Mid-Year Health Plan Check-Up: What You Should Be Tracking
While health plans can have their renewal at different times during the year, the majority of plans renew in January. As we round the midpoint of 2025, now is the perfect time for many employers and brokers to hit pause and take a comprehensive mid-year health plan check-up. A proactive review process helps you identify any gaps and ensure you're well-positioned for open enrollment and renewal season.
Why Mid-Year Reviews Matter
- Keep costs in check: A sound review can identify rises in claim trends, helping contain problem areas before it's baked into next year's budget.
- Spot early signs of misuse: Evaluating plan utilization uncovers patterns such as overuse, underuse, and non-essential care that impact financial and employee health outcomes.
- Gather employee feedback: Mid-year is a great time to get a pulse on member satisfaction before disenrollment or retention becomes an issue.
These insights are especially critical for self-funded plans, where employers bear more risk. Working with a forward-thinking TPA (third-party administrator) like Aither Health means your mid-year findings translate into smarter, more responsive strategies.
Let’s dive into five areas to ensure are included on your mid-year check-up.
1. Claims & Cost Trends
What to review:
- Year-Over-Year (YOY) and Year-to-Date (YTD) total spend
- High-cost claims (e.g., high-dollar procedures, chronic condition spikes)
- Prescription trends (especially specialty drugs)
Action steps:
- Benchmark claim costs and utilization against national industry data.
- Flag high-cost areas and engage in early intervention.
2. Monitor Plan Utilization
What to review:
- ER visits vs. urgent care usage
- Preventive visits (e.g., wellness exams, immunizations)
- Telemedicine and DPC service uptake
Action steps:
- Promote telehealth or DPC options to reduce ER visits.
- Target low rates of preventive care with communications tailored to identified gaps.
3. Check Employee Satisfaction & Engagement
Data sources to review:
- Mid-year surveys, benefit library downloads, and member inquiries
- Trends in complaints or claim appeals
Action steps:
- Use employee surveys to address potential pain points like cost surprises, care accessibility, and network issues.
- Push educational materials and resources around plan features, cost transparency tools, and navigating care.
4. Align with Renewal & Open Enrollment Strategy
Key benefits of early positioning:
- Gain negotiation headroom on pricing (shop around and analyze options thoroughly)
- Test potential benefit tweaks (e.g., new telehealth, mental health offerings, plan design changes)
- Launch early communications to build employee trust and reduce friction later
5. Partner with a Proactive TPA
In addition to good data, successful mid-year reviews require context and strategic follow-through. That’s where Aither Health shines.
- Transparent reporting: Dynamic dashboards break down cost, utilization, and member behavior.
- Early flagging: High-cost claims and outlier utilization are identified before they balloon.
- Actionable insights: We’re here to help implement targeted vendor strategies, care management, and cost containment every step of the way.
Embrace a Smarter, Smoother Renewal
Half the year is behind us, but that doesn’t mean choices in the second half are set in stone. A well-executed mid-year check-up ensures your plan is on track, your people are supported, and renewals are proactive versus reactive.
Ready to start your mid-year check-up or want hands-on support? Contact Aither Health today, and let's prepare for open enrollment with eyes wide open.