The Hidden Drivers of Healthcare Trend — and How Analytics Can Bend the Curve in 2026

Healthcare costs are accelerating into 2026, and many employers believe they understand what is driving their spend. In reality, most organizations are reacting to headline trend rather than managing the underlying financial risk embedded in their health plans.

In most plans, a small subset of claims, providers, and treatment decisions drives a disproportionate share of total cost. Left unmanaged, that concentration quietly creates six- and seven-figure exposure that sits beneath the surface of otherwise “average” spend.

When leaders can’t see where cost is concentrated, they default to blunt tools: higher contributions, tighter benefits, broader cutbacks. Those moves may feel decisive, but they rarely reduce total spend. They simply spread the impact across the entire workforce while the real drivers continue untouched.

The employers outperforming in 2026 won’t be the ones cutting fastest. They’ll be the ones using analytics to pinpoint controllable spend, intervene earlier, and reallocate dollars toward high-impact decisions that increase predictability and protect margins.                                               

The Core Insight: Cost Is Concentrated and Controllable

Healthcare cost increases don’t happen across a population uniformly. They are driven by a relatively small number of members, conditions, providers, and treatment decisions.

Recent analysis shows that members with more than $100,000 in annual claims represent just over 1% of plan participants, yet account for more than one-third of total employer healthcare spend. That population is also growing rapidly: the number of participants exceeding $100,000 in annual claims has increased by 40% over the past two years, according to Alliant Analytics.

When employers rely only on aggregate reporting, this concentration is easy to miss. Trend masks where costs originate and where they can be influenced.

The implication is simple: if these concentrated costs go unmanaged, healthcare spend will keep exerting disproportionate pressure on margins no matter what broader cost-containment steps you take.

The Questions High-Performing Plans Ask First

These five questions aren't checkboxes. They're a mindset shift: from "managing a trend" to managing exposure.

1. What Conditions Are Driving Our Highest-Cost Claims?

High-cost claims are often assumed to be unavoidable. In practice, many are predictable and, in some cases, preventable.

What analytics uncover

A small set of chronic conditions and complex procedures are the main cause of the increase in catastrophic claims. Conditions such as diabetes and musculoskeletal disorders frequently worsen over time before triggering major events. Late-stage diagnoses can convert manageable conditions into extraordinary claims exposure.

What strategic employers do instead

They don’t cut benefits broadly. They invest narrowly, where the dollars actually concentrate:

• Condition-specific clinical programs
• Early-screening and navigation support
• Targeted outreach for rising-risk members

Why it matters

When high-cost conditions escalate unchecked, predictable clinical risk becomes an unbudgeted financial shock. A single unmanaged diagnosis can represent hundreds of thousands of dollars in annual spend, while multiple cases can quickly create six- and seven-figure exposure at the plan level.

Addressed early, these conditions shift from volatile surprises to managed, forecastable spend, freeing capital that would otherwise be absorbed by avoidable escalation while improving outcomes for the employees who need it most.

Most employers focus on how many people are affected. The real issue is how costly each condition becomes when left unmanaged.

2. Are Certain Subpopulations Driving Disproportionate Utilization?

Not all utilization is a waste. Variation, however, always signals an opportunity for deeper understanding.

What analytics uncover

Claims often reveal pockets of elevated utilization linked to geography, shift work, access barriers, or local provider patterns. High emergency room use, for example, can reflect limited primary care access rather than poor member behavior.

What strategic employers do instead

They ask better questions:

• Is care access uneven across locations?
• Are shift schedules or job demands driving utilization patterns?
• Are environmental or demographic risk factors at play?

Why it matters

When utilization patterns go unexamined, avoidable spend compounds quietly year over year. Operational friction becomes persistent cost leakage. Addressed at the source, these patterns shift from recurring, unmanaged spend to predictable, controllable cost, allowing employers to stabilize utilization, reduce downstream claims, and protect budget certainty over time.

