Beyond Claims Totals: Revealing What’s Driving Your 2026 Health Plan Costs

Health plan costs are often front and center during renewal season. Yet focusing on one number, whether that’s your premium increase or the total cost of claims at year end, only tells part of the story. That’s especially true in level‑funded plans, where visibility into claims and cost drivers creates opportunities to manage costs before renewal.



At Trustmark, we make healthcare utilization reports available to help guide these discussions and considerations. They provide insights that are more powerful than a single number, offering a clear and comprehensive picture of what’s happening as the year progresses. Rather than a surprise at year end, you are empowered to take proactive steps for health plan cost control.

If you want to understand what’s truly driving your costs in your health benefit and what to do
to control them, here is what you need to know.

Transparency for a full picture of healthcare costs
With a self‑funded or level‑funded plan, you have access to meaningful data that goes beyond simply knowing how much you are spending. Healthcare utilization reports like those from Trustmark provide a regular, data-driven summary of how your plan is being used and how those patterns affect health plan costs.

By pairing utilization data with financial reporting, you gain a complete picture of both activity and impact. You can:

• Identify when claims activity increases and how trends develop over time
• See which services are driving spending (inpatient, outpatient, imaging, ER, etc.)
• Track total claims filed and paid
• Monitor pharmacy utilization trends and shifts in drug spending
• Understand high-level cost drivers by category
• Compare utilization rates across reporting periods
• Track preventive care participation
• Monitor patterns such as emergency room versus urgent care usage
• Connect utilization trends to financial outcomes and funding position

The value of connecting claims activity to financial impact
Linking claims activity to plan funding is one of the most valuable aspects of Trustmark reporting. These reports show you when claims spike and how those changes affect the prefund account. You can see whether your plan is trending toward a surplus or deficit. At renewal time, you can use your understanding of trends and trend drivers to make more informed and data-driven decisions. If data shows specific cost drivers, employers can alter plan designs (e.g., changing copays or deductibles) to steer utilization toward more cost-effective services, such as virtual care, or implement targeted employee education.

Reports that go beyond the basics
Looking at different kinds of reports at regular intervals gives you a complete picture of your plan's performance, along with valuable context. Combine utilization reports with financial reporting and deep dives into cost drivers and trends for the greatest transparency.

Periodic Healthcare Utilization Reports
Help employers monitor health plan costs throughout the plan year and into the next.

• Delivery: 6, 9, 12, and 18 months intervals:
• Cover overall claim trends and usage patterns
• Identify high-level cost drivers
• Track medical versus pharmacy trends
• Provide utilization rate summaries
• Highlight preventive services participation

Stop-Loss Statement
Because plan performance involves more than utilization, this report tracks financial metrics for managing plan sustainability.

• Delivery: Monthly
• Total claims paid to date
• Remaining prefund balance
• Specific deductible exceeders
• Stop-loss activity
• Trends toward surplus or deficit

On-Demand Reports
Sometimes standard reports raise deeper questions. If costs spike, a service category suddenly trends upward, or renewal preparation requires additional detail, on-demand reports can provide insights and answers.

• Claimant-level analysis (as appropriate)
• Service-specific breakdowns
• High-cost claim reviews
• Focused pharmacy trend insight
• Filtered views by category or timeframe

Getting the greatest strategic value from utilization reports
Reporting gives you incredibly useful insights. The real value of the data, however, is in how you use it. Consider these best practices:

1. Look beyond totals into trends - Totals tell you what happened. Trends give you insight into why and what might impact the future. You can spot emerging issues early and see patterns you might need to address with education or plan design changes.
2. Act early, well before renewal - Armed with information, you can make decisions that improve outcomes while there is still time. You may, for example, want to invest in education that reinforces in-network usage, promotes telehealth options, or encourages mail-order pharmacy use.
3. Consider both utilization and financial data - Get the full story when you understand the relationship between utilization and funding. You will know if current trends are sustainable or if you need to adjust at renewal. In level-funded arrangements, if claims are lower than expected, the employer can receive a refund (a "surplus"), which can be used to lower the next year’s costs.
4. Get deeper insights with on-demand reports - When something unexpected or significant emerges in your data, getting additional reporting can help you understand what is driving the change. For example: Increased emergency room visits may signal an access issue. Shifting prescription trends may indicate a need to educate members on using a lower-cost alternative if available.
5. Use reporting to target employee education - You can tailor employee education to address patterns such as high emergency room usage or reliance on brand-name drugs. When you see trends, sharing information can encourage smarter healthcare decisions without impinging on privacy.
6. Work closely with your broker - Your broker can help you turn utilization data into practical steps, like adjusting plan design, using wellness programs available, or improving network choices. These reports are especially helpful at renewal, letting you make decisions based on actual claims, not guesswork. Working together, you can manage health plan costs more effectively and plan for the year ahead.

Recapping the benefits of utilization reports

• Greater transparency into where health plan costs are going
• Early identification of cost drivers before they escalate
• Stronger positioning during renewal negotiations
• Better alignment of wellness and benefit design
• Reduced likelihood of surprise deficits
• Stronger broker-employer collaboration

From data to smarter decisions
Use healthcare utilization reports to get a clear view of how your plan is performing, why costs are changing, and insights that empower decisions that help take earlier action to control costs. With comprehensive reporting, you have the information you need to make confident decisions about funding, plan design, wellness initiatives, and employee education.

Turning insight into action
Understanding what’s driving your health plan costs is the first step toward making smarter, more confident decisions. Healthcare utilization reports give you visibility into trends, cost drivers, and financial performance — so renewal conversations are based on insight, not surprises.

If you’re a current Trustmark customer, your Client Manager is your best resource for reviewing reports, understanding what the data is telling you, and identifying opportunities to act on throughout the year — not just at renewal.

If you’re exploring Trustmark for the first time, talk with your broker to learn how level‑funded plans and transparent reporting can help you gain more control over healthcare costs and long‑term sustainability.

And if you’re a broker with clients who may benefit from greater cost clarity, contact a Trustmark sales consultant to learn how our reporting, funding strategies, and support model can help you deliver more value to your clients.

With the right data — and the right partners — employers, brokers, and advisors can move from reacting to healthcare costs to actively managing them.

About the author:
Katrina Anderson is a Client Manager at Trustmark Companies and brings 25 years of experience with the organization. She supports employers and broker partners by helping them navigate renewals, plan performance, and ongoing benefits needs.