer with multiple populations, markets and benefit programs may face a very different mix of cost drivers than another organization of similar size. Adding every available cost management program is unlikely to be the answer.
Instead, employers can use data to identify what is driving their health care spend, determine which affordability levers align with those needs and evaluate how those strategies work together.
A total cost of care approach broadens that evaluation beyond individual programs and negotiated discounts. It considers how care is priced, used, delivered and managed across the health system.
For employers, brokers and consultants, that creates a more useful blueprint: Understand the cost drivers first, then coordinate the strategies and capabilities that are most relevant to managing them.
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