Blog Posts

Our President, Kari L. Niblack, on the challenges facing self-funded employers, brokers, and the evolving TPA landscape in the year ahead

The self-funded healthcare market enters 2026 facing a convergence of pressures: rising stop-loss costs, expanding pharmaceutical complexity, heightened regulatory scrutiny, and an increasingly fragmented solutions marketplace. For employers and brokers navigating these challenges, the path forward requires sophisticated partnerships, data-driven decision-making, and a shift from transactional relationships to strategic collaboration.

Our President Kari Niblack brings more than 30 years of self-funded healthcare expertise, plus a legal background in ERISA law, to her assessment of what lies ahead. Here’s her perspective on the structural challenges that will define success in the coming year.

The Stop-Loss Challenge: Connecting Cost Containment to Risk Management

Self-funded employers face a critical challenge in 2026: controlling risk on the stop-loss side while simultaneously managing claims costs. These two elements, often treated as separate problems, are fundamentally connected, yet the communication bridge between them frequently breaks down.

“Partnerships are critical,” Kari emphasizes. “We’re seeing increases on the stop-loss side. The challenge is using sophisticated cost-saving tools and communicating with leaders in the stop-loss area to acknowledge those cost savings and rate accordingly.”

This requires long-term strategic positioning rather than year-to-year reactive planning. When employers implement high-impact solutions, whether specialized networks, care navigation platforms, or utilization management tools, those interventions should flow through to stop-loss underwriting decisions. Too often, they don’t.

Employers who succeed in managing this challenge understand that claims management and stop-loss protection aren’t separate silos. They’re components of an integrated risk management strategy that requires coordination between TPA partners, stop-loss carriers, and internal benefits leadership.

The Pharmaceutical Complexity: GLP-1s as the Visible Symptom

While GLP-1 medications have captured headlines and budget anxiety, they represent a broader challenge: how to approach high-cost pharmaceuticals through a whole-person lens rather than as isolated line items.

“Self-funded employers are struggling with direct solutions for GLP-1s and whole-member experience solutions,” Kari notes. “There’s a very high cost associated with GLP-1 utilization, and we need to support self-funded employers in evaluating all potential options to best serve their member population.”

Our approach through our partnership with Wondr Health illustrates the shift from medication-only solutions to integrated care. Members can choose from three different levels of care, with physician oversight integrated with nutritionists and mental health support, addressing the full scope of what makes these interventions effective.

“It’s not just the prescription. It’s not just the office visit. It’s the whole person solution,” Kari explains. “All of that is important.”

This philosophy extends beyond GLP-1s to behavioral health, physical therapy, and other areas where fragmented care undermines both outcomes and cost management. The employers who will navigate pharmaceutical complexity successfully are those who stop thinking about prescriptions as discrete problems and start building comprehensive support structures.

The Broker Landscape: Same Challenges, Different Pressure Points

Brokers face the same fundamental challenges as their employer clients, but with an added layer: the competitiveness created by ongoing mergers and acquisitions within the brokerage community.

“The mergers and acquisitions in the brokerage community have greatly impacted consultants,” Kari observes. “They face those very same challenges around the number of solutions, integration complexity, and regulatory navigation.”

What separates high-performing brokers in this environment is their ability to curate rather than simply present options. With hundreds of point solutions flooding the market, the value isn’t in offering more choices, it’s in thoughtful vetting and strategic combinations that address specific client needs without creating implementation chaos.

“We have an open door,” Kari emphasizes. “We work with the majority of brokerage firms around the country because we customize and combine their platform choices with our platform into a whole customized package. You’re not forced to buy a box.”

The brokers who thrive in 2026 will be those who position themselves as strategic partners capable of cutting through noise, not those who simply expand their vendor lists.

Regulatory Pressure: Level-Funded Plans Under Scrutiny

The regulatory landscape for self-funded plans continues to evolve, with particular attention to level-funded arrangements. There’s emerging discussion about whether level-funded plans should be treated as fully insured plans, a classification that would fundamentally alter their regulatory framework.

“Level-funded plans, in particular, are facing a higher level of scrutiny,” Kari notes. Drawing on her background as an ERISA attorney, she leads our internal compliance team, producing webinars and materials that keep clients ahead of legislative changes.

Beyond level-funded plans specifically, continued oversight on transparency, particularly around prescription medicine costs, will shape plan design decisions. The employers and brokers who approach transparency not as a compliance burden but as a competitive advantage will find themselves better positioned regardless of how regulations develop.

Our emphasis on transparent PBM partnerships reflects this proactive stance. “Transparency is key across the board,” Kari emphasizes. “It’s about partnerships that match how we feel clients should be treated.”

The Innovation Wave: Real-Time Navigation and Quarterback Care

Two innovations stand out as gaining the most traction in 2026: real-time care navigation that interfaces prior to point of service, and the emergence of direct primary care as the quarterback coordinating patient journeys.

Through our partnership with ZakiPoint, we enable members to connect via text, video, or calls directly with our care navigation team, achieving over 60% utilization compared to industry standards of 8-12%. This dramatic difference stems from making navigation seamless and accessible rather than a separate step members must remember to take.

Direct primary care models, meanwhile, position primary care physicians as true coordinators, guiding patients through x-rays, lab work, hospitalization, and surgical options with a longitudinal view of their care journey.

“Direct primary care is the quarterback, very much guiding the patient through the different parts of care,” Kari describes. “That continuity makes a massive difference in both outcomes and cost management.”

Technology Investment: Data Analytics as Foundation

When employers and brokers ask about technology investments for their health plan infrastructure, the answer starts with data analytics. Not dashboards for their own sake, but meaningful reporting that drives earlier, better-informed decisions.

“Demand more data, earlier in the process,” Kari advises. “Don’t settle for high renewals without any information. Analytics are key because they tell the story about what’s happening with the plan.”

We customize reporting for clients based on their specific decision-making needs. For a hospital client, that might mean detailed emergency room and urgent care utilization data. For a multi-site employer, it might emphasize geographic variation in care patterns. The technology serves the strategy, not the reverse.

“Seek out a customized solution so you have all the data at your fingertips to make more reliable and easier decisions that positively impact financials,” Kari recommends.

Positioning for Success: Ask More Questions

For employers and brokers positioning themselves for success in 2026, Kari’s advice is direct: “We love sharing information. Ask more questions. Demand more data. Don’t settle for high renewals without explanation.”

The competitive advantage goes to those who engage earlier in the strategic planning cycle, who push for transparency and customization, who view their TPA relationship as a partnership rather than a purchase order. In a market characterized by increasing complexity and rising costs, the organizations that thrive will be those that stop accepting standard answers to non-standard problems.

“Every single day, we have the ability to create positive impact for clients’ bottom lines and increase member satisfaction,” Kari reflects. “That’s what drives this work: knowing that when we do it right, we’re affecting not just health plans but recruitment ability, retention, and organizational strength.”

As 2026 unfolds, the challenges facing self-funded employers and brokers remain substantial. But so are the opportunities for those willing to engage strategically, demand more from their partnerships, and approach benefits administration as a competitive advantage rather than a cost center. The market will continue to reward sophistication, customization, and genuine strategic collaboration, qualities that separate transaction-based relationships from true partnerships built to navigate complexity.