High-cost claimant 2025 report: Where health claims are accelerating for employer plans

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Employer health plans are facing a new level of cost intensity and unpredictability as care becomes more complex and high-severity claims rise.

As healthcare costs continue to increase, the challenge for self-funded employers is no longer just that a small subset of members drives a disproportionate share of spend. That’s been true for years.

What’s new is the rapid growth within this high-cost segment, with million-dollar claimants increasing at the fastest pace, amplifying both financial risk and volatility.

Million-dollar-plus claimants are growing rapidly: The proportion of claimants with annual costs exceeding $1M rose by more than 45% from 2022 to 2024, with the steepest growth among million-dollar claimants, particularly those exceeding $2M.

Volatility and uncertainty: What’s changing is not only the magnitude of these claims, but also the instability. Only 21% of high-cost claimants persist year over year, increasing renewal uncertainty and complicating forecasting.

What this means for employers

As severity and volatility rise, employers managing the impact need to focus on strategic and targeted intervention in key, high-impact areas. High-cost claimants are not just financial risks, they’re strategic signals. Employers must shift from reactive protection to proactive prevention by:

• Leveraging data intelligence that integrates medical and pharmacy claims

• Optimizing benefit design and site-of-care

• Enhancing access to subspecialty care

• Activating early intervention programs like Lockton Nurse Advocate

• Promoting cancer screening and risk reduction strategies

• Addressing poor nutrition as a chronic disease driver through evidence-based nutrition therapy

The future of employer-sponsored health plans lies in transforming data into foresight — and using that foresight to lead. By understanding the human and financial dimensions of high-cost claimants, employers can design smarter strategies, reduce volatility, and improve outcomes for their members and their organizations.

Read more about the growing impact of high‑cost claimants and 8 key strategic levers where employers can make an impact in the full high-cost claimant 2025 report. (opens a new window)