The Data Divide: How Access to Healthcare Information Shapes Employer Strategies

The landscape of employer-sponsored healthcare is shifting dramatically as organizations grapple with escalating costs. A recent survey by the National Alliance of Healthcare Purchaser Coalitions highlights a critical factor that separates employers who merely express concern over rising healthcare expenses from those who take tangible action: access to data. The 2026 Pulse of the Purchaser survey provides compelling insights into how employer strategies are influenced by their ability to analyze medical and pharmacy claims data. As employers face an average projected healthcare cost increase of 7.7%, understanding the importance of this data access is more crucial than ever.

According to the survey, which gathered responses from 408 employers, those with full access to claims data employed an average of 11.9 high-value purchasing strategies, while those with limited or no access leveraged only 7.9 strategies. This disparity underscores a significant barrier to effective cost management: the inability to see and understand their own healthcare expenditures. As Shawn Gremminger, president and CEO of the National Alliance, notes, “When those barriers are removed, employers are better able to move from concern to action.” This article will explore the implications of these findings and offer insights into how employers can leverage data to control costs.

The Importance of Data Access in Healthcare Cost Management

Access to comprehensive medical and pharmacy claims data is not just a technical necessity; it is a vital component of strategic decision-making for employers. The survey revealed that employers equipped with full data access were more adept at implementing effective cost-saving strategies. These strategies include:

• Network Evaluation: Analyzing provider networks to ensure they deliver value.
• Hospital Price Review: Scrutinizing hospital charges for transparency and fairness.
• Vendor Audits: Evaluating the performance and cost-effectiveness of healthcare vendors.
• Reference-Based Pricing: Setting prices based on a percentage of Medicare rates.
• Direct Contracting: Forming agreements with healthcare providers to negotiate rates.
• Centers of Excellence: Directing patients to high-quality providers for specific procedures.

These strategies are not just theoretical; they have the potential to generate sustainable savings rather than merely shifting costs year-to-year. For instance, by employing reference-based pricing, an employer could save up to 30% on certain procedures compared to traditional pricing models. The critical takeaway here is that without access to the underlying data, employers are essentially flying blind, unable to make informed decisions that could alleviate their financial burdens.

Understanding the Current Landscape of Healthcare Costs

The backdrop of the survey findings paints a sobering picture for employers. With one in three employers expecting healthcare costs to rise by 9% or more, the pressure is mounting. Factors contributing to these cost increases include:

• Drug Prices: 77% of employers identified rising drug costs as a top concern.
• High-Cost Claims: 75% are worried about the financial impact of high-cost medical claims.
• Hospital Prices: 68% cited hospital pricing as a significant threat.

Hospital and facility costs account for a staggering 30.5% of total healthcare expenditures, while prescription drugs follow closely at 21.1%. This concentration of costs underscores the necessity for employers to take proactive measures in managing their healthcare benefits. Moreover, a notable trend observed in the survey is the shift in how employers perceive their role in the healthcare ecosystem. With 92% acknowledging that rising healthcare costs threaten their competitiveness and 93% anticipating that these costs will be passed onto employees, the ramifications extend beyond mere financial strain. They can affect employee morale, retention, and overall workplace engagement.

The Evolution of Pharmacy Benefit Management

Another intriguing finding from the survey is the noticeable shift in the pharmacy benefit management (PBM) landscape. The percentage of employers contracting with the three largest PBMs dropped from 63.4% in 2025 to 54.3% in 2026. This decline suggests a reassessment among mid-market employers, who are increasingly looking for alternatives to the traditional PBM model. Notably, among those still engaged with the Big Three PBMs, 55.7% expressed intentions to consider a change within the next one to three years.

One key factor influencing this trend is contract opacity. A significant 23.4% of employers using major PBMs admitted they were unaware of the specifics within their contracts, nearly double the rate of employers using alternative PBMs. This lack of transparency can prevent organizations from fully understanding their spending or making data-driven decisions about their pharmacy benefits. Moreover, the desire for reform in this area is palpable, with 87.6% of respondents advocating for changes that would promote greater clarity and accountability in PBM contracts.

Legislative Engagement and Future Directions

Another noteworthy trend from the survey is the increasing engagement of employers in healthcare legislative activity. In 2026, over half of the respondents (51.3%) reported involvement in federal or state healthcare initiatives, a significant rise from 42.5% in 2025. Employers with complete access to pharmacy claims data demonstrated even greater levels of engagement (61.3%) compared to those without such access (39.4%). This shift indicates a growing recognition among employers that active participation in policy discussions is essential for addressing their concerns about healthcare costs.

As employers become more informed and engaged, they are also developing specific policy preferences. Support for various reforms, including hospital price transparency and antitrust enforcement, has increased across the board. This progression suggests that employers are moving beyond mere frustration with rising costs and are beginning to articulate concrete solutions that could lead to meaningful change.

Key Takeaways

• Access to healthcare data is critical for employers seeking to implement effective cost-saving strategies.
• Employers expect significant increases in healthcare costs, with a majority anticipating these costs will be passed on to employees.
• There is a noticeable shift in the pharmacy benefit management landscape, with mid-market employers exploring alternatives to traditional PBMs.
• Employers are increasingly engaged in healthcare legislative activities, indicating a desire for policy reforms.
• Transparency in healthcare contracts and pricing is a key concern for employers aiming to control costs.

Frequently Asked Questions

How can employers gain access to their healthcare data?

Employers can request access to their healthcare data by negotiating specific terms with their insurance carriers or third-party administrators (TPAs). It is essential to include clauses in contracts that grant full claims-level data rights. Engaging a knowledgeable broker can also facilitate this process, ensuring that employers can effectively utilize the data to drive cost-saving initiatives.

What strategies can employers implement to control rising healthcare costs?

Employers can adopt several strategies to manage healthcare expenses, including network evaluation, vendor audits, and reference-based pricing. By leveraging data access, employers can identify high-value care options and negotiate better terms with providers. Additionally, engaging employees in wellness programs and preventive care can reduce overall healthcare utilization and costs.

What role does legislative engagement play in healthcare cost management?

Legislative engagement allows employers to influence healthcare policies that affect their costs and access to care. By participating in state and federal initiatives, employers can advocate for reforms that promote transparency, accountability, and competition within the healthcare market. This proactive approach can lead to more favorable conditions for managing healthcare expenses.

Why is transparency in PBM contracts important?

Transparency in pharmacy benefit management contracts is crucial because it enables employers to understand their spending and make informed decisions about their pharmacy benefits. Without clear information, employers may miss opportunities for cost savings or inadvertently engage in unfavorable agreements. Advocating for reforms that enhance transparency can empower employers to negotiate better terms and control their healthcare costs more effectively.