Paul Ashley, VP and consultant at NFP, joins the Benefits Brief to discuss the pressure employers are facing around healthcare costs and the strategies gaining more attention as they plan for 2027. The conversation covers cost containment, ICRAs, employees’ capacity for benefits changes, communication strategy, and the market forces influencing benefits decisions.
Paul Ashley's Background
- Works primarily with mid-market employers, with most of his consulting clients between roughly 500 and 5,000 employees.
- Larger employers in that range are more likely to have already finalized their 2027 benefits decisions, while smaller employers generally make those decisions somewhat later.
- Described August through December as peak season for his team.
Key Takeaways
- Employers that have not started seriously using cost-control levers are behind, as Ashley sees greater employer involvement in healthcare navigation as increasingly necessary.
- His view of ICRAs has become more favorable after seeing them work across employers of substantially different sizes, although he stresses they are not appropriate for every employer or every state.
- Employers may underestimate how much benefits change employees can handle when the change is supported by thoughtful communication and change management.
- Effective benefits communication should begin before open enrollment and continue throughout and after it rather than relying on a single enrollment-period message.
- For 2027, Ashley ranked cost containment first, followed by compliance and risk, employee trust and experience, and employee retention.
Recurring Questions
1. What’s one thing you’re telling every client this year, regardless of their size and situation?
Ashley recommends that employers get serious about using cost-control levers. He sees greater employer involvement in healthcare purchasing and navigation as increasingly necessary to create sustainability while helping employees reach higher-quality, lower-cost care.
Cost containment requires more employer involvement
- Employers may hesitate to introduce strategies that create disruption or friction for employees, and Ashley emphasized that the employee experience still matters.
- At the same time, he sees a need for employers to become more involved in helping employees navigate what he described as a relatively broken healthcare system.
- The goal is to help employees move toward higher-quality, lower-cost care rather than leaving them to navigate the system entirely on their own.
Many employers have already started
- Most of Ashley’s clients began working on these strategies years ago.
- His message to employers that have not started is that they should not continue waiting.
2. What have you changed your mind about since last enrollment season?
Ashley has become more comfortable with ICRAs and now believes they should at least be considered by a portion of employers. His view changed after seeing the approach work across organizations of significantly different sizes, although he remains clear that it is not appropriate for everyone.
Seeing ICRAs work changed his view
- Ashley saw the approach work for employers at several different sizes:
- Roughly 50 employees
- Roughly 200 employees
- Roughly 1,700 employees
- Those experiences gave him more confidence that the model can work across a broader spectrum of employers.
The employer becomes a change manager
- Moving to an ICRA changes more than the funding or plan structure.
- Ashley described the employer as moving from being primarily a plan sponsor and risk manager to becoming a change manager because employees are purchasing healthcare in a fundamentally different way.
It is not right for every employer
- Ashley stressed that ICRAs do not work equally well for every employer or in every state where employees work.
- He also cautioned that some implementations may be “more sold than bought.”
- His current position is that the option should at least be considered and then evaluated through a decision process to determine whether and when it fits.
3. What do you think most benefit leaders are underestimating right now?
The underestimated issue, in Ashley’s view, is employees’ capacity to handle meaningful benefits changes. He believes employees may be more willing to absorb change than employers assume, but only when employers support that change with thoughtful communication, branding, and change management.
Employees may tolerate more change than expected
- Ashley believes many employees recognize that the healthcare system has serious problems.
- He also believes they understand that some historical employer promises around healthcare are becoming difficult to sustain.
- That can make employees more receptive to change than employers may expect.
Communication determines whether change works
- Greater capacity for change depends on employers handling internal communication and change management well.
- Ashley cautioned against introducing a major benefits change for the first time shortly before open enrollment.
- Instead, employers should:
- Prepare employees beforehand.
- Communicate throughout the change.
- Continue communicating after enrollment.
- Explain why the change is happening, what it means, and how employees can navigate it.
Discipline matters more than sophisticated technology
- Ashley described effective communication as more about discipline than technology.
- Two approaches he has seen work well together are:
- A benefits landing page or microsite.
- A text-message campaign.
- Texts can provide short messages and direct employees toward a resource, link, phone number, or next action without requiring them to digest large amounts of information at once.
4. For 2027, what’s driving benefits decisions most? Is it cost containment, employee retention, employee trust and experience, or compliance and risk?
Ashley’s ranking:
1. Cost containment
2. Compliance and risk
3. Employee trust and experience
4. Employee retention
Ashley said he would prefer the order to be trust, retention, cost, then compliance. His actual ranking reflects the market environment employers are currently facing rather than his preferred priority order.
Cost containment
Cost containment ranks first because of the difficult health and welfare insurance environment.
- Ashley pointed to pressure in the fully insured market as well as stop-loss coverage for self-funded employers.
- He said his team began sensing the market shift in late 2024 into 2025 and felt it more substantially heading into the 2025 and 2026 cycles.
- By the first quarter of 2026, he was warning clients that the renewal cycle into 2027 could be even more difficult.
Compliance and risk
Compliance and risk ranks second as fiduciary responsibility around health and welfare benefits becomes more significant for employers.
- Ashley compared the shift to fiduciary responsibilities employers are already accustomed to on the qualified retirement plan side.
- He sees those responsibilities increasingly showing up in health and welfare plans.
- He described that development as overdue, but now an important part of the environment employers are navigating.
Employee trust and experience
Employee trust and experience ranks third.
- Ashley said he would personally prefer trust to rank first.
- He did not separately explain why trust specifically landed in third place beyond the broader market pressures pushing cost containment and compliance higher.
- Earlier in the interview, he emphasized that employee experience “matters a ton” when employers pursue cost-control strategies, but he did not explicitly connect that comment to the ranking itself.
Employee retention
Employee retention ranks fourth because Ashley currently sees the labor market as relatively balanced.
- He does not view the current market as clearly favoring either employers or employees.
- Hiring talent is still difficult, but he does not see employers facing an unusually severe talent shortage.
- That allows attraction and retention to fall below cost and compliance while those pressures are particularly strong.
Impactful Quotes
“The employee experience matters a ton. And to create sustainability and help employees navigate the relatively broken healthcare system, employers are gonna have to get a little more involved than they probably are comfortable doing in creating cost containment levers that help employees guide themselves to higher quality, lower cost care.”
“My mind has become very open to the fact that for a portion of the employer population, it is something they have to have on the table and think about. And when they do that, they go from being a plan sponsor and a risk manager to being a change manager because it's a one eighty in how we're doing healthcare purchasing.”
“I think the capacity for employees to absorb change is higher than the employers suspect. But that is only true when and if the employers get thoughtful about an internal communication, branding, change management strategy of whatever they're doing. And you can't just show up early November at open enrollment with one message and think that everybody's gonna get it.”
“The fiduciary responsibility of an employer has skyrocketed in recent years. So all that we're used to on the 401k qualified retirement plan side, that fiduciary responsibility has finally come to bear and show up on the health and welfare plan side.”
About the Benefits Brief
The Benefits Brief is an ongoing interview series from Bereave that asks benefits leaders, brokers, and employee benefits experts the same questions about what they are seeing today and what they expect ahead. As more experts participate, their answers create a growing view of changing priorities, areas of agreement and disagreement, and where employee benefits may be heading next.
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