Phoenix. Credit: Adobe Stock
Amid rising health care costs and ongoing regulatory shifts, leaders from across the self-insurance and stop-loss sectors gathered this week for the Self-Insurance Institute of America conference in Phoenix to discuss the rapidly evolving challenges facing the industry.
Employers, brokers, TPAs, carriers, and solution providers are working to improve outcomes, manage costly claims, and bring more predictability to a system often marked by uncertainty.
Here are some of the themes from what they said at SIIA 2025.
Broad-based rate increases in stop loss: The increases are being driven by multiple factors: rising claims severity, an uptick in costly specialty drugs, sustained pricing pressure from providers, and lingering post-COVID effects, including longer and more intensive hospital stays, particularly for cardiovascular care.
Together, these forces are reshaping how underwriters assess exposure and how employers manage their long-term health care budgets.
Changing regulation and price transparency: Regulatory discussions continue to intensify, particularly around potential moves related to price transparency.
Stakeholders across the ecosystem are grappling with how new mandates could reshape plan design, administrative processes, and data-sharing requirements.
While the path forward remains uncertain, one thing is clear: Transparency will increasingly define competitiveness and trust across the self-insured space.
Growth of level funding amid rising costs: Level funding continues to grow rapidly as the fully insured market faces steep premium hikes.
Employers are seeking more control and predictability, even as they face rate increases that mirror what's happening in the self-funded stop-loss market.
The convergence of these pressures underscores the need for smarter financing tools that help employers balance risk and stability.
Operationalizing innovation remains a challenge: The industry is full of promising ideas and new solutions, but putting them into practice at scale is still a major obstacle.
Many innovations never make it past the pilot stage due to fragmented systems, competing incentives, or the complexity of implementation.
To drive real change, the focus needs to shift from just developing new tools to actually executing and delivering them across the ecosystem.
The conversations I had this week reaffirmed my firm's commitment to helping our partners adapt to change, rather than react to it, with adaptive capital solutions. Reducing surprises, improving cash-flow reliability, and easing administrative burdens are essential to keeping health care accessible, affordable, and sustainable.
If there was one unifying theme from this year's event, it was urgency. The challenges of cost containment, transparency and execution can't continue to be deferred.
Our progress depends on translating good ideas into scalable, sustainable action.
Gerardo Zampaglione is the founder of Aegle Capital, a firm that helps self-funded health plans with financing.
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