MedCity survey 2025 Benefit Sentiment Index
The 2025 Benefit Sentiment Index reveals how experienced consultants are helping self-insured employers tackle industry challenges like rising costs, GLP-1 coverage, gaps in care coordination and visibility to ROI.
The study, now in its third year and conducted in partnership with MedCity News, captures the priorities, concerns and strategies that are reshaping the healthcare and benefits landscape.
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Advocating for independent navigation solutions
Two-thirds of consultants said they’re dissatisfied with navigation provided by insurance carriers. Instead, they're guiding clients toward independent navigation solutions that deliver better member experience, clinical integration, steerage and clearer cost savings.
of consultants steer clients away from carrier-based navigation
say current reporting delivers clear ROI
now counsel clients on AI in benefits — up from 20% in 2024
agree clinical integration is critical, but only 12% say it exists today
GLP-1 demand is skyrocketing — and so are expectations
Almost 90% of consultants now advise clients on GLP-1 drug coverage, but most recommend utilization restrictions — not blanket coverage. Independent solutions are better positioned to support outcomes-based frameworks.
- 87% of consultants now advise clients on GLP-1 utilization restrictions
- Only 16% recommend full, unrestricted coverage
- 54% help clients ensure GLP-1 outcomes are measurable
- 88% support step therapy or predictive modeling
"We guide clients to ensure expanded coverage is aligned with evidence-based criteria, requiring FDA-approved therapies and clinical necessity documentation.”
Clinical expertise is a must, but it’s rarely delivered
It’s clear that clinical expertise is a must-have in navigation – 100% of consultants agree a clinically embedded model is important, but few believe it’s delivered today. That leaves employers exposed to care gaps and rising risk.
- Just 12% say clinical integration is present in current navigation solutions
- 50% of consultants say clients report gaps in care navigation
There's a growing need to prioritize ROI and reporting capabilities
The insights and reporting being provided today don’t cut it. Consultants want real-time visibility, predictive analytics and strategic benchmarking that show true value.
- Only 28% say current reports show clear ROI
- Most prefer monthly or real-time data vs. quarterly snapshots
- Top complaints: cherry-picked metrics and lack of forecasting
Consultant strategies reflect employer realities
Self-insured employers face immense pressure to control pharmacy spend, drive engagement and manage costs.
- 62% are advising more often on drug cost strategies
- 33% now recommend wellbeing programs — up from 9% in 2023
- Top cost-saving tactics: Chronic condition management and preventive care
“Navigators must be independent. There is too much opportunity for self-dealing and conflicts of interest otherwise.”
Read the full 2025 Benefit Sentiment Index
Deeper insights lead to smarter decisions. See the full breakdown of what consultants are recommending and how Quantum Health’s model aligns with the future of healthcare navigation.