Purchaser Innovation and Policy Engagement Against a Backdrop of Unaffordability and Fiduciary Risk

The U.S. is confronting a health care affordability crisis. Health care cost increases have exceeded general inflation for decades and the gap has widened in recent years, with 2025 on track for health care spending to grow at its highest level in 13 years. The high and rising cost of health care – resulting primarily from high prices fueled by consolidation – is unsustainable.

Public and private purchasers who make up a significant portion of the commercial market are financially responsible for the majority of employee health care costs. As costs have soared, spending on health care has crowded out wages, dampened job growth, reduced business investment, and threatened state and local budgets.

Against this backdrop, purchasers are innovating on several fronts and taking new approaches to multiple health care strategies. They are purchasing care differently, choosing partners wisely, using transparent data to make more informed decisions, and scrutinizing their health plan for value. At the same time, purchasers recognize that the need to directly engage in state and federal health policy to support their strategies has never been more important.

Read our full issue brief on how large purchasers are meeting the moment by contending with the affordability crisis through innovations to how they procure and manage health care and advocate for pro-competitive health care policy reforms.