Bold Steps for 2025: How Employers Can Play the Long Game on Cost and Quality

By:

Chris Reed
Director of Value Creation

The past couple of months have seen the usual run of industry predictions and trends to watch and plan for in the year ahead. At Quantum Health, we’re always looking over the horizon and reading the tea leaves of our data and insights to keep our clients one step ahead. It’s in our founding DNA and hard-wired into our solutions.

So, when Business Group on Health (BGH) published their 2025 trends report back in December, we read it closely—not so much to find out what to expect and plan for but to validate what we’ve mostly known and have been laying the groundwork for over the past year or more.

What stood out?

As I’ve been having conversations with clients who are steeling themselves for a difficult year, here are some of the trends I’ve been calling out and guidance and encouragement I’ve been offering.

Small steps won’t cut it anymore—real change demands a leap forward.

The single biggest trend keeping every employer awake at night is the dramatic surge in healthcare expenses, which are projected to rise by 8% this year to historic highs. Driving this trend are the usual suspects like cancer, cardiovascular disease, diabetes, and musculoskeletal disorders. Meanwhile, specialty drugs to treat these and other chronic conditions such as autoimmune disorders have emerged as the fastest-growing cost center, accounting for 27% of employer’s total healthcare spend according to BGH’s 2025 Large Employer Survey. And with the spike in demand for GLP-1s and the FDA approving new high-cost drugs at a lightning pace, employers can only expect that percentage to grow.

How are employers responding?

• After years of steadily rising premiums, they’re realizing they can no longer cost shift their way out of this crisis.
• Only 34%, according to WTW’s annual survey, are planning to shift costs by bumping up premiums, and only 20% are promoting high-deductible plans.
• Employers are finding that legacy tactics and quick fixes are not enough to stem or reverse the surging cost trend.
• Getting costs under control while improving quality and outcomes will require bigger, bolder measures.

What kinds of big, bold measures are we talking about? And how is independent healthcare navigation critical to their success? As BGH observes, employers are turning to a combination of near-term cost controls and longer-term innovations and investments.

Near-term: Smart navigation to the right care, at the right time and place.

Right care/time/place (and price) is a mantra that can’t be repeated often enough. And smart healthcare navigation is key to any effort to operationalize this commitment to deliver better outcomes at a lower cost. At Quantum, we use our proprietary Real-Time Intercept® (RTI) technology to engage with members early and often in their healthcare journey—up to 120 days before a claim is even received—to bend the trajectory of care. This allows us to intervene and redirect care, preventing avoidable claims and delays, saving our clients $3.91 PMPM in unscheduled care alone.

With cancer, for example—the #1 driver of employer healthcare costs—speed of detection to treatment is everything. Delayed access to the right diagnosis and care plan early on not only results in worse outcomes for the patient but much higher (and avoidable) costs for employers. Our Premier Oncology Solution harness RTI and generative AI to identify early signals that a member is at risk to begin a cancer journey, allowing us to intervene and guide them to a center of excellence (COE) and/or a second opinion and send them down the most effective treatment path.

Another low-hanging fruit for cost-conscious employers is managing site-of-care for surgical procedures or administration of high-cost specialty drugs. At Quantum, we tap our extensive price data plus expert teams to shift treatments to lower-cost settings while improving the member experience. By optimizing surgery sites, we’ve saved clients $3.60 PMPM. And through our pharmacy navigation services, we’ve managed to shift 91% of eligible member treatments to lower-cost settings like a medical office or a member’s home, reducing treatment costs by 48% for an additional $0.71 PMPM in client savings. On top of the savings, a member who would have needed to take time off work to get an infusion at the hospital can do it from the comfort of their home.

Longer-term: Innovating and investing in cost and quality

Necessity, as they say, is the mother of invention. In the face of unprecedented cost trends and a turbulent payment landscape, HR leaders and CFOs are looking beyond short-term cost containment. They are “playing the long game” by investing and innovating with programs and partners that will set them up to radically enhance their ability to drive quality and value-based outcomes, today and in the future.

In recent years, as BGH points out, employers have poured big money into specialty solutions for a wide range of conditions—only to see increased care fragmentation, poor (or worse, unknown) utilization, and disappointing ROI. At Quantum, we see employers overspending an estimated 30% annually on healthcare due to members underutilizing point solutions and going out-of-network or to high-cost, low quality providers. To help our clients reinvent how their employees shop for care, we launched our Care Finder™ provider search, cost and quality tool. This empowers members to search for providers and facilities that are: in-network, cost-effective, high-quality, and aligned to member needs and preferences. Employers benefit from up-to-date population insights to help them evaluate their benefits and ensure they’re delivering value.

Fewer vendors + More accountability = Better results

As they retool their strategies, savvy employers are also cleaning house by consolidating solutions and holding fewer partners accountable to higher standards. They’re increasingly turning to comprehensive, integrated navigation platforms like Quantum’s to rein in the solution sprawl and deliver meaningful, measurable results. One area of employer focus for evaluating partners BGH rightly points to is on “their ability to garner meaningful engagement.” According to Quantum Health’s 2024 EBN engagement study:

• 67% of employers see increasing employee engagement with benefits as essential to reducing long-term healthcare costs...
• …while 73% believe it is key to improving healthcare outcomes and employee satisfaction…
• …and yet, only 20% of benefits leaders surveyed believe their employees are currently optimally engaged with their health benefits.

At Quantum, we’re redefining engagement as an accurate measure of the kind of member behaviors and outcomes our clients care about. We’ve also expanded it to reflect the full benefits ecosystem surrounding members, including providers and plans. The right navigation partner should serve as the nexus for every meaningful interaction, helping inform and match members with the right solution at the right time. And we should be 100% on the hook for results. For our clients that adds up to:

• 5.9% savings in the first year
• 14.7% by year five
• ROI for long-term cost control of 8.9:1

These savings aren’t just possible - they’re proven. See our externally validated, full book of business results >>

The opportunity: Employers can be the “change agents” healthcare needs

Every crisis breeds opportunity. And the healthcare cost crisis is no different. But bold change is never easy, especially for HR leaders who are already feeling overwhelmed and under-resourced. The good news is they don’t need to—and simply can’t—go it alone. At Quantum Health, we’re not only here to link arms with employers, but are doing our best to blaze the trail and help them stay ahead of the curve on all these challenges and opportunities.

As we take this on, it’s important to pause and remind ourselves that the bold measures the times are calling for are not only going to stem runaway costs—they’re also going to make for healthier and happier employees. Employers who embark on this journey should take heart in knowing they are true change agents who are poised to make a lasting difference for their people, and for healthcare as a whole.