Beyond Cost-Shifting: Why Higher Deductibles Aren’t Solving the Affordability Problem

For years, plan sponsors have followed a familiar script: raise deductibles, increase cost-sharing, and hope the math works. And, for a while it did, but not anymore.

Healthcare costs continue to climb; faster than inflation, faster than wages, and faster than most plan sponsors can absorb. An article from the Wall Street Journal highlighted that the average family plan now costs nearly $27,000 a year following 3 years of 6-7% growth.¹ Many plan sponsors are still seeing double-digit increases, even after years of plan design changes.

So, confronted with the unsustainable increase to cost of care, plan sponsors have had to make the difficult decision to shift more cost to members in order to preserve budget within the business.

Higher deductibles, higher copays, narrower networks, and yet costs keep rising.

Because cost-shifting doesn’t address what’s actually driving spend.

Healthcare costs aren’t evenly spread. A small group of members accounts for a disproportionate share of spending. Today, 1% of members drive 21% of costs, and 5% drive half. That concentration is only intensifying.²

High-cost claimants, those with over $100,000 in annual spend, have grown 61% in just a few years.³ No deductible can solve that.

At best, higher cost-sharing reduces low-value utilization. At worst, it delays necessary care, until it becomes a high-cost claim.

Members feel the pressure. More than 60% worry about money weekly, and many are forced to choose between healthcare and everyday expenses like groceries.⁴

When care becomes unaffordable, people don’t become better consumers, they disengage. And when they reengage in the healthcare system, they’re sicker.

This is where the current approach breaks down.

Plan design operates at the point of payment. But the real opportunity sits earlier, at the point of care. Advanced Primary Care (APC) shifts this focus.

Instead of reacting to expensive events, it prevents them. Through better access, tighter coordination, and continuous engagement. APC addresses the root causes of cost growth: unmanaged chronic conditions, fragmented care, and delayed intervention.

With one Bolton Health client offering APC, engaged membership saw 21% lower total costs than those who were not engaged in the APC, amounting to about $93 less per member per month. Avoidable acute care dropped sharply, including 41% fewer inpatient admissions.⁶ Success wasn’t driven by cost shifting, but rather true cost reduction.

The takeaway is simple.

Costs will keep rising. Plan design alone won’t stop it.

Plan sponsors that want to bend the trend need to focus less on what happens at the back end of the plan, and more on what happens at the front door.

Here’s a simple place to start: Look at your top 5% of claimants over the last 12 months.

Then ask one question: What would have to happen earlier to prevent those costs?

If your current strategy doesn’t have a clear answer, that’s the gap.

 

 

1 | The average cost of a family health insurance plan is now $27,000. The Wall Street Journal. Anna Wilde Mathews. (2025, October 22).

2| How do health expenditures vary across the population? Peterson-KFF Health System Tracker. (2024, January 5).

3 | High-cost claims and injectable drug trends analysis. Sun Life. (2025).

4 | Money worries fuels mental health decline among workers, report finds. BenefitsPRO. (2025, May 21).

5 | As health insurance costs soar, CFOs seek ways to dull the pain. The Wall Street Journal. Jennifer Williams. (2026, March 12).

6 | Reimagining healthcare: How advanced primary care can transform health plans and improve lives. Bolton Innovation Group.