Articles
July 23, 2026
Healthcare costs continue to rise sharply. But for all the energy spent on plan design, network negotiations, and premium modeling, one of the biggest cost drivers in employer-sponsored healthcare rarely shows up on a spreadsheet: confusion.
At this year’s bswift Idea Exchange, Kim Evans, VP Partner Ecosystem at bswift, hosted a panel making a compelling case for reframing the cost containment conversation. She was joined by Diana Kowalski, Senior Product Strategy Manager on bswift’s Evive team, Janine Gianfredi, Chief Marketing Officer at Alliance Partner Transcarent, and Bryan Levy, Managing Director of Strategy at Alliance Partner Inspira Financial. Their collective argument? Employers are solving for the wrong thing.
Confusion Is a Cost Driver
The familiar list of healthcare cost drivers, like rising cancer rates, mental health claims, and musculoskeletal issues, is real. But Janine offered a sharper frame: underneath all of it is the cost of confusion, the cost of inaction, and the cost of misdirected care. “Those are the three pillars that underlie a lot of the issues we’re seeing right now,” she said, “and none of them show up cleanly in a claims report.”
The data backs this up. One in three American workers doesn’t understand the benefits they selected during open enrollment, and less than one-third fully use their supplemental benefits.¹ ² These aren’t engagement problems. They’re comprehension problems with real financial consequences.
Diana called it missed care avoidance: when someone delays going to the doctor or doesn’t fill a prescription, “you don’t always see that right away. But over time, that’s exactly what turns into more serious conditions, avoidable ER visits, or higher claims costs down the line.” Bryan added that poor benefit selections compound year over year — driving disengagement and eroding healthcare engagement altogether. “The culmination of historic decisions really prevents engagement and making the right decision on plans or care paths.”
The Access-Activation Gap
Family health coverage premiums now average nearly $27,000 annually, yet 78% of employers believe their workers are highly satisfied with their benefits while only 59% of employees agree.³ ⁴ The gap isn’t about the quality of the benefits — it’s about whether employees can actually use them.
As Diana put it, access isn’t the same thing as activation. “The challenge really isn’t about offering great benefits. It’s about making sure people are actually utilizing them in those moments that matter.” A lower-cost plan can look compelling at enrollment but create real problems throughout the year if employees aren’t equipped to navigate it. Bryan described this as a self-reinforcing trap: expensive reactive care leaves employees with no financial runway for preventative care, which makes the next health event more expensive still.
The implication: plan design is just the beginning. How benefits are communicated, contextualized, and supported throughout the year determines whether they actually work.
When Decisions Get Made Under Pressure
Even well-prepared employees can lose the thread when a real health crisis hits. Janine noted that logic gives way to emotion in those moments — people reach out to whoever they trust most. “That’s a very privileged position to be in,” she said, pointing out that most employees don’t have a clinician on speed dial. That gap is where employers can make a genuine difference, not with more information, but with fast, trusted access to guidance. “It all starts with trust,” Janine said.
Thinking Beyond Open Enrollment
Open enrollment is preseason. The real game is played all year long. As Diana put it, “Enrollment is really just the moment where someone is selecting their coverage. It’s not where we see the actual value start to happen.”
Value comes from meeting employees in real time—guiding them to the right care, lower-cost options, or support when they’re ready to act. That’s the idea behind benefits activation: helping people take the next best step in the moments that matter.
Janine pointed to a concrete example: Transcarent, both a bswift Alliance Partner and a bswift client, implemented Emma™ Intelligence, bswift’s AI-native benefits assistant, to guide their own employees through enrollment. The result was a 20% reduction in company costs driven by better-informed employee selections. Bryan added a behavioral design lens: the 401k industry cracked the savings problem not through education campaigns, but through defaults and auto-escalation. The same logic applies to healthcare: make the smart choice the easy choice.
The Reframe
The employers getting cost containment right aren’t the ones with the most aggressive plan design changes. They’re the ones leading with people. As Janine put it: “At the end of the day, it’s about people and the family members that they love and the care that they need. That is the way to get people to take action —not leading with cost.” As Bryan added: “We need to stop educating people and help guide.”
The employers who internalize that distinction are the ones who will bend the curve.
Sources
- Voya Financial. “Voya Survey Finds One-Third of American Workers Don’t Understand the Benefits They Selected During Open Enrollment.” 2023.
- NFP. Annual Employee Benefits Trend Report. 2025.
- KFF. 2025 Employer Health Benefits Survey.
- Fitsmallbusiness.com, citing multiple primary sources. “Employee Benefits Statistics 2024.” 2024.
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