Gallagher data shows a $20,000 vs $10 communication gap driving unnecessary healthcare waste
US employers are spending up to $20,000 per employee annually on health plans and less than $10 per employee communicating them. John Tournet, US Chief Executive Officer of Gallagher's Benefits & HR Consulting Division in Chicago, says that imbalance is why employees show up at the wrong provider, duplicate tests, use emergency rooms for conditions that a phone call could have resolved, and generate out-of-network costs that feed straight back into the premiums employers are already struggling to contain.
"It's chronic under-investment in the communications piece," Tournet said.
The benchmark comes from an Aon report on healthcare cost management. It reframes a problem many HR leaders approach as a plan design question, when the plan itself is often not the issue. Most employees encounter the healthcare system at moments of maximum stress, without preparation and without guidance, and make the most expensive decision available to them simply because nobody told them about a better one.
The cost of sending employees in blind
Unnecessary emergency room visits, duplicate diagnostic testing, and avoidable out-of-network billing inflate a plan's claims experience and drive premium increases at the next renewal. According to a 2024 national study by Employee Benefit News, sponsored by Quantum Health, a healthcare navigation company serving more than 500 self-insured US employers, 37 percent of employers are now offering healthcare navigation services specifically to reduce this kind of waste. Eighty-nine percent are taking at least one active step to lower healthcare costs.
Navigation has moved from a supplemental benefit to a cost-control strategy, and the loyalty returns are real alongside the financial ones. Employee survey data from employers with strong navigation programs consistently shows retention gains tied directly to the experience of being helped through a difficult healthcare moment.
"When you simplify that moment for someone, it stays with them," Tournet said.
Research on benefits costs and HR strategy has consistently found that replacing an employee costs more than $30,000, a figure that quickly dwarfs any premium savings from a benefits rollback. Navigation programs that reduce avoidable exits are a retention investment as much as a healthcare one.
A fragmented benefits stack is making the problem worse
Most employers have added benefits point solutions faster than they have integrated them. Standalone programs for pharmacy benefits, musculoskeletal care, diabetes management, mental health, and infusion therapy sit inside the same benefits stack without connecting to each other or to the employee trying to figure out which one covers their situation.
Employees with a complex health need face multiple entry points, multiple phone numbers, multiple logins, and no obvious starting place. Many give up and use whatever is most familiar, which is usually the emergency room or the first provider name that appears in a search.
Tournet describes the fix as a "one quarterback" model: a single contact point, human or AI-assisted, that can see across the entire benefits stack and route employees to the right resource in real time. Employers that have implemented this approach have seen healthcare costs lower than they were ten years ago, which Tournet describes as nearly unheard of in the US healthcare market.
HR teams are increasingly turning to AI for benefits education as employees themselves look to AI for answers to benefits questions. Fifty-seven percent of HR professionals already use AI in benefits education or training, according to a survey of more than 300 HR professionals by InComm Benefits, a US-based payments technology provider.
When AI navigation works and when it doesn't
The AI Tournet describes is not a chatbot bolted onto an existing portal. It combines claims data, demographic information, provider quality scores, and an employee's current deductible status to generate real-time navigation at the point of need. A call about a lost insurance card can simultaneously flag an unused wellness benefit or trigger a post-surgery follow-up, turning a transactional interaction into a genuine care coordination moment.
Embedding AI across ten separate, fragmented point solutions recreates the very problem it's meant to solve. The effective model is a single interface, whether inside the human resources information system (HRIS) or a separate integrated platform, that can also surface alerts for HR when follow-up is needed.
Employee willingness to engage with AI benefits tools remains a live variable. Prudential's 2026 Benefits & Beyond study found that 83 percent of employers want to use AI for benefits guidance, but only 58 percent of employees say they would use it, a gap that communication strategy has to close before technology investment pays off.
GLP-1 volatility and the limits of point-solution thinking
Glucagon-like peptide-1 (GLP-1) medications, widely prescribed for obesity, diabetes, and cardiovascular risk reduction, are a live example of what happens when point solutions move faster than navigation strategy. Some employers that moved quickly to cover these drugs are already pulling back coverage due to unexpectedly high utilization and costs, creating confusion for employees at precisely the moment they most need guidance on where to turn.
Tournet's advice is to push the benefits conversation beyond annual plan design. Multi-year, experience-focused strategy treats navigation as infrastructure rather than an add-on: mapping how employees actually move through the healthcare system, identifying where they lose their way, building communication across the channels different employee populations actually use, and feeding engagement data back into plan design rather than waiting for the next renewal to prompt a review.
Every avoidable ER visit, every duplicate test, every out-of-network bill generated by an employee who didn't know better is a cost that a $10 communication investment might have prevented.
"The financial case and the human case point in the same direction," Tournet said.
