Why Data Is King in Healthcare Cost Containment: You Can't Fix What You Can't See

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Why Data Is King in Healthcare Cost Containment: You Can't Fix What You Can't See

Taylor Neill
April 22, 2025
4 Minute Read
Cost Containment

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The most common complaint we receive as Regional Practice Leaders comes at renewal time: “Every year, our premiums go up—and we have no idea why.”

That’s where the conversation usually starts. The employer has just received another double-digit increase. They’re frustrated. And their current carrier won’t give them a clear answer about what’s driving the cost.

What Your Clients Don’t Know Is Costing Them

We suggest recommending to your clients that they ask their mega carrier the following questions:

What are our top 10 drugs by spend?

What diagnoses are driving our claims this year?

Which members are at risk for high-cost conditions next quarter?

In most fully insured plans, the response will be predictable: “That data isn’t available.”
But don’t take that at face value. Insurance is built on data. Every premium, every risk model, every forecast—it’s all based on statistics.

The problem is not that insurance companies can’t access the data. They just don’t want to share it. (And why would they? They would then have to explain to the insured why so much of their annual premium goes into the carrier’s pockets as profit.)

As an advisor, that puts you in a tough spot. You’re being asked to reduce costs without the visibility to know where savings are even possible. It’s like being told to patch a leaking boat—without knowing where the leak is.

Group captives take a different approach. When you place clients in a group captive program, their data belongs to them. Employers can finally see what’s going on inside their plan so they can take action—and save money.

You’re being asked to reduce costs without the visibility to know where savings are even possible. It’s like being told to patch a leaking boat—without knowing where the leak is.

Why Claims Transparency Is the Foundation of Cost Containment in Healthcare

In a fully insured environment, employers might receive a loss ratio report at renewal, but it won’t tell them where the spend is concentrated or what to do about it. There’s no ability to break out medical vs. pharmacy costs, review diagnoses, or examine utilization patterns.

In a self-funded group captive with Roundstone, claims data is shared openly—and advisors and clients can act on it quickly. They can log into the CSI Dashboard for real-time insights and get proactive guidance from Roundstone’s CSI Team.

That’s how you get from frustration to cost containment.

Key Healthcare Cost Drivers Hidden in Fully Insured Plans

Once advisors and employers have access to detailed claims data, the trends become impossible to ignore. Most plans have significant cost drivers that go unnoticed—and unmanaged—in the fully insured model.

Below are some common examples.

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High Pharmacy Spending

Specialty medications are a major cost driver, often accounting for over half of total spend. Fully insured carriers typically retain rebates and make it difficult to track which drugs are driving cost. Advisors need data to uncover these opportunities and recommend transparent PBMs or sourcing alternatives.

Unmanaged Chronic Conditions

Without diagnosis codes or care management data, employers have no way to identify members with conditions like diabetes or renal disease who are at risk of high-cost episodes. This leads to more ER visits, hospitalizations, and downstream spend that could have been prevented.

Misaligned Plan Design

Even minor changes to copays or incentives can significantly alter utilization behavior. But advisors can’t recommend those changes without data to back it up.

How Captive Benchmarking Supports Smarter Decision-Making

Roundstone’s captive is a deep well of actionable data. We have more than 20 years of performance metrics across industries, regions, and demographics to help advisors compare a client’s performance to meaningful benchmarks.

This gives advisors the tools to make confident, data-backed recommendations.

Turning Data Into Action in Year One

The biggest opportunity often comes in the first 6 to 12 months after a client joins the captive. That’s when previously hidden cost drivers are revealed—and advisors can deliver immediate value.

Roundstone provides monthly and quarterly reporting that helps advisors stay in front of emerging trends. When new diagnoses arise or high-cost claims appear, the CSI Team flags them and recommends targeted solutions that can be implemented midyear—not just at renewal.

Advisors Don’t Need to Be Analysts—They Need the Right Partner

One of the most common hesitations we hear from advisors is: What if I don’t know how to interpret the data?

That’s where Roundstone makes the difference. The CSI Dashboard is easy to navigate, with clear data categories and trend analysis. But more importantly, our CSI Team works with you to explain what the data means and what to do next.

You don’t have to be a clinical expert or a data analyst. You just need a partner that knows how to turn insights into action.

Better Care and Lower Costs Are Not Opposing Goals

Cost containment doesn’t mean cutting corners on care. The most impactful savings often come from improving access to the right care at the right time.

With data, advisors can help clients:

Launch disease management programs that reduce complications

Promote preventive care and early intervention

Incentivize lower-cost, high-quality providers

Reduce avoidable ER visits and hospital stays

These aren’t just financial wins. They’re quality-of-life improvements for employees. That’s the kind of impact that builds loyalty—and long-term client relationships.

What Sets Roundstone Apart for Advisors

Not all captives offer the same experience. Roundstone is built to support advisors—not replace them. Our model is designed to make you more valuable to your clients by giving you tools that drive strategy, retention, and growth.

Roundstone offers:

In-house underwriting and stop-loss claims management
Transparent PBM access with full rebate pass-through
100 percent return of unused premium—$91.8 million and counting
The CSI Dashboard with real-time claims data
Vetted vendor partnerships for pharmacy, care management, and more
Midyear implementation flexibility—no need to wait for renewal
Advisor enablement, not competition

FAQs: Higher Deductibles and Self-Funding

What cost drivers can claims data reveal in a self-funded plan with transparent TPAs and PBMs?

Claims data highlights costly trends—like specialty drug use, unmanaged conditions, and misaligned plan design.

How can an advisor support cost containment in self-funded group captives?

With tools like Roundstone’s CSI Dashboard, expert support, and continued education from Roundstone, advisors can easily act on data without being analysts.

Help Clients Spend Smarter With Data-Driven Solutions

The fully insured model keeps employers in the dark—and keeps advisors on defense. But when you move to a self-funded group captive with claims transparency, you gain the insight and flexibility to reduce costs and improve care quality.

With Roundstone, you’re not just reacting to another increase. You’re driving a strategy based on real data, real savings, and real results.

Ready to deliver more value to your clients? Request a proposal and see how Roundstone can help you grow your business through data-driven cost containment.

ABOUT THE AUTHOR

Taylor Neill

Regional Practice Leader at Roundstone. Taylor’s territory is the state of Texas.

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Taylor Neill
April 22, 2025
8 Minute Read
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