Is Claims Visibility Missing From Your Health Plan?

Employers aren’t getting enough access to their claims data, and it’s hurting their bottom lines and downgrading their member experience.

According to the National Alliance of Healthcare Purchaser Coalitions’ 2025 Pulse of the Purchaser survey, 67% of employers still can’t get complete claims data, and four in ten say their vendors have outright refused to provide access.

Plus, that percentage increases significantly as employer size drops, going from 74% for employers with 50K+ employees, to 52% for employers with fewer than 1,000 employees—meaning more than one-half of employers you’re talking to are lacking the claims transparency they need to make informed, strategic decisions about their healthcare plans.

However, this is an easy problem to solve if you know where to point your clients.

Limited Visibility Costs Employers

Under the traditional, fully insured carrier model, employers pay a premium and the carrier handles everything else. When they receive their renewal numbers, often with increases, there is little to no insight into where the increase came from or what’s driving costs, month to month.

This lack of visibility creates pain points that equate to lost revenue for employers.

They can’t identify cost drivers.

What’s driving spend among their population? Access to claims data can highlight whether expensive prescriptions, poor utilization management, specific conditions, or other factors are causing costs to increase. A rise in spend can mean very different things depending on whether members are simply using more care, or the average cost of care has gone up. Furthermore, those two scenarios call for different fixes. Without claims data, employers are left guessing which forces are behind the changing number on their renewal, and they may end up responding with changes that don’t solve the entire issue.

They can’t manage renewals proactively.

Instead of walking into a renewal conversation with evidence-backed insights, employers have no way to secure a premium that reflects their members’ actual health needs. Claims analytics can’t predict costs with certainty, but reviewed consistently throughout the year, it gives employers time to investigate a developing trend well before renewal takes over the conversation. Plus, it helps them tell the difference between a one-time, isolated high-cost claim and an ongoing pattern that could shape next year’s costs.

They can’t evaluate plan design effectively.

Without the inputs on utilization, including details like where employees seek care, what services are being used, and how the network is performing, it’s impossible to make informed decisions about how they can optimize their plan for cost and member experience. Claims data can also highlight where members are missing care altogether, like ongoing treatment for a chronic condition without correct follow-up services, or lower-than-expected usage of preventive screenings. These gaps in awareness, access, or plan engagement can guide employers to change or increase member communication or education about their benefits.

It’s not just the employer that this lack of transparency impacts. When brokers don’t have access to a group’s claims, it’s difficult to bring real strategic guidance to conversations with employers.

Self-Funding Opens Up the Data

This is where self-funding expands employers’ options entirely. With a self-funded health plan, the employer funds claims directly, rather than paying a bundled premium to the carrier, and therefore they gain access to underlying information that fully insured plans don’t provide.

Self-funded employers can see:

• Which conditions are driving spend
• High-cost claimant trends, including whether an episode of care has concluded or is expected to continue
• Utilization patterns
• Real performance results on PBMs, stop-loss, and other vendors

With greater access, employers can view data and act on it. Adjusted plan designs, targeted wellness and utilization initiatives, stronger negotiations, and more strategic renewal conversations are all benefits that come with claims insights.

For brokers, it’s a powerful differentiator that empowers evidence-driven guidance, builds trust with clients, and adds credibility to your relationship. Bring a self-funded strategy to the table that brings together cost containment, administrative support, and data analysis, and you’re providing a level of insight and control they haven’t had before.

Choosing the Right Partner

Finding the right administrator partner is the critical piece that brings together the self-funding solution and adds value to data-backed decisions. Data access is only half the equation. Data must also be accurate, use a consistent methodology period over period, and be delivered in a frequent enough cadence to reflect what is actually changing in the plan. A report is only useful if it is regular and reliable.

Point C offers real-time, customizable reporting with meaningful analysis. Employers and brokers who work with Point C can build, customize, and share their own reports, as well as work with the Point C team to identify key cost drivers and turn data into action - whether that’s adjusting the plan mid-year or building a renewal strategy based on more than guesswork.

Data visibility helps empower better health plan decision-making and uncovers new ways to lower costs. Self-funding, paired with the right administrator like Point C, is how employers finally tap into the full package.

Connect with us now to learn more about our reporting capabilities and how they can add to your client strategy.