SEB Marketing Team 

If you feel like you’re playing a permanent game of “whack-a-mole” with your healthcare budget, you aren’t alone. As we move into 2026, employees are expected significantly more for healthcare spending.

For HR and Benefits leaders, the “wait and see” approach is no longer just ineffective—it’s a fiscal liability. The 2026 landscape is being reshaped by the explosion of GLP-1s, a rise in late-stage cancer diagnoses, and a surge in mental health utilization. To survive this, we have to stop looking at what happened last quarter and start predicting what will happen in the next four.

From Hindsight to Foresight: The Predictive Pivot

Most organizations manage healthcare spend through a rearview mirror. They see a high-cost claim after it has already hit the ledger. By then, the opportunity for intervention has vanished.

The shift to a proactive strategy relies on predictive modelling. By synthesizing administrative data and historical claims, you can identify “rising risk” employees. These aren’t your current high-cost claimants; they are the individuals whose clinical markers suggest they are six months away from an ER visit or a chronic diagnosis. Identifying these patterns early allows for clinical navigation and “care gaps” closure—interventions that save lives and six-figure claims simultaneously.

Decoding the “1% Problem”

It is a well-known industry axiom that roughly 1% of your members drive 30% or more of your total spend. But in 2026, the complexity of these claims is reaching a new point. We are seeing:

• Specialty Pharmacy Surges: Expensive therapies for autoimmune conditions and oncology are now standard, not exceptions.
• Late-Stage Diagnoses: Deferred care from previous years is manifesting as complex, late-stage conditions that require intensive, high-cost management.

Data analytics allows you to peel back the curtain on these drivers. Instead of seeing a generic “increase in spend,” you can pinpoint exactly where the leakage is occurring—whether it’s a specific pharmacy subclass or a lack of cancer screening adherence—and deploy targeted Centres of Excellence (COE) to manage that specific risk.

Three Data-Driven Moves for Immediate Impact

To move the needle before your 2026 renewal, focus your analytical lens on these three areas:

1. Pharmacy Spend Audit: Go beyond the surface-level rebates. Audit your PBM (Pharmacy Benefit Manager) to ensure National Drug Code (NDC) reporting is accurate and that you aren’t overpaying for “me-too” drugs that offer no additional clinical value.
2. Care Gap Identification: Use your data to find members who are missing essential screenings (like mammograms or colonoscopies). A $500 screening today prevents a $150,000 claim next year.
3. Utilization Monitoring: Are your employees using the ER for non-emergencies? Data can reveal if you have a “navigation” problem that could be solved by better promoting telehealth or primary care access.

Demanding Accountability from Partners

Your TPAs (Third-Party Administrators) shouldn’t just be processing checks; they should be your frontline defence. In 2026, “standard reporting” isn’t enough.

It’s time to enforce performance guarantees backed by your own data. If your vendors can’t demonstrate they are steering members to high-quality, high-value providers, they are part of the 9% problem. Use your claims data as leverage in RFP conversations—over 50% of employers are already doing exactly that this year.

The Human Element: Building a Culture of Care

Data might feel cold, but its application is deeply human. When we use analytics to identify a “rising risk,” we aren’t just saving money; we are reaching out to an employee to offer support before they hit a health crisis.

A proactive culture means moving from “insurance provider” to “health partner.” It’s about using insights to provide personalized support, ensuring your people get the right care at the right time. In 2026, the most successful companies won’t be the ones with the biggest budgets, but the ones with the smartest data.