PWC f/k/a Price Waterhouse Coopers projects “an 8% year-on-year medical cost trend in 2025 for the Group market and 7.5% for the Individual market. This near-record trend is driven by inflationary pressure, prescription drug spending and behavioral health utilization.” The projection is based in part on a survey of healthcare plan actuaries. The survey also finds that plan efforts to cut costs have “not led to sustainable results, largely due to three reasons: 1) a siloed and modular approach centered on improving operations without addressing the underlying deficiencies in dependent functions; 2) greater focus on easy-to-address levers (e.g., administrative cost) and lesser focus on initiatives that are complex and need a longer time to realize savings (e.g., medical cost, care management, provider collaboration); 3) lack of a dedicated enterprise function to monitor, evaluate and implement agile initiatives to improve profitability (revenue and cost).”
Read the full report here: https://www.pwc.com/us/en/industries/health-industries/library/assets/pwc-behind-the-numbers-2025.pdf