Insights To Strengthen Your Company’s Health Insurance Strategy

Sep 01, 2026

Read Time 2 Minutes

Healthcare costs are rising, and employers may face significant challenges from high-cost claims. Anthem’s 2025 healthcare data featured in the “High-cost claim and claimant whitepaper” shows that a small group of members drive most of the spending, often due to ongoing and complex health conditions. This can create financial uncertainty for your business, making proactive risk management essential. 

Here are just a few of the insights from the 2025 data.

 

A Small Number Of Conditions Drive The Majority Of High-Cost Claims

 

The top 10 condition categories represent around 75% of the total spend for all health insurance claims in 2025. 

 

Behavioral Health And Maternity Are Quickly Growing Categories

 

Behavioral health and maternity are the fastest-growing areas among high-cost health insurance claimants. These categories saw spending rise by 26.5% and 26.2%, respectively. Maternity claims over $100,000 increased by nearly 30%, underscoring a sharp rise in these high-cost claims.

 

Specialty Drugs And Gene Therapies Have A Major Impact

 

Advances in specialty drugs and gene therapies are creating new possibilities for people with complex and serious conditions, while also creating new considerations for employers managing healthcare costs. Cancer drugs account for the majority of specialty drug spending among high-cost claimants. Gene therapies are rarely needed, but when they are, a single treatment can cost from $850,000 to more than $4 million.

 

Circulatory System Claims Remain The Highest-Spend Category 

 

Circulatory system costs rose 10.9% from 2023 to 2025, driven mainly by a 9.5% increase in the number of claims. Median cost per claim increased 1.2%. This category also had the largest individual claim across all categories.

 

Partnering To Better Manage High-Cost Claims

 

High-cost claims can quickly disrupt a company’s healthcare budget. By leveraging the right analytics and protective strategies, employers can reduce financial uncertainty. Anthem partners with self-funded employers, providing powerful healthcare data insights and tailored support to help you navigate these health insurance challenges and better protect your bottom line.

 

For more actionable strategies and in-depth insights, download the complete whitepaper.