What to measure
Evidence before assumptions.
- Complete claims access
- Recurring performance reporting
- Identified cost drivers
- Vendor data rights
← The Framework
Component 02
Data, Analytics & Transparency
Do we actually know where our healthcare dollars are going?
Clear definition
Data, analytics and transparency create the visibility employers need to understand claims, prices, utilization, vendor performance and the drivers behind a plan’s financial results.
Common mistakes
What weakens performance.
- Relying on renewal spreadsheets and loss ratios alone
- Accepting incomplete vendor reporting
- Collecting data without a decision process
High-performance practices
Build a deliberate approach.
01
Establish year-round medical and pharmacy reporting
02
Trace spend by condition, provider, site of care and service
03
Put data ownership and access requirements in vendor agreements
Definitive employer guide
A high-performance health plan cannot be managed from renewal summaries alone. Employers need timely, usable access to medical, pharmacy, eligibility, pricing and vendor-performance information.
Transparency is valuable only when it supports a decision. The work is to establish both reliable data rights and an operating cadence that turns insight into action.
From reports to decision-ready data
A report is not a strategy. Leaders need agreed definitions, recurring delivery and enough detail to distinguish trend, price, utilization and performance.
The practical question is not whether a vendor offers this capability. It is whether the plan team has a clear owner, decision standard and review cadence that turns information into action for employees and the organization.
Data rights and vendor agreements
Access, format, timing, ownership and audit rights should be contract terms, not informal expectations. Plan sponsors need continuity when vendors change.
The practical question is not whether a vendor offers this capability. It is whether the plan team has a clear owner, decision standard and review cadence that turns information into action for employees and the organization.
Building a usable performance baseline
Use claims, pharmacy, eligibility, provider and service data to identify where spending is concentrated and why. Start with a manageable set of questions rather than an exhaustive dashboard.
The practical question is not whether a vendor offers this capability. It is whether the plan team has a clear owner, decision standard and review cadence that turns information into action for employees and the organization.
Turning insight into action
Every report should connect to a decision, owner and follow-up. Review trend with clinical and member context to avoid treating utilization as a problem by default.
The practical question is not whether a vendor offers this capability. It is whether the plan team has a clear owner, decision standard and review cadence that turns information into action for employees and the organization.
Privacy and responsible use
Use aggregated, de-identified information for plan oversight and follow appropriate privacy safeguards. Transparency should improve stewardship without compromising individual confidentiality.
The practical question is not whether a vendor offers this capability. It is whether the plan team has a clear owner, decision standard and review cadence that turns information into action for employees and the organization.
Five metrics every employer should monitor
Claims-data completeness and timeliness
Track this measure monthly or quarterly, compare it with prior periods, and connect variance to a named decision or accountable owner.
Pharmacy-data reconciliation
Track this measure monthly or quarterly, compare it with prior periods, and connect variance to a named decision or accountable owner.
Top cost and utilization drivers identified
Track this measure monthly or quarterly, compare it with prior periods, and connect variance to a named decision or accountable owner.
Vendor report delivery and accuracy
Track this measure monthly or quarterly, compare it with prior periods, and connect variance to a named decision or accountable owner.
Actions tied to recurring reviews
Track this measure monthly or quarterly, compare it with prior periods, and connect variance to a named decision or accountable owner.
Maturity progression
Crawl. Walk. Run. Sprint.
Crawl
Establish baseline data, assign ownership and document the immediate decision gaps.
Walk
Create a recurring review cadence and use evidence to challenge vendor assumptions.
Run
Integrate the work into benefit design, contracting and employee-facing pathways.
Sprint
Continuously test results, refine incentives and share clear performance accountability.
Ten questions to ask
- 01What data can the employer receive and retain?
- 02How current is medical and pharmacy reporting?
- 03Can we identify the drivers of cost and utilization?
- 04Do definitions remain consistent across vendors?
- 05Which reports support actual decisions?
- 06Who validates data quality?
- 07Are provider price and quality visible together?
- 08Can data survive a vendor transition?
- 09What privacy safeguards govern access?
- 10What decision will this month’s report change?
What good looks like
Managed, not merely renewed.
A high-performing approach is transparent, actively governed and connected to employee experience. It gives leaders a repeatable way to test assumptions, make tradeoffs and improve outcomes over time.
Related 
- Health Plan Data Checklist
- Claims Baseline Guide
- Health Plan Score Priorities Brief
Frequently asked questions
Where should an employer begin?
Start with the plan data, contract language and governance process already in place. Identify the decisions that lack evidence, then establish a focused 90-day diagnostic work plan.
Is this only relevant at renewal?
No. Renewal is an outcome of year-round management. The highest-value work happens before terms are presented, while there is time to analyze, negotiate and design a better approach.
Sources & references
Evidence that supports the work.
This guide combines the Framework methodology with primary government guidance and independent health-policy research. Sources are included for further review and are not legal, tax or clinical advice.
- Reviewed / updated
- Framework component
- Data, Analytics & Transparency
- Book connection
- Chapter 17 and related chapters
- Author
- Corry Hull, REBC®, CSFS® — Vice President of Employee Benefits, BHC Insurance; Health Rosetta Advanced Advisor; author of The High Performance Health Plan.
U.S. Department of Labor — Employee Benefits Security Administration↗Centers for Medicare & Medicaid Services — Transparency in Coverage↗U.S. Department of Health & Human Services — No Surprises Act↗Internal Revenue Service — Publication 15-B↗KFF — Employer Health Benefits Survey↗RAND — Hospital Prices Paid by Private Health Plans↗
Book connection
Chapter 17: Seeing the economics
Chapter 17 and related chapters
The transparency chapter gives leaders a way to move from carrier summaries toward decision-ready claims and vendor data.
Explore the bookHealth Plan Score connection
Data, Analytics & Transparency
Can the plan team identify the main cost, utilization and performance drivers with complete, recurring data?
A lower score points to data-rights, reporting cadence and a defined process for acting on what the data reveals.
Take the Health Plan ScoreDecision-support documents
Put the strategy to work.
resourceHealth Plan Data Checklist
A printable Employer Benefits IQ worksheet for defining the decision, evidence, accountable owner and review cadence.
Author perspective
Corry Hull, REBC®, CSFS® — Vice President of Employee Benefits Consulting at BHC Insurance, Health Rosetta Advanced Advisor, author of The High Performance Health Plan, founder of Employer Benefits IQ, 2026 Health Rosetta Rosie Award recipient, public speaker and employee benefits strategist.
Explore the Health Plan ScorePut the methodology to work
Apply the HPHP methodology with .
Employer Benefits IQ is the practical application platform for employers who want to use education, tools, data, vendor intelligence and decision support in real-world benefits decisions.
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