Cost containment is a sequence of judgments, not a list of tactics.
Most groups that try to control cost pull one lever, usually the deductible, and watch the trend return the next year. The levers are not equal, they depend on each other, and the order they are pulled in matters more than any one of them.
The levers, and the order they depend on each other.
Each card opens the full guide for that lever. None of them works well alone.
Market Check
Whether a renewal is competitive is a question about the market, not about last year. A written market check answers it, and knowing when not to run one is part of the judgment.
Contribution Strategy
What the employer pays and how it is split by tier changes cost and enrollment at the same time. The two effects have to be modeled together, or the saving shows up as lost enrollment.
Plan Design
Deductibles, copays and coinsurance move cost between the plan and the employee. Whether total cost falls depends on how employees behave when they face it.
Pharmacy
Prescription trend outpaces medical trend at many groups, and the contract decides how much of it you can see. Reading the contract is the work.
Funding Model
Fully insured, level-funded and self-funded plans put different amounts of claims risk on the employer. The right one turns on claims history and tolerance for variance, not on group size alone.
Claims and Eligibility Audit
Billing errors and ineligible coverage are paid for quietly. An audit that checks every claim, rather than a sample, is how they are found and recovered.
Navigation and Advocacy
Steering employees to the right care, and standing with them through claims they dispute, moves cost without touching the plan design.
Vendor Strategy
Point solutions accumulate faster than anyone measures them. The question is which ones earn their fee and which are overlap.
Direct Contracting
Contracting directly with providers or centers of excellence can price a defined set of services outside the carrier network. It fits some groups and some services, not all.
Before pulling a lever, find out what is driving the number.
The same increase can come from three different causes, and each one points to a different lever.
What Claims Data Can Tell You
Cost drivers, large-claim exposure and what a plan change would do, along with the limits you have to respect.
Trend Against Your Own Experience
How a carrier weighs your claims against the market when it prices a renewal, and what that means for the number you are given.
Managing High-Cost Claimants
A few members can shape a year. What an employer can and cannot do about it.
The starting point changes with the size of the group.
Small Group
Pricing is largely set by the market, so contribution, plan design and the market check carry most of the weight.
Mid-Market
Your own claims begin to count, so pharmacy, the funding model and audits enter the picture.
Large Group
Claim concentration and stop-loss terms dominate, and carve-outs and direct contracting become worth modeling.
Enterprise
Governance decides the outcome: a committee cadence, vendor accountability and a measure of what you already bought.
Free calculators for the decisions on this page.
Carrier Switch Savings Calculator
Compares total premium over several years and subtracts the one-time cost of switching.
Percent vs Flat Dollar Contribution Calculator
A percent contribution grows with each renewal and a frozen dollar one does not. See the difference.
Renewal Cost Sharing Calculator
Shows the impact on the company and on each paycheck under different ways of absorbing an increase.
Stop-Loss Attachment Point Calculator
Enter enrollment, expected claims and deductible to see the aggregate attachment point.
Pharmacy Rebate Value Calculator
Estimate what rebates are worth when you review a pharmacy benefit contract.
Specialty Drug Exposure Calculator
A few members on specialty drugs can drive a large share of claims. See how exposed you are.
Where this connects.
Healthcare Analytics
How we read claims, pharmacy and benchmark data against a decision.
The Cost-Control Playbook
Eight levers, in the order to pull them.
Funding Options Compared
Fully insured, level-funded and self-funded plans side by side.
The questions that come before the first lever.
Ten questions employers bring us about controlling cost.
Which cost lever saves the most?
It depends on what is driving the cost. A group with a few very large claims, a group with heavy specialty pharmacy and a group with a mispriced renewal each have a different answer. The common mistake is choosing by familiarity, which is why most groups start with the deductible. We read the claims and the renewal first, then rank the levers for that group.
Will raising deductibles lower our costs?
It lowers the plan’s share of each claim, and the employee pays the difference. Whether total cost falls depends on whether employees delay care they needed or simply pay more for care they would have had anyway. It also changes enrollment and how the plan reads to candidates, so it belongs in a model with contributions, not on its own.
Should we market the plan every year?
Not necessarily. A market check is worth running when the renewal is hard to defend against what the market would offer, and not worth running when it is already competitive. Running one on a fixed schedule regardless can also dull the response you get from carriers. The reasoning is here.
What is the difference between cutting cost and shifting it?
Containment lowers total spend. Shifting changes who pays. A higher deductible, a larger employee contribution or a narrower network can look like a saving on the employer’s line while the cost moves to employees. We separate the two so the number you report is the one that actually fell.
Can we lower cost without cutting benefits?
Often, because several levers act on price rather than on coverage: a market check, pharmacy contract terms, claims and eligibility audits, and the funding model. None of them changes what an employee is covered for.
Does a wellness program lower health plan cost?
Results vary widely, and they are hard to show in one employer’s data because the numbers are small and the effects take time. We ask what the program is meant to change, how it will be measured and what you would do if the measure comes back flat. Point solutions are judged the same way.
How much can we realistically save?
Nobody can say honestly before reading the data. Savings depend on where the group starts, which levers are still open and how the market prices the group. What we can tell you early is whether the renewal is competitive and where the opportunity sits. Send us your renewal and we will say so plainly.
What is a dependent eligibility audit?
A check that every covered dependent meets the plan’s definition, usually by documentation. A plan pays claims for ineligible dependents until someone looks. It recovers avoidable cost without changing anyone’s benefits. Here is how it works.
Can a small employer use self-funding?
Level-funded plans put part of the claims risk on the employer with stop-loss protection above it, which makes the structure available to smaller groups. Whether it fits depends on the group’s claims history and how it would absorb a bad year. The funding options are compared here.
How early should we start before renewal?
As early as the data allows. Funding, pharmacy contract and plan design decisions need lead time, and the room to act narrows once rates are released. If your renewal is closer than you would like, send it anyway. Some levers still work.
Ready? Upload your renewal, or talk it through with someone first. No cost, no obligation.
General information about cost containment, not legal or tax advice. Plan-specific questions belong with the right adviser, and we will bring them in.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents, two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →
Cookies on This Site
We use cookies to keep the site working properly and to understand how it is used. You can decline anything that is not essential. See our Privacy Policy for the detail.
- Essential — needed for the site to load and for you to move around it. These cannot be switched off.
- Analytics — tell us which pages get read, so we know what is worth writing more of.
- Advertising — set by third parties such as ad and social platforms to measure and target campaigns.