What It Takes To Really Get Ahead of Healthcare Costs, with Jim Winkler

For three years running, employers have forecast their healthcare costs and been wrong. In 2025 the median forecast was 6.8% and actual costs came in at 8.8%, the widest miss in a decade. Jim Winkler, Chief Strategy Officer at Business Group on Health, joins Nancy Ryerson to unpack what's behind the miss and what it should change about how benefits leaders plan.He talks through hospital and outpatient pricing, the pharmacy spend hiding inside the medical plan, why employers keep considering changes instead of making them, and why he believes protecting the current system is more disruptive than changing it. In this episode, you'll learn:Why a widening forecast miss is pulling CFOs and CEOs into benefits decisionsHow to find the pharmacy and infusion spend sitting inside your medical claimsWhat to look at now so a cell and gene therapy claim isn't a 2028 problemHighlights:(00:00) Meet Jim Winkler(03:25) The colored sticker on his brother's folder(04:59) Where electronic health records still fall short for patients(06:51) Three straight years of missed cost forecasts(09:24) What's pushing hospital and outpatient costs up(10:47) Why cell and gene therapy spend is so hard to predict(12:58) The gap between what employers consider and what they implement(15:33) How framing changes employer appetite for limiting choice(18:07) Why navigation reaches people too late(28:42) The pharmacy spend hiding inside the medical plan(31:51) The No Surprises Act and AI-driven upcoding(35:16) What a benefits leader should do Monday morning(39:13) Why maternity could be the next cost surprise Resources:Nancy Ryerson’s LinkedIn: https://www.linkedin.com/in/nancyryerson/Jim Winkler’s LinkedIn: https://www.linkedin.com/in/jimwinkler/ Lantern’s LinkedIn: https://www.linkedin.com/company/lantern-specialty-care/about/