Following the recent news that Bruce D. Roffé, P.D., M.S., H.I.A., president and CEO of H.H.C. Group, was accepted into the invitation-only Forbes Business Council, he continues to share his perspective on one of healthcare's most pressing challenges: why rising healthcare costs persist despite the growing number of cost-containment solutions available.
Forbes Business Council is a professional organization for successful business owners and leaders selected based on the depth and diversity of their experience and professional achievements.
In his recent Forbes Business Council article, "The Disconnect in Cost Containment: It's More Than Just Repricing," Bruce challenges one of the industry's biggest assumptions—that
Bruce poses a straightforward but important question:
If healthcare cost-containment solutions are working, why do healthcare costs continue to rise?
His answer points to a distinction that H.H.C. Group has long emphasized:
Cost management and cost containment are not the same thing.
Cost management tracks healthcare spending after it occurs.
Cost containment prevents unnecessary spending before dollars leave the plan.
That's why H.H.C. Group helps payors move beyond repricing through claim-level review, provider negotiation and payment strategies that reduce avoidable medical spend.
The Industry Is Measuring Too Much and Controlling Too Little
Many cost containment measures are designed to give employers the appearance of control via reports that highlight savings, vendor performance or on paper discounts that look substantial. The problem is that these measures don't always lead to an appropriate final payment.
Even large discounts off inflated charges may still leave the plan overpaying. A claim can be processed through a standard repricing tool without a thorough review of billing details, medical support, coding logic or provider payment position. That's where the disconnect begins. Employers want to know not only whether something was discounted but whether the amount paid was actually appropriate.
The Pressure on Payors Is Growing
This concern is becoming more urgent. PwC's 2027 Behind the Numbers report projects commercial healthcare cost trend will reach 9% in 2027, the highest level in 17 years. Hospital and related services inflation reached 7.59% year over year in February 2026.
The report also points to a more sophisticated reimbursement environment, with 70% of health plans ranking AI enabled tools that help providers capture more revenue as a top three cost inflator. Along with providers winning 88% of NSA IDR disputes with payers in 2025.
For employers, brokers, TPAs and stop loss partners, these pressures can affect reserves, renewals, plan performance and confidence in whether current controls are truly able to deliver results.
Repricing Answers Only Part of the Question
Those surface level payment tools become less reliable on their own. Repricing can support a broader payment strategy and help establish a starting point for review but it's not the full answer. A complex claim may require line item analysis, DRG validation, medical bill review, clinical review, Medicare based benchmarking or provider negotiation. Each of those steps answers a different question:
Those are the relevant questions because waste doesn't usually appear at the aggregate level. It's embedded in individual claims, where billing choices, coding decisions, contract terms and clinical facts determine whether a plan overpays.
What Payors Need Now
The next phase of cost containment requires clearer authority, better timing and stronger payment discipline. Employers and their advisors need to define who can question a claim, when a provider should be engaged, which claims deserve deeper review and how the plan will respond when a payment position is challenged.
That preparation has to happen before the claim becomes difficult to control. Once a high dollar payment has been made or a dispute has moved too far, options narrow. The strongest results come from early scrutiny, complete documentation and a defensible strategy that can withstand pushback.
H.H.C. Group Helps Close the Gap
H.H.C. Group helps payors identify questionable charges, review billing accuracy, evaluate reimbursement against appropriate benchmarks and pursue fair provider payments. H.H.C. Group's attorney-led negotiation team brings experience to complex provider conversations, while the medical bill review, line item review, DRG validation, RBP and clinical review capabilities help clients determine what is excessive, unsupported or better addressed through a different payment approach.
That combination is the differentiator because no single method fits every claim. Some bills need coding and billing scrutiny. Others require clinical judgment. Some call for direct negotiation with provider decision makers. The value is knowing what the claim requires and acting before unnecessary spend becomes final.
The New Standard Is Proof
Bruce's Forbes article gives employers and their advisors a clearer way to frame the conversation. The market no longer needs more surface metrics. It needs cost strategies that can show how decisions were made, why payments were appropriate and where unnecessary expense was prevented.
For payors, waiting for medical costs to become easier to manage is not a strategy. The better answer is to become more disciplined, more informed and more prepared on every claim that deserves a closer look. H.H.C. Group gives clients the structure to do exactly that.
Read Bruce's full Forbes article here to learn why the disconnect in cost containment deserves a closer look.
Contact H.H.C. Group today to strengthen your claim strategy, reduce avoidable spend and protect your plan from unnecessary medical costs.
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