2026 MARKET TRENDS

Audits & Assessments

Key Takeaways

A growing number of new federal and state bills are increasing the need for transparency and driving payers to validate accurate benefit administration through audits
The complexity of benefit program management is creating greater demand for reporting, data collection and oversight across medical, pharmacy, wellness and other programs
Employers are prioritizing audits, high-cost claimant management and evaluations of vendor program effectiveness as key components of benefits oversight

The oversight required of administrators continues to expand as financial and operational expectations around benefit management evolve.

Overview

With a constant stream of new healthcare-related bills being introduced at the federal and state levels, the push for transparency and lower costs is a key theme shaping emerging legislation. As new regulations advance, the need to validate accurate implementation and adherence is growing. Auditing has become a primary method for payers to stay on top of the management of their healthcare programs.

The oversight required of administrators continues to expand as financial and operational expectations around benefit management evolve. Increasing complexity has heightened the need for more detailed reporting and comprehensive data collection to identify trends and opportunities across benefits such as medical, pharmacy, population health and hospitalization. As AI advances rapidly, auditing and reporting deliverables will continue to evolve, enabling more efficient and effective monitoring of delegated program administration.

Increasing Need for Benefits Audits

According to the Brown & Brown Employer Health and Benefits Strategy Survey results, just over 86% of participants plan to conduct audits within the next 24 months. This reflects the growing need for auditing driven by new legislation and heightened transparency requirements. Plan sponsors may also want to ensure their benefit programs are managed accurately and that they receive the full value promised in their contracts.

Auditing provides a way to verify accurate administration, which is critical. Brown & Brown's auditing services identified issues in 100% of medical audits completed in 2025. Because administrator contracts commonly limit how far back audits can look, it is recommended that employers perform audits annually, or at minimum, every two years to help monitor mistakes within benefit program administration.

Employers should consider reviewing their contracts to understand their audit rights and seek assistance from their consultant or broker if guidance is needed. Employers who have never audited their administrator, or who have not done so in more than two years, should research auditing services and consult with an experienced auditing firm to determine which services could best support their goals.

Employers Prioritize High-Cost Claimants

In 2026, employers plan to place a high priority on addressing high-cost claimants. This increased focus is driven by both the rising frequency and severity of high-cost claims. According to EBRI, 5% of covered individuals account for 57% of total health spending, with costs driven by medical inflation, chronic disease, advanced treatments and specialty drugs. Sun Life’s 2025 High Cost Claims and Injectable Trends report shows that million-dollar claims have increased 61% over four years and 29% in 2024 alone compared to 2023.2

As chronic conditions grow more common, the population ages and breakthrough treatments such as gene and cell therapies enter the market, employers should expect high-cost claimants to remain a major challenge. These dynamics contribute to the rising frequency and complexity of claims and place sustained pressure on health plan costs.

Employers could aim to take a proactive approach that includes predictive analytics for early identification, robust care management programs, pharmacy benefit optimization and stop loss coverage. Employers that invest in proactive care management and thoughtful plan design are better positioned to reduce the financial impact of high-cost claimants without compromising care quality or employee well-being.

Employers Focus on Effectiveness of Benefit Plans and Vendor Programs

Employers are increasingly prioritizing the effectiveness of their benefit programs and vendor partnerships, expecting measurable value and improved health outcomes. 95% of employers surveyed by Brown & Brown identified the effectiveness of the benefit program as a medium to high priority.1 However, many employers still lack visibility into the quality and clinical appropriateness of care delivered through vendor programs. Thirty-six percent ranked management of vendor services and performance as one of their top challenges, underscoring the need for clearer insight into program impact.

Vendors and plans often report engagement or participation metrics, but these do not necessarily reflect clinical effectiveness or adherence to evidence-based care. Employers need insight into whether programs follow evidence-based guidelines, improve chronic condition management and enhance preventive care. Without this information, efforts to improve workforce health and manage costs remain difficult.

Employers should incorporate clinical assessments into their benefit evaluation process at least once every three years. These assessments help identify care gaps, optimize vendor performance, support consistent member experiences and encourage early identification and appropriate management of high-cost claimants.

1Brown & Brown. Employer Health and Benefits Strategy Survey, 2026. 2Sun Life. 2025 High Cost Claims and Injectable Trends Report.

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Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory, tax guidance and/or advice. If legal advice, counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intended to provide a general overview of the topics and services contained herein. Brown & Brown, Inc. and all its affiliates make no representation or warranty as to the accuracy or completeness of the document and undertakes no obligation to update or revise the document based upon new information or future changes.