Virtue Health

Meet Virtue Health, a private group purchasing consortium that allows employers to share risk, control costs, and increase benefits – with ease.

09/03/2026

Insurers point to hospitalizations, physician care, high-cost specialty drugs, and rising behavioral health utilization as key contributing factors to the 10.8% median medical trend.

That is a number worth explaining to clients. A premium increase can be negotiated at the edges; underlying trend has to be managed.

The gap is closing.

09/01/2026

The distribution matters more than the median.

59% of insurers filed increases between 10% and 20%. 18% requested increases in excess of 20%.

Changes are based on expectations for healthcare prices, benefits usage, and the health of members.

For advisers, that means the 2027 renewal season is all about determining whether the funding structure itself still fits the client.

07/30/2026

Behavioral health is the cost driver almost nobody has in their 2026 projection.

Inpatient claims up nearly 80%. Outpatient up around 40%. PwC projects another 10 to 20% in spend for 2026.

Why it hides: it's under-represented in traditional stop-loss reporting. Oncology and cardiac show up clearly, so they get the attention. Behavioral health accumulates where the standard reports miss it, and lands in your renewal as a number you didn't model.

It's not the biggest driver. It's one of the fastest-moving. Those are the ones that break projections.

If your 2026 model has behavioral health at last year's trend, that's the line to pressure-test now.

Source: Virtue Health 2026 State of the Market Report.

Link in comments.

07/28/2026

PwC just restated 2024 and 2025 upward and now projects a 9.0% medical cost trend for 2027.

That is roughly three times the pace of everyday inflation. And trend keeps getting revised in one direction: higher. Every year the working assumption turns out to have been too low.

If you have been building renewals off a number that felt conservative a year ago, it is now the floor.

Underestimating trend does not save money. It just moves the surprise to renewal day.

Link in comments.

07/23/2026

39% of all stop-loss claims over $1 million come from children under age 10. Triple any other age group.

Most benefits consultants build their renewal story around cancer and cardiac. That's not where the biggest exposure lives anymore.

These are neonatal, perinatal, and congenital claims. Medical advances kept these kids alive. Nobody rebuilt the actuarial tables for what it costs to keep them alive. Birth-related claim frequency more than doubled between 2024 and 2025.

Cancer isn't the whole story. Stop there and you're already behind.

07/21/2026

Under 2% of prescriptions now drive roughly half of pharmacy spend.

Pharmacy trend is running about 2.5 points above medical. A handful of specialty scripts can move an entire plan's numbers.

The concentration is the risk, A few claimants, an outsized share of the cost.

Managing the top-line drug spend is not enough. You have to manage the few claims doing most of the damage.

The fastest-growing cost center rarely shows up in an average. Look at the tail.

Link in comments.

07/16/2026

Your claims were under control last year.

Your renewal didn't care.

That's the part nobody wants to say out loud.

The AMWINS 2026 State of the Market report does say it out loud; carriers are applying medical cost trends of 10% to 12% in formula renewals, with pricing models that bake in buffers to offset volatility.

Translation: the renewal your CFO is staring at right now was built to protect the carrier. Not to reflect your actual performance.

This is not a conspiracy. It's the structure.

Fully insured small group ACA rates landed around 11% on average this renewal cycle. Self-funded groups with no proactive claims management are seeing similar pressure.

The data in this report is what you bring to that meeting when your CFO says the increase doesn't make sense.

Because they're right. It doesn't. And now you have the numbers to explain why, and what a different approach actually looks like.

Link in the comments.

07/14/2026

AMWINS just dropped its 2026 State of the Market report on employee benefits.

We read it, so you don't have to show up to that CFO meeting empty-handed.

Here's what the data says is happening right now:

- Stop loss carrier loss ratios hit their highest point in at least 8 years.
- Carriers applied medical cost trends of 10% to 12% in formula renewals, with built-in buffers on top.
- Publicly filed small group ACA rate changes landed around 11%.

And this year could mark the highest annual renewal projections in more than a decade.

That's not a typo. That's the market.

So, when your CFO opens the renewal and the number is higher than last year (even though claims were solid), they're not wrong to be confused.

They're just not looking at the right data.

The problem isn't last year's claims.

It's that the whole market is repricing risk upward, and most employers aren't set up to understand that distinction. Or do anything about it.

That's the conversation you need to have before the renewal lands. Not after.

This report gives you the numbers, the context, and the language to walk into that room as the most informed person in it.

Link to download in the comments.

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Website

https://virtuealliance.com/

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