Why Plans Pay More and Get Less: The Benefits Design Disconnect

Many benefit plans and wellness programs appear comprehensive on paper yet still deliver suboptimal outcomes for members managing chronic and complex health needs. In response, plans often add new programs or services, yet outcomes and costs continue to move in the wrong direction. For trusts and organizations, this shows up as rising costs, repeat utilization and frustrated members who fall between traditional benefit categories.

Complexity, chronic conditions and fragmented care pathways intersect, revealing where benefit design is misaligned with how members experience care.

This webcast will explore:

• How common benefit programs unintentionally create gaps in care
• Why adding more benefits does not resolve structural design issues
• Why episodic and transactional benefits fail to support chronic and complex health needs
• How fragmentation drives higher utilization, rising costs and lower member satisfaction
• Practical benefit design that improves outcomes.

Attendees will leave with a practical framework for assessing whether plan design is meeting member needs and how insights from high-claims demographics can guide smarter, more sustainable benefit decisions.