The Fiduciary Reckoning: Why 2026 Is the Year to Rethink Benefits Standard Practice

The recent MBGH Pulse of the Purchaser employer survey data hit hard with this quote:

"The current environment is a dumpster fire with unlimited fuel as long as employers and plan sponsors put up with the status quo."

That’s pretty blunt. Benefits leaders should be worried because the data backs it up. 

The Numbers That Should Worry You

91% of peers cite drug prices as a significant threat to affordability.
87% point to high-cost claims.
72% identify hospital pricing as unsustainable.

But here's what really matters: when asked about their top fiduciary concerns, peers overwhelmingly flagged payment integrity and conflicts of interest in PBM practices and hospital billing.

This isn't about cost anymore. It's about whether you can trust the system you are paying billions into.

The Hidden Crisis: The Data You'll Never See

The survey reveals something even more troubling:

• 41% of employers don't have complete access to all health data fields
• 37% have partners who refused to provide complete data access
• Only 33% believe their data environment is truly transparent

Think about that. As fiduciaries, employers are making decisions about benefit design, vendor selection, and plan strategy, often without complete visibility into where the money is actually going.

You can't manage what you can't see. And you can't fulfill your fiduciary duty with one hand tied behind your back.

Why Forward-Thinking Employers Are Taking a Different Approach

54% of MBGH employers now identify as Change Agents or Early Adopters—up from 42% in 2022. What makes them different?

They get 3 key things:

1. Cost Management Isn't Just About Plan Design

Traditional strategies like sites of care, centers of excellence, and tiered networks are table stakes. The real opportunity lies in what happens after care is delivered: in the claims process, the billing cycle, and the member's ability to navigate their benefits.

2. Your Fiduciary Exposure Is Growing, Not Shrinking

One survey respondent put it bluntly: "Many employers may not be aware of the significant fiduciary risk in using brokers, consultants, and PBMs. We took these responsibilities away from the intermediaries to reduce our risk."

The question isn't whether you have fiduciary exposure. It's whether you have the tools to manage it.

3. Member Financial Exposure Is a Fiduciary Issue

When almost half of Americans receive healthcare bills with errors, and almost 50% of employees lose their FSA dollars annually, and most don’t get value out of voluntary benefits purchases, that's not just a member satisfaction problem—it's a fiduciary failure. We're failing to ensure plan expenses are reasonable, and we're failing to help members maximize the benefits they've earned.

Claims-Driven Financial Advocacy: The Next Step

The focus should be on claims-driven financial advocacy. 

Most benefits strategies focus upstream—on network design, formulary management, and utilization controls. But the MBGH data shows employers are increasingly focused on downstream transparency: 78% are reviewing pharmacy claims to identify trends and negotiate better contracts, and 72% want to ensure compliance with fiduciary duty to pay only reasonable expenses.

This is why forward-thinking employers are deploying AI-powered claims advocacy platforms that:

• Provide complete visibility into medical, Rx, dental, and vision spending—the transparency that 67% of employers say they lack‍
• Proactively identify and correct billing errors on 100% of claims—because fiduciary duty means ensuring you only pay for what's reasonable and necessary‍
• Maximize member benefit utilization—recovering lost FSA/HSA dollars and securing voluntary benefit payouts members didn't know they were entitled to
• ‍Generate measurable ROI—not in "projected savings" but in actual dollars returned to the plan and to members

When a single platform can return approximately 3.5% of total medical spend—we're not talking about marginal improvements. We're talking about a fundamental shift in how we approach cost management and fiduciary responsibility.

The Real Question for 2026

The MBGH survey shows that 21% of employers changed PBMs in the past year, with another 48% considering a change. They're looking for better pricing, more transparency, and formulary control.

The bigger opportunity isn't changing vendors—it's changing the game entirely. 

Instead of accepting that "this is just how healthcare works," you deploy technology that:

• Catches the $500 member billing error and the $2k employer overcharge and recovers those funds without member behavior change or additional workload. 
• Automatically secures voluntary benefit payouts that would otherwise go unclaimed
• Provides the complete data access that 41% of employers are currently denied

Moving Beyond the Status Quo

The survey respondent who called this a "dumpster fire" was right about one thing: it only continues as long as we put up with it.

54% of MBGH employers now consider themselves change agents.
The question is, are you one of them?

Maintaining the status quo isn't neutral—it's a choice. And it's a choice that comes with increasing fiduciary risk, rising costs, and missed opportunities to serve your member population better.

The tools exist. The technology is proven. The ROI is measurable.

What's needed is the desire to expect more.

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At Reclaim Health, we partner with self-insured employers who refuse to accept "standard practice" as good enough. Our AI-powered platform provides the transparency, advocacy, and measurable results that transform healthcare financial management from a cost center into a strategic advantage.

Learn more about how we're helping benefits leaders fulfill their fiduciary duty while delivering measurable value: www.reclaim.health

Reclaim Health is a proud Partner Member of MBGH.