June 18, 2025

As the midpoint of 2025 approaches, now is the ideal time for employers to assess the performance of their self-funded health plans. A proactive, mid-year review not only helps control rising health care costs but also ensures your employee benefits remain competitive and aligned with workforce needs. At Nova Healthcare Administrators, Inc., we specialize in helping employers optimize health plan performance, reduce spending, and improve care outcomes through strategic, data-driven solutions.

Here are five essential steps to strengthen your employee health benefits program before renewal season:

 

1. Evaluate Utilization Management Programs

Are your employees receiving the right care, in the right setting, at the right time? Effective utilization management prevents unnecessary procedures and high-cost services while promoting high-value, evidence-based care. Conducting a mid-year review of prior authorizations, inpatient stays, and specialty service use can uncover cost-saving opportunities without compromising care quality.

2. Strengthen Chronic Disease Management

Chronic health conditions are a top driver of employer health care costs. Is your workforce actively participating in your chronic disease management or case management programs? Nova’s in-house medical management solutions help members with diabetes, cancer, and other chronic or complex conditions stay on track, reducing avoidable ER visits and hospitalizations that lead to costly claims.

3. Monitor Pharmacy Benefit Spend and PBM Performance

Prescription drug costs, especially for specialty medications, continue to rise sharply. Reviewing mid-year pharmacy utilization can identify opportunities to improve formulary management, promote generic alternatives, and introduce step therapy protocols. Employers should also assess whether their pharmacy benefit manager (PBM) is meeting contract guarantees and controlling high-cost drug spending.

4. Explore Cost-Saving Alternatives Like Direct Primary Care (DPC)

Cost-effective options like Direct Primary Care (DPC) offer unlimited access to primary care services with no out-of-pocket cost to members, promoting preventive care and reducing costly urgent care or ER visits. Employers may also consider integrating virtual care, telemedicine, or flexible spending accounts to improve access and affordability without raising premiums.

5. Engage Employees and Improve Health Plan Communication

Your health benefits only matter if your employees understand and use them. Mid-year is a great time to survey employees or gather informal feedback to uncover gaps in knowledge or unmet needs. Regular, easy-to-understand communications ensure employees know what preventive services are covered under their health plan, how to reach their insurer and what additional benefits they have access to, such as telehealth.

 

The Bottom Line

A mid-year benefits review can deliver major value, preventing expensive surprises at renewal time while improving employee health and satisfaction. Small adjustments today can lead to long-term cost control, smarter care utilization, and stronger employee engagement tomorrow.

Nova offers flexible, customized solutions designed to control health plan costs while enhancing employee experience. Our in-house medical management team, advanced analytics, and experience with self-funded health plans allow us to identify savings opportunities, optimize plan design, and drive better care outcomes—helping your organization thrive in a challenging benefits landscape. Click here for more strategies to optimize your health plan spend.