High-cost claims are becoming a major financial burden for employers offering health insurance. Although they represent a small portion of total claims, they account for a disproportionately large share of overall healthcare spending. These claims are often tied to individuals with complex, chronic, or rare conditions, extended inpatient care, or the use of high-cost specialty medications. As both the cost and frequency of these claims rise, it becomes more difficult for employers to predict and manage healthcare spending. Employers are left to absorb these costs, often with limited insight into where the biggest risks lie or how to intervene effectively, ultimately driving up premiums and making healthcare coverage more expensive for employers and their employees.
To help employers navigate this complex challenge, the Kentuckiana Health Collaborative (KHC) and the National Alliance of Healthcare Purchaser Coalitions (NAHPC) are partnering to launch a new initiative: Employer Actions to Address High-Cost Claims. The KHC is participating in this initiative alongside five employer coalitions: Central Penn Business Group on Health, Employer Coalition of Louisiana, Gateway Business Health Coalition, Healthcare Purchaser Alliance, and Northeast Business Group on Health. The KHC’s role is to support employers in Kentucky and Southern Indiana by helping them better understand the factors driving high-cost claims and develop strategic, long-term approaches to managing them.
Employers who take part in the initiative will complete a short pre-survey that evaluates their current approach to managing high-cost claims. From there, they will gather internal data to help pinpoint the most significant cost drivers within their covered population. The program culminates in an in-person workshop on September 9, 2025, where employers will come together to learn, share, and strategize alongside peers and technical experts.
During the workshop, employers will learn how to identify the primary drivers behind their high-cost claims and analyze their data to gain deeper insights into these cost factors. They will explore strategies to prevent and reduce the impact of high-cost claims, including how to use predictive models and clinical or utilization patterns to detect potential issues early. Additionally, the program will guide employers in building the necessary infrastructure to support a sustainable, long-term strategy for managing healthcare costs.
Through expert guidance, practical tools, and focused education provided by the KHC and NAHPC, the Employer Actions to Address High-Cost Claims initiative will help employers deepen their understanding of the challenges posed by high-cost claims. The program will support employers in establishing effective management strategies tailored to their unique needs and equip them to implement comprehensive interventions. By participating, employers can expect to build a stronger foundation for ongoing cost control, ultimately driving better financial outcomes and healthier workforces.
Employers interested in participating are encouraged to reach out to info@khcollaborative.org for more information or to sign up. This is a valuable opportunity to join a community of employers committed to addressing one of the most complex and costly challenges facing employers today.
