Rising Costs and the Case for Data-Driven Risk Management

1The perfect storm

2026 healthcare costs are up 6.5% per employee — the highest annual increase in 15 years. Employer health spending now averages $16,500 per employee, and the drivers are converging simultaneously.

Medical inflation, workforce shortages across clinical specialties, and a sustained utilization rebound post-pandemic are compounding in ways that make traditional budgeting unreliable.

2Where the money goes

High-cost claimants — the top 1% — account for roughly 35% of total plan spend. Single gene therapy treatments now exceed $4M, and GLP-1 medications are doubling in spend year-over-year, projected to reach $150B by 2030.

• Gene/cell therapies ($2M–$4M+ per treatment)
• GLP-1s (Ozempic, Wegovy — doubling annually)
• Oncology biologics (average $250K+ per case)
• Behavioral health (up 30% post-pandemic)

3Building a data-driven response

Traditional budgeting breaks when one $3M claim can blow an annual forecast. The modern approach combines real-time claims scoring, predictive high-cost identification, stop-loss threshold monitoring, and trend analysis by service category.

• Score every claim at intake for high-cost trajectory
• Monitor stop-loss attachment points in real time
• Segment spend by service line to spot trend shifts early
• Model scenarios for renewals using actual claims mix

4How CodaHx helps

Our dashboards surface high-cost trajectories, stop-loss exposure, and trend anomalies before they become surprises. Employers see risk in real time instead of discovering it at renewal.