Amid rising cost pressures, it will become imperative for insurers to do more to demonstrate true value to plan sponsors and clients, according to a new report.
Consulting firm Numerof & Associates released its annual outlook analysis for 2026, which highlights the biggest trends to watch for insurers and other segments. Payers, for instance, should be tracking a growing interest in direct-to-consumer or direct-to-employer relationships that cut out the middleman.
Michael Abrams, managing partner at Numerof, told Fierce Healthcare that the push is being driven by the employers themselves, who are feeling the squeeze of rising medical costs. A survey from the Business Group on Health released earlier this year found employers expect costs to increase by 9% in 2026.
"It's one of the biggest items in any financial picture for a company, and it's getting very, very painful," Abrams said.
He said that because employers have so much direct exposure to the rising cost trend, they have the "motivation and the means" to find a solution or alternatives that help ease the sting.
"Because it's such a big cost, they will make time to research options," Abrams said.
Consumers are also seeing the effects of rising healthcare costs in their wallets, but Abrams said they're not equipped to identify effective ways to address it. If the industry made it easier for consumers to access and use transparent cost information, they may be more proactive and involved.
Employers are also advocating for this information to be more readily available to workers~ and for models to shift in ways that generate greater value. While the move to value-based care has been slow overall, uptake in the employer space has traditionally lagged other markets.
Areas where employers are looking at these DTC models include bundles for certain episodes of care, such as an orthopedic surgical procedure, or even bundled payments for all per-member-per-month cost, per the report.
"You don't have a choice about insuring your workforce, but it does seem as though, increasingly, you don't have any control over the cost," Abrams said. "And when employers ask, 'Why is this the way it is?' Everybody points at everybody else."
Another area where new models are likely to take shape is prescription drugs, particularly for high-priced branded products that remain a sticking point, according to the report. The pressure on pharmacy benefit managers in tandem opens the door to new tactics.
In addition to spotlighting these key cost pressures, the report also highlights steps that insurers should be considering as they build strategies to address the current environment. For one, payers can be more effective at demonstrating value to their clients, which will become especially critical as they eye these models that circumvent or diminish their role.
Also, these companies can do more to engage providers and patients directly, which can reduce member churn and identify the potential partners well-positioned to take on risk and embrace value-based care models.
Considering approaches that lean on artificial intelligence and other emerging technologies will likely prove critical, the Numerof consultants said. Abrams said that to date, insurers have generally identified ways AI can reduce their costs, but there's still room to grow in producing tangible benefits for members and plan sponsors.
"The insurance industry has forever worked on the notion that the consumers that they cover—whether they're through employers or individual consumers—they're going to change insurers every two and a half years," Abrams said.
"But I think, increasingly, the issue of demonstrating your value by finding ways to keep insureds healthier, happier ... is something that needs to be addressed more seriously than it has been so far," he continued. "And we are seeing startups that will do it if the big companies won't."