Many white arrows and a big yellow arrow pointing up
Earlier this year, I spent several days in Q1 with nearly 100 benefits leaders from large employers across the country. These were sustained, small-group conversations about the U.S. health care system and the challenges they're navigating every day.
One theme really stood out. The role of the benefits leader has evolved so dramatically that the job would be unrecognizable to a leader 20 years ago. From the outside, it still looks like plan design, vendor management, and renewals. The leaders I spent time with described something far broader and far harder
Health care is now one of the largest, fastest-growing expenses on an employer's balance sheet, and benefits leaders are the ones expected to manage it. The role has absorbed finance, strategy, employee experience, and policy, often all at once. Most told me that shift was unplanned. It is the product of sustained cost pressure and the hard realization that many solutions promising savings have fallen short.
Here are my clearest takeaways on that evolution.
1. Benefits leaders are now shrewd evaluators of health care quality, not "hype".
Health care costs continue to inflate at an unsustainable pace, with specialty care driving a disproportionate share of that spend. Cancer, musculoskeletal care, and other complex conditions – episodes that can't be managed well with simple, incremental tweaks to benefit design – now account for a growing share of total health care spend. Over the past decade or so, employers have adopted a growing number of point solutions intended to tackle those costs. Unfortunately, benefits leaders have found that while many claim to lower those costs and improve outcomes, few actually do.
Those of us building solutions in this space have a responsibility to provide benefits leaders with a transparent, rigorous framework for how we deliver savings and outcomes. We also understand completely that leaders want to do their own analysis, too.
"If you're relying on your carrier partner to build out metrics for you, you'll never get a great outcome," says Michael Costello, Senior Director, HR, Benefits Commercial Strategy at NextEra Energy Inc., shared with me. Fair enough.
In response, the evaluation process for benefits has become incredibly rigorous. Benefits leaders are poring over data – clinical outcomes, site-of-care variation, total cost of care, engagement rates – and asking harder questions of vendors.
One leader put it plainly during a roundtable: "No one is interested in hype. We need tools that work."
What I heard consistently was a demand for transparency and proof: show me the outcomes, show me the savings, show me the methodology, and then I'll make a decision.
High costs are creating multifaceted benefits teams with diverse skillsets. Many of the leaders I met with are putting together teams with a deeper understanding of analytics – teams that can develop more rigorous, cost- and quality-focused selection processes for vendors.
In an environment where specialty care is driving a disproportionate share of spend, being an informed, careful purchaser of health care has become a core part of the role.
2. Benefits leaders have to be health care and marketing experts now, too.
While benefits teams have historically focused primarily on designing programs and making them available to employees, today's leaders are responsible for ensuring employees can actually find, understand, and use those programs in the moments that matter most.
What surprised me is how deep that expertise has to go. Tony LaCrosse at the University of Colorado told me he has effectively become a pharmacy specialist and a policy specialist just to keep up with how the landscape is shifting. That experience is increasingly common. The leaders doing this well are building teams with genuine health care knowledge: people who understand clinical outcomes, drug pricing, site-of-care dynamics, and the policy environment well enough to ask the right questions of their vendors and health plans.
In addition, several leaders told me they're now hiring marketers and communications specialists directly onto their teams with these objectives in mind. They described investing in more navigation and outreach to ensure that high quality care pathways are actually utilized. After all, even the most innovative solution will fall short if employees can't easily access it or don't understand how to use it.
And part of that strategy also includes empowering their vendors. While in the past, benefits leaders have limited how often solutions can directly communicate with their employees, that's changing. Dawn Beaudin, VP of Benefits at Hyatt, put it simply: "The vendors who deliver hard dollar savings are going to get my approval to do more outreach."
3. Benefits leaders have an opportunity to reshape American policy.
Tensions around policy have surfaced repeatedly in my recent conversations with employers.
Many describe feeling cautious about stepping into policy conversations, even as those debates increasingly affect cost and access. Health plans or PBMs under questioning, for example, point to continued employer purchasing behavior as evidence that their clients are "satisfied" with the status quo. Judges and regulators will scan the record for employer dissatisfaction, and when they don't find it, they assume the system is indeed working.
Benefits leaders are stepping up.
"We have to take charge and hold our partners accountable across the supply chain," Rosa Novo, Executive Benefits Director at Miami-Dade County Public Schools – the third largest school district in the country – told me. "We have to elevate our voice and have a different presence."
Many of the leaders I spoke with are beginning to step confidently into advocacy roles; they're finding pragmatic ways to get involved by leveraging trade groups, participating in local consortiums, and engaging in direct, constructive dialogue with policymakers around health care costs and access challenges.
"Even if your company can't or won't advocate for policy changes," one leader told me, "You likely belong to powerful trade groups or local consortiums who are willing to fight that fight."
For many benefits leaders, this represents a meaningful expansion of the role. But beyond that, it's emblematic of the recognition that the voices of employers – the largest purchasers of care in the health care system – carry more weight than most realize.
A final thought
Health care is not getting any simpler. That much is clear. But I left these meetings feeling inspired by the ways in which benefits leaders are stepping up to meet the moment.
The leaders I met with have taken on the roles of health care analyst, experience designer, and policy advocate largely by necessity. Escalating costs and the limitations of existing solutions have pushed the role to evolve.
That evolution is more consequential than ever. And while benefits leaders are rising to meet the moment, the responsibility doesn't rest on their shoulders alone. The partners and solutions serving them must evolve in tandem. Now's the time for greater transparency, accountability, and above all, results. Anything less is unacceptable.
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