3. How Do Our Costs Vary by Provider — and Why?

Many plans are paying premium prices for average results simply because no one is connecting the dots.

What analytics uncover

Provider consolidation has widened price variation dramatically. Employers often pay 20–30% more for identical services within the same market, depending on provider contracts and site of care.

What strategic employers do instead

They treat provider choice like any other purchasing decision:

• Compare negotiated rates across providers using transparency data
• Redirect volume toward high-value sites of care
• Explore reference-based pricing or targeted network strategies
• Steer imaging, labs, and routine procedures away from high-cost hospital settings

Why it matters

Price variation isn’t theoretical. In a single market, the same knee replacement can cost nearly twice as much depending on the carrier, and almost three times more depending on the provider, without any corresponding difference in outcomes.

At scale, those gaps quietly compound into six-and seven-figure overspend baked into annual budgets.

When employers lack visibility into where these price differentials exist, they unknowingly fund inefficiency year after year. When analytics expose both carrier-level and provider-level variation, employers can redirect care toward higher-value options, recapturing hundreds of thousands of dollars repeatedly while preserving access, outcomes, and critical provider relationships.

4. Are Our Members Receiving High-Quality Care or Simply Expensive Care?

The most expensive care is often the care that fails.

What analytics uncover

High-quality providers frequently lower total cost over time by reducing complications, readmissions, and avoidable follow-up care. Episode-based analysis shows the full financial impact of care from diagnosis through recovery, and what it costs the employer when outcomes fall short.

What strategic employers do instead

They use quality as a cost strategy:

• Incorporate quality data into provider guidance
• Incentivize use of high-performing providers
• Establish centers of excellence for complex, high-cost treatments
• Leverage bundled pricing to reduce variability and risk

Why it matters

Poor-quality care doesn’t just affect outcomes. It amplifies total cost from complications, rework, and repeat utilization, creating six- and seven-figure downstream financial drag over time.

Claims data shows that members receiving poor-quality care generate materially higher average claim costs than those treated by high-performing providers with costs steadily declining as quality improves. When quality is built into provider strategy, employers reduce episode variability, prevent costly failures, and convert hidden six- and seven-figure financial drag into more predictable, defensible spend while improving outcomes employees actually experience.

5. Are the Drugs and Solutions We Pay for Actually Delivering Results?

Utilization does not equal value.

What analytics uncover

High-cost medications and point solutions often show uneven adherence and inconsistent outcomes. GLP-1 medications, for example, deliver meaningful results only when appropriately targeted and sustained over time.

What strategic employers do instead

They demand evidence and governance:

• Are members achieving meaningful outcomes?
• Are programs reducing downstream claims?
• Are vendors delivering on promised results?

When the answer is no, they adjust eligibility, tighten governance, or evaluate new partners.

Why it matters

High-cost drugs and programs can quietly erode return on investment when they’re funded without measuring results. By evaluating outcomes, not just utilization, employers can shift spend away from low-return treatments and toward programs that demonstrably reduce long-term risk, stabilizing cost while improving value over time.

Treating the Health Plan Like a Business System

A high-performing health plan requires the same discipline applied to any critical business investment:

• Diagnosis before intervention
• Precision instead of broad cuts
• Measurement of outcomes, not activity

Analytics provide the foundation for this discipline. They reveal what is happening beneath the surface and enable leaders to act where impact is real.

Trend Will Rise. Exposure is Optional.

Most employers assume their highest-cost claims are unavoidable.

Alliant’s analytics platform integrates medical and pharmacy claims across carriers with provider cost, quality, and outcomes data, delivering a comprehensive view of plan performance.

Our consultants use these insights to:

• Identify the true drivers of healthcare trend
• Design targeted, evidence-based interventions
• Improve care quality while controlling cost
• Connect employers with vetted partners capable of executing effectively

In an environment defined by rising costs and incomplete information, insight is the advantage. Alliant helps employers use it — and take control.