Employers still can’t Get Off The Dime to beat healthcare costs

U.S. employers are facing a growing healthcare cost challenge that is becoming too significant to remain primarily an issue for human resources departments. The concern was highlighted nearly two decades ago in the book *Get Off The Dime*, which argued that American companies were spending enormous amounts on healthcare without having enough information or purchasing expertise to understand the value they were receiving. Today, the problem has become even more pressing as employer healthcare costs are projected to rise sharply in the coming years.

WTW expects employer healthcare costs to increase by about 11% in 2027, while Aon is projecting an increase of approximately 9.5%. Such increases could represent one of the largest jumps in healthcare costs in more than two decades. While companies were once able to absorb annual increases of 5% or 6% without significant effects on profitability, larger increases are increasingly attracting the attention of CEOs, CFOs and corporate boards.

The central problem is not simply that hospitals, insurers or pharmaceutical companies are charging more. The deeper issue is that many employers still lack the infrastructure and information needed to understand what they are paying for and why their healthcare expenses are increasing. In most other areas of business, companies closely monitor suppliers, prices, contracts and performance, but healthcare purchasing often remains considerably more complicated and fragmented.

Large corporations routinely use sophisticated systems to track spending on technology, transportation, energy, raw materials and other major expenses. Healthcare, however, involves information spread across claims databases, pharmacy systems, insurers, third-party administrators, provider contracts and numerous specialized service providers. This fragmentation makes it difficult for employers to obtain a complete picture of their healthcare spending.

The emergence of artificial intelligence could potentially change this situation by helping companies analyze large amounts of fragmented healthcare information. Instead of simply reporting that healthcare expenses have increased by a certain percentage, AI-powered systems could help identify the underlying causes of those increases and show employers where they may have opportunities to improve value.

For example, employers could examine whether rising costs are being driven by hospital prices, increased utilization, specialty medications, cancer treatments, emergency department visits, provider consolidation or changes in contractual arrangements. They could also identify which providers or services are contributing most significantly to cost growth and compare their spending with other purchasers.

At the same time, hospitals and health systems are becoming more sophisticated in their own use of technology. Artificial intelligence and advanced revenue-cycle systems are increasingly being used to improve medical coding, identify missed charges and increase collections. This creates an important imbalance if healthcare providers become more technologically advanced at managing revenue while employers remain limited in their ability to understand how that revenue is generated.

The rapid growth of expensive specialty treatments and medications is adding another layer of complexity. Some cancer therapies and specialty drugs can cost hundreds of thousands of dollars, while the use of GLP-1 medications has also expanded significantly. Aon reported that employee utilization of GLP-1 medications for weight loss among its clients increased 75% in 2025. Although these medications can provide substantial health benefits, employers must also consider questions involving utilization, treatment duration, cost and long-term value.

These challenges have traditionally been handled largely through corporate benefits departments and outside consultants. Human resources professionals play an important role in managing employee benefits, but modern healthcare purchasing increasingly requires expertise in finance, medicine, actuarial analysis, economics, data science and technology.

Traditional benefits consultants can help companies negotiate renewals, compare premiums, design benefits and communicate changes to employees. However, employers increasingly need more detailed intelligence than a report showing that healthcare spending increased by 10%. They need to understand what caused the increase and what actions can be taken to address it.

Healthcare technology companies have responded by developing platforms that collect and visualize information for employers. Yet simply placing fragmented data into a dashboard does not necessarily give a company the purchasing intelligence required to make better decisions. The next generation of healthcare technology will need to explain the reasons behind spending patterns, identify potential opportunities and help employers act on those findings.

Data remains one of the biggest obstacles. Healthcare information is distributed across thousands of organizations, each with different systems, incentives and responsibilities. Although employers and employees ultimately provide a substantial portion of the money flowing through the healthcare system, they often do not have direct control over all the information necessary to evaluate those expenditures.

The situation is unusual when compared with other industries. A major corporation would not normally spend hundreds of millions of dollars on a supply chain without knowing what it was buying, how much individual suppliers were charging and whether those purchases were producing value. Yet similar levels of opacity have persisted in healthcare for decades.

Previous efforts by major corporations demonstrate how difficult the problem can be. Amazon, JPMorgan Chase and Berkshire Hathaway launched Haven in 2018 in an effort to rethink healthcare for their employees and appointed physician Atul Gawande to lead the initiative. The organization ultimately shut down less than three years later, illustrating the difficulty of changing a healthcare system characterized by fragmented information, competing incentives and complicated purchasing relationships.

The current cost environment could nevertheless create a new opportunity. Employers may increasingly recognize that simply shifting expenses to workers through higher premiums, deductibles and copayments does not solve the underlying problem. It may reduce an employer’s immediate costs, but it transfers more of the financial burden to employees and their families rather than improving the efficiency of healthcare itself.

A more strategic approach would treat healthcare purchasing like any other major corporate expenditure. Employers could give CFOs and CEOs greater visibility into healthcare spending, use AI to analyze clinical and financial data and develop stronger negotiating positions based on reliable information.

The technology to support such a transformation is becoming increasingly available. Artificial intelligence can process large volumes of data and identify relationships and patterns that would be difficult to detect through conventional analysis. However, technology alone will not solve the problem. Companies will also need the right organizational structure, data access and expertise to turn information into meaningful decisions.

The future of employer-sponsored healthcare may therefore depend on bringing together medicine, finance and technology rather than treating healthcare purchasing solely as an HR responsibility. If companies begin using their enormous purchasing power alongside better information and AI-driven analysis, they could gain greater leverage over one of their largest and fastest-growing expenses.

The central message remains similar to the argument made in *Get Off The Dime*: employers cannot continue treating rising healthcare costs as an unavoidable expense that must simply be accepted. With healthcare increases approaching double digits, the financial consequences are becoming too significant for corporate leaders to ignore. The challenge now is whether companies will use AI and better purchasing intelligence to finally gain greater control over the healthcare costs they finance.