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Commercial health plans face mounting pressure as medical and pharmacy costs continue to rise. Employer groups—both fully insured and self-funded—are demanding solutions that deliver value, manage spend and keep coverage affordable. The challenge: improve member health outcomes while reducing avoidable costs.
Here are three key trends forward-thinking plans are addressing to succeed:
- Medication Use as a Critical Cost Driver
Pharmacy costs don’t stop at the prescription counter—they ripple across the entire healthcare system. Drug therapy problems (DTPs), including duplicate therapies, untreated conditions and nonadherence, often lead to avoidable ER visits, hospitalizations and worsening chronic disease. Plans that address these issues early can avoid significant downstream medical expenses and improve member health.
- Predictive Analytics as a Game-Changer
The shift from reactive to proactive care is well underway. Predictive analytics surface members most at risk for nonadherence or complications, enabling plans to intervene before costs escalate. By turning data into actionable insights, health plans can target outreach, focus resources and prevent avoidable high-cost claims—all while supporting long-term member well-being.
- Behavioral Science Driving Member Engagement
Clinical recommendations only work if members follow through. Behavioral science closes this gap by addressing real-world barriers such as forgetfulness, mistrust or competing priorities. Techniques like tailoring communication, simplifying steps and celebrating small wins help members adhere to medications, complete preventive screenings and engage in other healthy behaviors. When layered with clinical expertise, these and other strategies help members stay on track with therapy and care to achieve better health.
The Bottom Line
Commercial plans that combine predictive analytics, clinical expertise and behavioral science aren’t just containing pharmacy costs—they’re driving measurable improvements in member health and plan performance. In today’s competitive landscape, these strategies are more than operational necessities—they’re key market differentiators.
