As we enter a new year, self-insured employers are taking stock of what they’ve faced, what they’ve learned and what lies ahead. At this past Self-Insurance Institute of America National Conference, the conversation wasn’t just about what’s happening now, it was about what’s coming next. From artificial intelligence to fiduciary litigation, the sessions and sidebars reflected a landscape defined by uncertainty, innovation and mounting responsibility for self-insured employers.
As always, aequum was there, not just to observe but to connect, listen and engage directly with the issues facing plan sponsors, TPAs and cost containment partners. Looking ahead to 2026, here’s what stood out most and what should carry into this year’s planning.
AI Is No Longer a Buzzword — It’s a Necessity
Artificial intelligence was everywhere and not just in the abstract. Speakers and vendors alike emphasized how AI tools are already being used to parse through massive data sets, flag potential fraud and optimize claims negotiation strategies.
For self-insured plans, the message was clear, AI isn’t coming, it’s already here. The plans that learn to use it well will be the ones better equipped to manage cost, reduce exposure and respond to outlier claims in real time.
aequum is already seeing the impact. Tools that analyze price transparency data or claims patterns help inform legal strategy, reimbursement positioning and overpayment recovery. AI alone isn’t the solution, it has to be paired with human expertise, fiduciary awareness and strong plan governance.
Price Transparency: The Rules Are Just the Start
Price Transparency Rules are still top-of-mind across the industry. The real shift at SIIA wasn’t about compliance, it was about what happens next.
Plan sponsors and vendors are starting to act on the data, not just collect it. Several companies are leveraging transparency files to strengthen claim negotiations, expose billing irregularities and even pre-empt high-cost disputes.
In discussions with partners and new entrants in the self-funded space, one theme emerged: transparency data isn’t useful unless you know what to do with it. That’s where advocacy, analytics and legal support converge.
aequum’s approach has always emphasized actionable intelligence, using data to challenge inflated charges, support reimbursement strategies and defend plan decisions. Price transparency helps level the playing field but only if you know how to play.
Fiduciary Responsibilities Are Under the Microscope
SIIA 2025 put a spotlight on fiduciary risk, especially as it relates to benefit design, vendor selection and claims oversight. With recent litigation challenging plan decisions and fee arrangements, employers are being asked to show more than good intentions. They need documented, defensible processes that prioritize the best interest of plan participants.
Best practices discussed at the conference included:
• Conducting regular audits of third-party administrator (TPA) performance.
• Building data access clauses into vendor contracts.
• Ensuring that plan design aligns with fiduciary standards, not just convenience.
This isn’t just about avoiding lawsuits. It’s about maintaining trust, transparency and long-term plan sustainability.
High-Cost Claims and Pharma: The Pressure Keeps Building
While AI and transparency tools offer hope, the reality of high-cost claims, especially in specialty pharmacy, remains a growing concern. Session after session echoed the same message, a single claim can blow up a plan even if it is properly managed.
Anticipating the date when, not if, the plan suffers a high-cost claim, many attendees discussed point solutions – including layered strategies, carving out specialty drugs, pre-authorizing certain treatments or using aggressive forms of reference-based pricing. Even with those tools, plans are still exposed to provider pushback and out-of-network tactics that can be best countered by legal intervention and negotiation.
This is aequum’s territory. When high-cost claims lead to dispute, our team steps in to protect the plan, support the participant and negotiate fair outcomes.
The Self-Insured Future: Uncertain but Full of Opportunity
Beyond the content of the sessions, what made this year’s SIIA conference unique was the tone. Cautious optimism. Realistic ambition. An openness to rethink legacy assumptions.
Self-insuring continues to expand. New players are entering the space, some with fresh ideas, others looking for experienced partners. We spent time reconnecting with longtime collaborators and meeting early-stage companies who are using data, tech and advocacy to reshape how plans defend themselves.
That’s not just encouraging. It’s necessary.
aequum’s Perspective: Protect the Plan, Empower the Participant
What we heard at SIIA confirms what we see every day, the gap between benefit design and plan performance is where risk lives. It’s also where opportunity lives to reduce waste, defend claims and drive better outcomes for employers and employees alike.
aequum helps self-insured plans navigate that space by offering:
• Claims dispute support using price transparency and AI insights.
• Legal advocacy to defend against excessive or abusive billing, including management of the No Surprises Act Independent Dispute Resolution process.
• Overpayment recovery to preserve plan funds and correct leakage.
• Real-time data visibility to support fiduciary compliance.
• Participant representation in resolving balance billing disputes.
Whether you’re building a new plan or strengthening an existing one, the rules are changing and staying ahead of them takes more than compliance.
Staying Ahead of the Curve
As you evaluate what worked, what didn’t and what needs to change, aequum is here to help. If you want to get ahead and stay ahead of emerging risks, the insights from SIIA confirm a compliant, tactical response won’t be enough. Make 2026 a time for developing a response of stronger defenses, better data and clearer strategy.
Contact aequum to find out how we can help your plan use data, advocacy and legal muscle to stay compliant, stay competitive and stay protected.