Costs are up 9% next year. The usual playbook can't touch it.
You can't squeeze 150 basis points out of a 9% trend · The 2027 planning cycle starts with a number no plan design can fix
As benefits teams open the 2027 planning cycle, the starting number is brutal. Employer health costs have outpaced wages by nearly 3x over the past 25 years, and next year offers no relief. PwC's latest Behind the Numbers report projects a 9% commercial medical cost trend for 2027, a 17-year high, driven by specialty drugs like GLP-1s, a 62% surge in behavioral health utilization, and AI billing tools that capture higher-severity coding without adding actual care. Reflecting these pressures, broader industry benchmarks show blended employer costs averaging over $18,500 per employee
The second invoice goes to your employees
To absorb it, most teams are already playing defense. Mercer's national data shows 48% of large employers planning design changes for 2027 that raise worker deductibles or copays, and 31% moving to non-traditional structures like high-performance networks and variable copay designs to force savings. A majority will also raise employees' monthly premium contributions.
The manage-it-down method is a second invoice, and your workforce is the one who receives it. The federal out-of-pocket maximum climbs to $12,000 for an individual and $24,000 for a family in 2027, a 13.2% jump in a single year. Nearly half of insured adults already say they worry about affording their deductible, and financial stress is one of the clearest drivers of disengagement and turnover. Every dollar you shift off the plan tends to reappear somewhere less visible, as recruiting spend, retention risk, and lost productivity.
Doing the same thing, expecting different results
Across the industry the moves are remarkably uniform: adjust the formulary, raise the deductible, add another point solution, sharpen the PBM contract, run it back next year. Twenty-five years of that has not bent the curve, and the reason is structural. The math is unforgiving: just 1 to 2% of members drive 30 to 35% of claims, and marginal plan-design changes can't touch them. The structural barrier is not a lack of programs. It is timing. The lower-cost pathways employers have already built often appear after the employee has made the decision that sets the claim in motion.
A different lever: the conversation where the cost forms
Neatly starts where the cost actually forms: the doctor-patient conversation. Our ambient AI health companion sits with the employee before, during, and after every visit, translating what the doctor said and routing them to the covered, in-network, lower-cost option your plan already pays for. When a physician mentions a complex cardiac or orthopedic procedure, Neatly can prompt in real time: "Your plan covers 100% of this procedure through the corporate COE - tap here to coordinate."
Why more employers haven't moved yet
The hesitation is understandable. A new vendor is a risk, AI raises fair questions about accuracy, and nothing about this looks like last year's renewal deck. The employers leaning in are not the biggest gamblers in the room. They are the ones who have done the math on the current trajectory and concluded that the real risk is another year of the same.
What the market is telling us
What we are hearing from prospective pilot partners is consistent. They want to help employees reduce avoidable out-of-pocket costs. They want more people routed into the MSK, women’s health, navigation, and specialty programs they already fund. And they want earlier insight into where spend is beginning to form, before claims arrive months later and the best intervention window has already passed.
That is what a Neatly pilot is built to test. We load your benefits context, pressure-test it against real employee scenarios, and show how guidance can appear at the moment it matters: when a treatment path is being discussed, when a referral is being made, when a medication is being considered, or when a covered program could change the outcome.
Neatly Health supports patients in understanding and navigating their care. It does not provide medical advice or replace clinical judgment.
