In today’s environment, benefits leaders and advisors are expected to be both stewards of employee well-being and savvy financial strategists. But too often, the tools they have to work with—PDF plan summaries, outdated reports, and opaque carrier data—don’t support the level of precision or foresight needed to manage healthcare costs strategically.

At Serif Health, we’re changing that. Understanding the drivers of healthcare costs is critical to making smarter healthcare and benefit decisions.

At Serif Health, we focus on what truly drives healthcare costs: unit prices and utilization patterns, not just premiums. Our methodology reveals the real, forward-looking cost of care associated with specific networks—empowering Employers and Benefits Partners to select and create smarter benefits from the start.

Total Cost of Care: The New Standard for Smarter Plan Decisions

Since 2000, the cost of health insurance has tripled–and most employee wage growth over the past three decades has gone toward covering rising premiums rather than increasing take-home pay. 

Let’s face it—tracking premiums and administrative fees is only part of the equation. True healthcare spend comes from unit costs and utilization.

That’s why Serif Health focuses on Total Cost of Care, not just rates or carrier discounts.

By building a complete picture of an employer’s utilization—what services are used, how often, and where—we layer in current, market-specific negotiated rates to create a real-time, future-facing cost model. This is a game-changer compared to the traditional, retrospective claims reports most employers rely on.

Employers also carry fiduciary responsibility under ERISA to act in their employees’ best interest. As recent lawsuits have shown, failing to evaluate plan costs—especially when better data is available—can create legal risk.

From Historical Claims to Predictive Insights

Serif’s approach combines:

• De-identified or employer-supplied claims data 
• Price transparency data across payers, geographies, and service lines
• Census-based demographic modeling for service demand

This allows us to generate a claims-based utilization profile and apply today’s negotiated rates, so you can model what future spend will actually look like—not just what happened last year.

And with our proprietary Relative Cost scoring, employers can compare how different provider networks or contracting strategies impact total cost of care—even without submitting claims or census data. This enables fast, apples-to-apples evaluations of potential network changes or steerage models.

Not all networks are created equal—Relative Cost scoring shows you why.

The phrase “Total Cost of Care” is often used in the context of value-based care or population health—typically referring to chronic condition management, unnecessary utilization, or coordinated care delivery. But with the advent of machine-readable price transparency data, a better definition of Total Cost of Care is now possible: one that combines historical utilization with real-time, market-specific prices to forecast future spend, benchmark provider networks, and guide smarter healthcare decisions.

A Clearer View of Employer Healthcare Costs and Spend

Think of it this way: rather than asking “What did we spend last year?” Serif helps you ask, “What should we be spending—and where can we optimize?”

By analyzing spend through this lens, employers and brokers can:

• Identify high-cost outliers in provider networks
• Evaluate PPO contracts based on actual cost impact
• Select and create networks, steerage models, or plan components that reduce waste
• Justify plan design changes with defensible, data-backed benchmarks

This isn’t just analytics. It’s a strategic advantage at renewal time—and all year long. With this level of visibility, Employers and their advisors can move beyond reactive cost control and start making smarter, data-driven healthcare decisions—from network selection to plan design and vendor evaluation.

Want a Sample Report?

Whether you’re an employer evaluating your own plan design—or a consultant advising multiple clients—see how current costs stack up against market benchmarks and uncover smarter plan design opportunities.

Reach out to Whitney at Serif: whitney@serifhealth.com

Want even more control? Serif’s Signal tool gives employers and benefits partners on-demand access to payer-negotiated rates by CPT code, geography, and provider—ideal for contract modeling and pricing transparency initiatives.

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