During this uncertain economy, it seems like the cost of everything is going up. Inflation is high, cost of living has increased and families and businesses alike are feeling the pinch of tightening budgets. 

Unfortunately, healthcare is no exception. Experts predict we will continue to see healthcare costs rise throughout 2025 and beyond . Not only is this completely unsustainable and a concern for employers whose budgets are already strained, but it’s a concern for employees and their families as well.

HR professionals are having to ensure that every dollar they're spending on benefits is well utilized because their budget is being highly scrutinized as a result of the macroeconomic conditions.

Read on for what you should be considering for 2026 benefits planning. 

Healthcare costs are continuing to climb

SHRM  predicts that healthcare costs will increase between 8% and 9% in 2025 due to medical inflation. This undoubtedly means employers will be looking to their benefits consultants to help build cost containment strategies now more than ever. HR teams are tasked with the challenge of meeting increasing employee expectations when it comes to benefits and total rewards, while staying within tightened budgets. This means that they must find effective ways to strike a balance between reducing healthcare spend and keeping employees engaged by providing high-quality benefits experiences. 

And HealthJoy is here to help. 

How HealthJoy lowers spend for high-cost claimants by 21%

At HealthJoy, we utilize several strategies to lower healthcare costs while still providing a streamlined, personalized benefits experience. 

We conducted a study to understand the effect of our care navigation platform on the top 5% of claimants to determine whether individuals who were engaged with HealthJoy generated lower claim amounts than individuals who did not activate HealthJoy.

We found that high-cost claimants who activate HealthJoy see a 21% reduction in healthcare spend compared to those who do not activate HealthJoy–a win-win for the employee and the employer. 

Here are specific strategies we utilize that contribute to this controlled healthcare spend.  

Redirect employees to high-quality, affordable care 

Often, when an individual has a healthcare need, they go to the closest medical facility or wherever they can be seen the quickest. While being seen promptly and conveniently is important, it doesn’t always result in the highest-quality or the most affordable care option. 

Our smart care platform connects members to in-network, affordable, top-rated providers that fit their needs.

The study revealed that 44% of the healthcare savings from HealthJoy come from steering towards more affordable providers and services as well as proactive redirection. 

Specialty networks

For employers, 5% of employees often drive 50% of healthcare costs.  Elective surgeries are a top driver of rising healthcare costs for employers.

With cost containment being a critical focus of almost every employer’s benefits strategy for this year, the question remains, how can large claims like surgeries be reduced? At HealthJoy, we partner with Lantern Surgery Care –  the market leader in driving surgical savings, providing employers with 60% lower surgical spend. This reduces healthcare spend for employers and out-of-pocket costs for employees.

Lantern Surgery Care is fully integrated into HealthJoy’s navigation experience, which seamlessly provides members with dedicated support and superior access to surgical care right within the HealthJoy app. 

 In addition to the undeniable cost savings, Lantern Surgery Care is the most accessible and largest network compared to similar centers of excellence. The average driving distance to a Lantern Surgery Care facility in the US is just 29 miles. This is crucial because employees can drive to a location near them, instead of flying to a specialist. HealthJoy supercharges utilization of this program to 5x higher than independent centers of excellence.

This partnership gives HealthJoy’s clients – many of whom have fewer than 10,000 employees – seamless access to the Lantern specialty network, historically limited to enterprise accounts.

Virtual care solutions

Another way HealthJoy helps employers control healthcare spend is through steerage to high-quality, virtual care options. These services are available 24/7 and allow employees to be seen by a provider without leaving the comfort of their home. 

This is particularly important for members without an established primary care physician. Nearly one-third of Americans have little to no access to primary care, meaning they are far more likely to seek out healthcare services at an urgent care or emergency room, which significantly increases the cost of care. 

Virtual Primary Care is a solution to this problem. Within the HealthJoy app, users receive recommendations for virtual care options, and this helps drive utilization. Our research shows that 16% of the healthcare savings that HealthJoy generates for employers come from telemedicine alone. 

