Employers expect healthcare costs to rise an average of 7.7% next year before plan design changes, and one in three expect increases of 9% or more, according to the National Alliance of Healthcare Purchaser Coalitions’ 2026 Pulse of the Purchaser survey.
Here is the finding that should reframe every conversation in our industry: the employers facing the steepest increases are not doing more about them.
Cost pressure, it turns out, does not predict action. Data access does.
Visibility, not pain, is what moves purchasers
The National Alliance surveyed 408 employers on 26 hospital and high-cost-claim purchasing strategies. Employers with full claim-level access were running an average of nearly four more strategies than employers with limited or no access. On the “considering” side, the two groups were statistically indistinguishable.
Read that carefully. Intent is evenly distributed. Capability is not. Every employer wants to manage spend. Only the ones who can see their claims actually do it.
And the gap is widest exactly where leverage lives. On the strategies that require comparing prices, evaluating networks, negotiating with providers, or challenging vendor performance, employers with complete claims access outpaced those without by 20% or more. Reference-based pricing: roughly three times the adoption. Negotiating limits on outlier facility prices: more than three times. Direct contracting: more than double. The strategies that bend cost curves are effectively unavailable to purchasers operating blind.
Access on paper is not access in practice
Roughly one in three employers report they lack complete claim-level access, and only about three in five are confident they could audit their own files. Survey respondents described holding audit rights on paper while contract terms and technical silos made those rights unusable.
Where the data lives is the tell. About three-quarters of employers store claims data with their health plan or TPA, and that group reports the lowest rate of complete access, around 59%. Employers using an independent data warehouse report complete access above 84%. The party holding the data largely determines whether the purchaser can use it.
The survey is careful to note these are associations, not proven causation. Employers who were already acting may have demanded access. But the direction of the implication is the same either way: access and action travel together, and opacity and inaction travel together.
The trust cost of opacity
The same pattern shows up in confidence. Employers without full pharmacy claims access were more than twice as likely to question the integrity of PBM administration and the reasonableness of PBM compensation. Purchasers do not extend trust to what they cannot verify. In a post-CAA fiduciary environment, that is not a soft problem. Plan sponsors are legally obligated to verify, and vendors who make verification hard are accumulating a liability that eventually converts into an RFP.
What this means if you administer the plan
If you are a TPA or health plan, you are the storage arrangement in that chart. That position is either your biggest retention risk or your strongest retention asset, and the survey suggests employers are deciding which.
The instinct to guard data feels protective. The evidence says it is corrosive. Restricted access breeds distrust, distrust drives market movement, and the survey shows purchasers actively shopping for partners who offer transparency and control. Meanwhile, only about 30% of employers regularly use hospital price and quality information in purchasing decisions, and the most cited barrier is not willingness. It is staff capacity. Employers do not need more files. They need partners who convert data into decisions they can act on.
That is the opening. The administrator who delivers usable, verifiable, decision-ready intelligence does not become more replaceable by sharing it. They become the reason the client stays.
Where TALON sits in this
TALON was founded on the premise this survey now quantifies: healthcare’s cost problem is an information problem, and markets only function when both sides can see prices. Our platform turns 25B+ adjudicated claim records and 99.9% payer MRF coverage into intelligence that TPAs, health plans, and advisors put directly in front of employers and members through tools like MyMedicalMetrics™ and MyMedicalShopper™. We make our partners the ones who deliver visibility, because the data now shows visibility is what separates purchasers who act from purchasers who worry.
The dividing line in employer healthcare is no longer who feels the most pressure. It is who can see. Decide which side of that line your clients experience with you.
