You don’t need to look far to understand why affordability is on everybody’s minds this year. The cost of nearly everything—from groceries to utility bills—continue to skyrocket. Medical cost trend is also projected to remain elevated for the fourth consecutive year, following a brief dip in 20221. In this inflationary environment, it’s more important than ever to look at plan design from all angles to optimize savings—and long‑term success. Below are several cost‑control strategies that work well to help self-funded employers manage costs more effectively over time.
Integrated programs for ongoing cost management
Effective cost control begins with better visibility. As claims grow more complex and high‑dollar events become more frequent, employers benefit from having strong oversight throughout the claim lifecycle. A comprehensive, multi-layered approach is key to success—focusing on paying claims accurately and recapturing savings when appropriate.
Strategies that support this approach include reviewing claims both before and after payment. Additionally, maintaining reliable processes for evaluating in‑network, out‑of‑network and high‑risk claims and closely examining facility and provider charges help to minimize potential fraud, waste or abuse. Looking at claims from all sides helps to uphold high standards for payment integrity—and creates more opportunities to maximize savings within self‑funded plans.
Alternative and captive models
Traditional self‑funding is the standard for many large employers. At the same time, smaller and mid‑sized organizations are increasingly exploring options such as captive and consortium arrangements. These models allow employers to pool risk and stabilize volatility as part of a broader group, rather than managing it alone. At Meritain Health®, much like the broader market, we’ve seen continued growth in captives over the past few years—driven largely by employers seeking greater predictability and risk protection.
Similarly, alternative health plan designs continue to gain momentum. While different in structure, these models typically focus on steering members toward high‑value providers with proven outcomes. Often using copay structures or network‑based incentives, they help ensure members receive evidence‑based, cost‑effective care. Depending on plan design, strategies like these can reduce total costs anywhere from 10 to 30 percent annually,
Targeted point solutions to address key cost drivers
Chronic conditions, rising prescription prices and behavioral health needs remain major cost drivers for many employee populations. These areas continue to account for a significant share of employer health care spend. Targeted point solutions can help address these challenges, complementing regular plan design to further support members.
A few examples include:
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- Telehealth options for primary and general care.
- Virtual musculoskeletal care for chronic pain.
- Behavioral health programs.
- Women’s and family health support.
For organizations unsure where to begin, a population analysis can help identify the most pressing needs and determine which solutions are best aligned with current risks. A curated approach can also serve as a great starting point, offering a solution set designed to address common pain points.
Wellness strategies focused on engagement and prevention
Prevention remains one of the most effective long‑term cost‑control strategies. When members feel supported and empowered to take charge of their health, employers often see gains in both productivity and reduced cost of care.
As behavioral health claims continue to rise, programs that support employees’ physical and mental well‑being are increasingly important. Structured wellness programs, such as Healthy Merits, that combine personalized goal setting with accessible digital tools can help reinforce healthy habits in sustainable, meaningful ways. Over time, especially when paired with coaching and incentive structures, wellness efforts can influence overall population health, reduce the incidence of high‑cost events and support better employee well‑being.
Getting more with us
At Meritain Health®, we consistently deliver measurable savings, mitigate risk and reduce medical costs through data‑driven insights, payment integrity, curated point solutions and member engagement. If you’d like to explore self‑funded options or targeted strategies that support long‑term cost control, we’d welcome the opportunity to connect.
Sources
1 PWC, Behind the Numbers 2026
This material is for information only and is not an offer or invitation to contract. Health benefits and health insurance plans contain exclusions and limitations. Plan features and availability may vary and are subject to change. See your plan documents for complete description of benefits, exclusions, limitations and conditions of coverage.