Chronic condition management

The CDC reports some shocking statistics around chronic conditions in the United States. According to their research, an estimated 129 million people in the US have at least 1 major chronic disease.  42% report they are managing at least 2 chronic conditions, and 12% have at least 5.  These chronic conditions can be physically, emotionally and financially debilitating and represent a large portion of employer healthcare spend. 

At HealthJoy, we simplify the process and reduce the cost of managing chronic conditions such as diabetes, pre-diabetes and hypertension. And that’s why we've partnered with Teladoc Health to revolutionize chronic care. 

HealthJoy Chronic Care powered by Teladoc Health lightens the burden of managing chronic conditions by providing a unified care experience for employees managing one or multiple chronic conditions. 

This partnership helps employees manage their symptoms and get the care they need, whether it’s a clinical solution, lifestyle or behavioral factor, or even holistic care. 

Musculoskeletal condition management

Roughly half of Americans suffer from some form of musculoskeletal (MSK) condition. With the prevalence and chronic nature of these conditions, it’s no surprise that MSK is one of the most common cost-drivers for healthcare spend in the U.S. Employers spend an average of $7,800 per employee struggling with an MSK issue. 

HealthJoy’s Virtual MSK Therapy provides convenient, effective and inexpensive exercise therapy for individuals struggling with virtually any type of back and joint pain throughout the body. Our Virtual MSK Therapy program comes at a low cost to the employer and is free to the employee. By using our brain-based approach, this program provides life-changing pain relief and is a better care option than a costly and (potentially) ineffective surgery. 

And employers love the cost savings as well. Clients see around $2,572 claims avoided per participant, and members experience an 82% reduction in pain with 85% function improvement on average.

Rx Savings 

One of the most common cost drivers we hear clients talking about lately is prescription drugs. These medications account for roughly 20% of total employer healthcare spending. Pharmaceutical companies raised the list prices of over 800 prescription drugs by a median of 4% in January 2025.This is a problem that’s not going away anytime soon. 

According to our latest Member Health Goals data, the number of employees requiring a prescription is increasing. Two-thirds of the 55-65 age group are regularly taking prescription drugs, but this is even affecting younger age groups.25% of 18-25 year-olds are taking medication as well.  

Additionally, the cost (and demand) of the most common prescription drugs requested are increasing. GLP-1 medications used for weight loss– like Wegovy, Ozempic and Mounjaro – are dominating the top 10 requested drugs through the HealthJoy Rx Savings program.

At HealthJoy, we just launched two exciting new enhancements to our Rx Savings feature to ensure employers save on pharmacy spend. We’ve partnered with CareValidate’s CareGLP to deliver up to 50% savings on GLP-1 medications for employees while shielding employer pharmacy spend. 

We’ve also integrated with GoodRx, which means our Rx Savings feature can now deliver automated, personalized savings recommendations – up to 80% off retail prices for members directly within the HealthJoy app.

 This multi-faceted approach to Rx Savings helps reduce out-of-pocket costs for employees and reduces healthcare spend for employers. Our data shows that HealthJoy’s Rx Savings provides an average savings of $253 per request, which adds up to substantial savings when you consider every enrolled employee.  

Healthcare consumerism in 2025

“Healthcare consumerism” is a relatively new concept that was born out of quickly rising healthcare costs. Not only is the cost of healthcare rising, but the cost of health insurance as well. 

This combination has led individuals, known as the new “healthcare consumers”, and employers to explore alternative options. According to the American College of Healthcare Executives (ACHE), rising out-of-pocket costs are turning passive healthcare consumers into active ones. 

This is where HealthJoy comes in. Our care navigation solution can take that burden of finding the highest-quality care for the lowest cost, off the shoulders of employees and HR teams. We provide personalized recommendations – adapting to unique wants and needs – producing cost savings for the employee and their employer. The result – healthier employees and a healthier bottom line.

Get in touch with one of our experts to learn how HealthJoy can reduce employer healthcare spend.