Employers face a benefits deadline long before open enrollment
At the CFO Leadership Council’s fall conference in Westminster, Colorado, Marsh McLennan Agency senior vice president Marybeth Gray delivered a blunt warning to finance leaders: the time to begin planning for a company’s 2028 health benefits is January 2027. Waiting until summer, in her view, leaves too little room to renegotiate coverage, compare carriers, or redesign a program before costs have already hardened into next year’s budget.
Her message landed in a room of more than 300 attendees who already understand the pressure. Healthcare costs have climbed as much as 76% over the last decade, a rise that has pushed employer-sponsored coverage from a human resources line item into a core finance problem. Gray framed the issue in immediate terms: health spending does not sit still, and the decision to delay action is itself a decision.
The financial strain is not abstract. Employers have been forced to think about premiums, utilization, chronic disease burden, and plan design in the same breath, because each of those forces feeds the next budget cycle. In that setting, early planning becomes a clinical-adjacent strategy as much as a budgeting exercise, since the structure of a benefit plan can shape whether employees with diabetes, cancer risk, or other costly conditions receive timely care or drift into more expensive episodes later.
Carrier changes and early planning are becoming budget tools
Gray argued that planning in summer is already too late because implementation for the following year happens far earlier than most employers realize. June, she said, is implementation time. By that point, the carrier selection, network analysis, cost modeling, and employee communication work have already been set in motion. For large employers, this can mean a long runway for disruption, but also a better chance to correct course before costs lock in.
A switch in carriers is often unpopular, especially when employees are attached to existing networks or familiar administrative systems. Even so, Gray pointed to major employers that have made the kind of change smaller organizations often avoid. General Motors’ move from Blue Cross Blue Shield of Michigan to Aetna served as her example of the scale of action some buyers are now willing to consider.
No carrier has a monopoly on affordability. The point is leverage, not brand loyalty.
In employer health purchasing, inertia can be expensive. When premiums rise faster than wages, and when claims trends keep moving upward, staying with a familiar vendor may feel safe while quietly eroding budget flexibility. Gray’s advice reflected a hard-nosed purchasing philosophy: if a plan is not being actively re-evaluated, it is already drifting on autopilot toward higher cost.
High-cost claimants drive the real spend, not wellness program loyalists
Gray drew a sharp distinction between broad wellness efforts and the subset of employees most responsible for claims inflation. Wellness programs remain popular and can support workplace culture, but they usually do not shift total spend in a meaningful way because the employees most eager to participate are rarely the ones driving the largest bills. The cost pressure comes from high-cost claimants and top utilizers, especially people living with chronic conditions that require frequent services, drug therapy, or repeated interventions.
That point matters because employers often default to visible but low-yield interventions. Step challenges, fitness incentives, and other voluntary programs may help some workers, but they do little to blunt the cost curve when a small subset of patients accounts for a large share of claims. Gray’s example was diabetes management, where structured outreach and coaching can improve adherence, reduce avoidable complications, and limit the downstream cost of emergency visits, hospital care, and specialist escalation.
Auto-enrollment in coaching programs for employees with chronic disease was one practical step she described. The logic is straightforward: people with the heaviest utilization often need proactive engagement, not a passive invitation. When carriers can identify those members early and employers ask for the right utilization data in January, plan sponsors are better positioned to target interventions where the financial and clinical stakes are highest.
Modern diagnostics could change how plans spend money
Gray also pressed employers to think about the mismatch between contemporary medicine and outdated benefit design. Her phrase was memorable: “The science is George Jetson; the benefits are still Fred Flintstone.” Beneath the humor was a serious argument about whether plans are keeping pace with tools that can identify risk earlier and match therapy more precisely.
Genomic testing was one example. These tests can assess inherited risk for certain cancers, creating an opportunity to direct surveillance, counseling, or preventive care earlier in the course of disease. If a health plan covers that testing in a thoughtful way, the payoff may come not only in better clinical decision-making, but also in avoided advanced disease and lower downstream spending.
Pharmacogenomic testing is another example. By helping determine which medications are more likely to work for a given individual, these tests can reduce the trial-and-error cycle that often drives extra office visits, medication switches, and unproductive treatment months. In chronic disease management, those delays can become expensive quickly. A medication mismatch does not simply waste pharmacy dollars; it can worsen symptoms, trigger complications, and move a patient toward a higher-acuity setting.
Employers have been slow to build these tools into benefit design, even as the evidence base and vendor ecosystem have expanded. Gray’s question was not rhetorical for effect. It was a direct challenge to finance leaders who still separate “medical innovation” from “benefits administration” as if the two operate in different budget universes.
Rising medical spend is now a finance problem, not an HR sideline
The conference setting made Gray’s central point hard to miss. Finance leaders were already discussing cost containment, and health benefits sat squarely inside that conversation. The language of human resources no longer captures the full burden of premium growth, chronic disease management, and vendor strategy. When healthcare costs accelerate, they affect operating margins, compensation strategy, and workforce planning all at once.
Gray’s emphasis on January planning, carrier scrutiny, and targeting high-cost claimants reflected a pragmatic response to a system in which the most expensive members often determine the trajectory of annual spending. The practical burden for employers is to move earlier, ask for better data, and invest in interventions that match the source of the cost rather than the visibility of the program.
What remains unresolved is how quickly employers will adopt the more data-driven strategies Gray described, and how consistently carriers will provide the utilization detail needed to identify the highest-cost members early in the cycle. The larger question sits in the gap between medical innovation and benefit design: whether plan sponsors are prepared to use modern diagnostics and chronic disease tools before another budget year is already out of reach.