Healthcare cost pressure alone does not predict which employers take action on it. The stronger predictor is whether an employer can see their own claims data. Where that data is stored turns out to matter as much as whether they formally have access to it at all.
Those findings come from the 2026 Pulse of the Purchaser survey, published by the National Alliance of Healthcare Purchaser Coalitions (National Alliance). The survey drew on 408 employer and purchaser responses fielded in May and June through its member coalition network. It is a non-probability sample of employers engaged enough to participate in a healthcare purchaser coalition.
Among 26 hospital and high-cost-claim strategies tracked by the survey, employers with full claim-level access to medical claims data were more likely to be using every one. Those with full access used an average of 11.9 strategies, against 7.9 for those with limited or no access. Both groups expressed similar interest in adopting new strategies. The gap lay in capability, rather than intent.
The survey tested whether employers facing the steepest projected cost increases were more likely to adopt purchasing strategies. They were not. Employers expecting 9 percent or more in cost increases were no more likely than others to be using the 26 strategies tracked. The same held for employers already paying above-average premiums.
For data access, the pattern was different. All 26 strategies pointed the same way: more strategies used among employers with full claims access. Twenty-one of the 26 were statistically confirmed.
The report notes these are associations, not cause-and-effect findings, and that employers with access may act more because they can see more, or may have sought access because they were already acting.
Three-quarters of employers store their claims data with their health plan or third-party administrator (TPA). That group reported the lowest rate of complete claims access at 59.2 percent for medical claims.
The contrast with independent data warehouses is sharp. Only one in four employers names an independent warehouse as their claims storage arrangement. Among those that do, 85.9 percent report complete medical claim-level access and 84.1 percent report complete pharmacy claim-level access, the highest of any storage type in the survey.
A May 2025 Health Affairs analysis by Georgetown University researchers found that self-funded employers have limited bargaining power to demand usable claims data from TPAs. Federal law requires TPAs to provide the information but does not specify usable form. Some carriers use separate data-sharing agreements to restrict access on confidentiality grounds, the researchers noted.
Overall, 65.3 percent of respondents of the National Alliance survey reported having complete medical claim-level access. But only 58.6 percent said they were allowed to audit their own complete files, a gap of about seven points between those who say they have access and those who can verify it.
The survey asked how employers use health data, broken down by employer size. Larger employers use data for more purposes. The gap widens on the functions that require accountability over vendors rather than just internal cost tracking.
Cost analysis was nearly universal across all sizes: 75 percent among employers under 1,000 employees, 77.6 percent among mid-size employers (1,000 to 9,999), and 87.5 percent among those with 10,000 or more. The gaps were small.
Financial integrity of the plan showed a wider split. Among employers under 1,000, 32.1 percent used claims data to examine plan financial integrity. Among those with 10,000 or more, the rate was 68.8 percent.
Vendor performance management followed a similar pattern at 34.5 percent versus 67.2 percent. Benchmarking went from 40.5 percent to 78.1 percent across the same size bands.
The report notes these gaps are statistically meaningful and that small employers may receive claims reports but lack the staff time, tools, or support to act on them.
The strategies with the largest gaps between full-access and limited-access employers were concentrated in areas that require price comparison, provider evaluation, contract negotiation, and vendor oversight. Evaluating networks on price and quality showed a 22-point gap (49 percent versus 27 percent). Advanced primary care showed a 23-point gap (45 percent versus 22 percent) and direct contracting with hospitals showed a 22-point gap (39 percent versus 17 percent).
Hospital price data presents a related challenge. Only 30.4 percent of employers regularly use it to guide purchasing decisions. The most commonly reported barrier was not disagreement with the data but limited internal staff capacity, cited by 12.9 percent as the biggest single obstacle, with the disconnect between price and quality data following at 12.4 percent.
The data point to a specific opportunity for brokers working with smaller plan sponsors. Small employers use claims data almost universally for cost analysis. What they are less able to do is use it to examine plan financial integrity, benchmark against peers, or hold vendors accountable, the functions that generate the most value at renewal.
The CAA 2026, signed on February 3, extended disclosure requirements beyond PBMs to cover TPAs and other plan service providers. A Department of Labor proposed rule published January 30 would require PBMs and TPAs to provide extensive advance disclosures when contracting with ERISA self-funded group health plans, with proposed applicability for plan years starting July 1. A broker who helps a small employer establish the infrastructure to collect, store, and act on claims data ahead of those timelines is positioned to add value that a competing quote cannot replicate.
