Q&A: How Are Employers Supporting High-Cost Claimants While Managing Costs?

Q&A: How Are Employers Supporting High-Cost Claimants While Managing Costs?
June 9, 2026 4 mins

Q&A: How Are Employers Supporting High-Cost Claimants While Managing Costs?

Managing High-Cost Claimants: Employer Strategies

High-cost claimants continue to drive a disproportionate share of healthcare spend and volatility. Aon’s 2026 Health Survey shows how employers are responding, and where there are opportunities to manage costs without eroding support for employees in the future.

Key Takeaways
  1. A successful high-cost claimant strategy integrates different components: vendor oversight, predictive analytics, funding strategy and targeted clinical management.
  2. Forward-thinking employers use predictive analytics to improve budgeting and strategic planning, as well as exploring non-traditional funding arrangements.
  3. High cost claims are increasingly manageable when employers move from broad cost controls to targeted, data driven strategies focused on both financial and clinical risk.
Q: How are employers improving oversight of vendors and claims?

A: Employers are sharpening their focus on vendor oversight and claims payment integrity. More than half rely on carrier utilization management programs, while others supplement with third-party solutions. At the same time, there is room to strengthen accountability by evaluating vendors on outcomes, not just activity. Measurable outcomes could include reduced hospital admissions or faster intervention for high-cost conditions. Employers can use audits, performance guarantees and ROI measurement to validate impact.

  • 52% of employers use carrier utilization management programs
  • 20% use third-party solutions
Q: What role does data and analytics play in managing high cost risk?

A: Employers are viewing predictive analytics as a core capability, in addition to existing retrospective reporting tools. Leading edge employers increasingly use predictive insights to identify emerging high-cost risks sooner. They also use analytics to improve budget planning, explore alternative funding, such as stop loss or captives, and evaluate network strategies, to manage volatility from large claims. Lastly, employers are using advanced analytics to identify which population health trends are likely to drive future high costs.

  • 1 in 3 employers are already using predictive analytics for budget planning or cost containment strategies
Q: How are employers approaching financial risk?

A: While traditional funding approaches remain common, employers are increasingly reassessing how they manage cost, risk and predictability in their health plans.

Many employers use self funded plans, often with individual stop loss overlays to address the highest cost claims. However, growing cost volatility is driving increased interest in level funded and captive arrangements that offer additional financial guardrails. Appropriateness varies by employer size, cash flow and risk tolerance.

  • 45% use self funded plans with internal funds
  • 41% use individual stop loss
  • 29% use fully insured arrangements

Interest in alternative funding continues to rise as claims volatility increases.

Q: How are employers providing support for the highest risk individuals?

A: Predictive analytics enable earlier identification of high-cost or high-risk members, allowing employers and their partners to deploy specific navigation and clinical support. These approaches help steer individuals to appropriate care, reduce avoidable utilization and improve outcomes.

Targeted clinical outreach and support:

  • Predictive identification of emerging high cost individuals: 31%
  • HCC care coordination: 25%
  • Predictive decision support: 24%
  • Care navigation and medical support: 19%
  • Third party cancer support: 14%
Q: What separates employers making progress from those struggling with cost volatility?

A: Employers who see stronger results with high-cost claims develop an integrated strategy. Rather than relying on a single lever, they combine different approaches, including: vendor oversight, predictive analytics, funding strategy, network strategy and clinical management. This coordinated model enables earlier action when risk begins to emerge.

High cost claims are increasingly manageable when employers move from broad cost controls to targeted, data driven strategies focused on both financial and clinical risk.

Next Steps for Employers

  1. Assess exposure to high cost claimants and claims volatility.
  2. Evaluate whether analytics are being used before or after costs emerge.
  3. Review complex cases and deploy risk mitigation strategies including stop-loss and captives.
  4. Audit claims, direct care to high-quality providers, review complex cases and align stop-loss coverage to your risk and financial goals.
  5. Consider detailed audits and claim renegotiation to correct billing errors and ensure parties are complying with contract terms.
  6. Leverage advanced analytics to identify network and centers of excellence optimization opportunities and quantify potential savings from directing care to the highest value, highest quality providers.
  7. Invest in clinical strategies that intervene earlier and support better care decisions.
  8. Monitor and evaluate the effectiveness of these strategies over time with strong vendor oversight and performance guarantees that align with measurable outcomes.

High cost claims are no longer just a financial issue. They test how well data, funding and clinical strategies work together when risk begins to emerge. The most effective employers are not eliminating risk. They’re gaining earlier visibility, clearer choices and greater confidence in how they support high cost individuals over time.

General Disclaimer

This document is not intended to address any specific situation or to provide legal, regulatory, financial, or other advice. While care has been taken in the production of this document, Aon does not warrant, represent or guarantee the accuracy, adequacy, completeness or fitness for any purpose of the document or any part of it and can accept no liability for any loss incurred in any way by any person who may rely on it. Any recipient shall be responsible for the use to which it puts this document. This document has been compiled using information available to us up to its date of publication and is subject to any qualifications made in the document.

Terms of Use

The contents herein may not be reproduced, reused, reprinted or redistributed without the expressed written consent of Aon, unless otherwise authorized by Aon. To use information contained herein, please write to our team.

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