Coverage Isn’t Access: What Education Benefits Leaders Are Learning About the Cost of Care

Insights from a recent Rezilient Health webinar, "Rethinking employee healthcare in education," featuring Susan Bain, Director of Benefits at the Oklahoma State University.

Ask any benefits leader in higher education to name their hardest problem right now, and you'll hear a version of the same thing: they're being asked to manage rising healthcare costs while improving access and the employee experience, all at the same time. Those three goals tend to pull against each other. Most of the tools on the market solve for one at the expense of the others.

For schools, colleges, and universities, the squeeze is especially acute. Tuition pressure, state funding constraints, the race to recruit and retain talented faculty and staff, and healthcare inflation are all competing for the same dollars. As Susan Bain, who oversees benefits for roughly 7,500 employees and about 11,000 covered lives across the Oklahoma State University system, put it: "We simply can't continue accepting double-digit healthcare increases. If you sit still and just continue to raise premiums, that is not the solution."

This is the shift we're seeing across the education space — and it starts with reframing what the actual problem is.

The numbers behind the pressure

The cost trend is not a blip. Employer health benefit costs per employee are projected to rise 6.5% in 2026 — the steepest increase in 15 years, and that's after accounting for the cost-reduction measures employers are already taking; without them the figure would approach 9%, according to Mercer's National Survey of Employer-Sponsored Health Plans.

At the same time, the tried-and-true response — cost shifting through higher deductibles and employee premium contributions — has a ceiling. Push too far and you erode the very value employees are supposed to be getting from the plan. One in three educators say they've skipped routine medical care in the past year because of cost, not because they lacked coverage.

And the access problem is worsening independently of cost. The average wait for a new-patient physician appointment is now 31 days, up 19% since 2022, per AMN Healthcare's 2025 survey. When people can't get in when they need care, they don't simply wait — they route themselves to urgent care and the emergency room, the most expensive doors in the system, often for things primary care could have handled.

Reframing the problem: coverage is not access

The most important idea from the conversation is deceptively simple. Coverage and access are not the same thing, and treating them as synonyms is where a lot of benefits strategies go wrong.

"You can have the richest plan available to your employees, but if you don't have adequate access…then it's a little bit all for naught. An insurance card doesn't necessarily improve health — it's the access to care that does." - Susan Bain, Director of Benefits at the Oklahoma State University

That distinction reorders the whole strategy. A plan document is a promise; access is whether that promise can actually be redeemed — same day or next day, without a month-long wait, without a two-hour round trip. For a rural, geographically distributed workforce, that gap is even wider. Oklahoma State sits about an hour from both Oklahoma City and Tulsa, with representatives in all 77 counties of a state that is, in Bain's words, "considered a rural state. We just don't have a lot of access to care."

When access is the real constraint, the question stops being "how much plan can we afford?" and becomes "how do we make good care genuinely easy to reach?"

Primary care as the highest-leverage investment

If access is the lever, primary care is where you pull it. It is one of the few places in healthcare where spending a little earlier reliably avoids spending a lot later.

"Primary care is probably one of the best investments that we can make in our employees...Today's minor issues become tomorrow's major claims. If we can be a little bit proactive and provide the opportunity for them to have more access to care, then we can long-term save the health of our plan." - Susan Bain, Director of Benefits at the Oklahoma State University

The behavioral logic is intuitive. People choose the path of least resistance, Bain's analogy was the convenience store versus the grocery store: "Why do they go to the ERs and urgent cares? It's the same reason you run into the quick stop to pick up a Diet Coke versus driving across town to the grocery store — because it's quick, easy, convenient." Make good primary care the convenient option, and utilization follows: "The majority of people, whenever they have an option that's convenient and easily accessible, they'll take advantage of that."

This is the case for what the industry increasingly calls advanced or direct primary care: a front door that offers same-day and next-day appointments, that can serve both acute needs and the ongoing relationship of a primary care provider, and that meets people where they are — including virtually. In practice, that means models like hybrid in-person and virtual primary care, backed by connected diagnostics and asynchronous specialty consults, can activate employees who simply weren't engaging with the system before.

Fewer front doors, not more point solutions

The instinct when a benefit gap appears is to add another vendor. But more vendors has not meant more people getting care. It has usually meant more complexity, and complexity is its own barrier to access.

"Healthcare in itself is complex, and you've got a million point solutions that are all fantastic...It's our job as a benefits team to present a nice, complete package. A crucial element is to have some type of care navigation, care management component to that package… to help our members locate the right care for the right situation." - Susan Bain, Director of Benefits at the Oklahoma State University

She's direct about the discipline that requires: "Sometimes employees get a little bit of benefit overload whenever there's too many options. Whenever we're not able to see the utilization numbers favorable, we really may need to consider: is that a point solution we're going to continue?"

The strategic move here is a reduction, not an addition — consolidating fragmented tools behind a single, coordinated front door with real care navigation, so an employee's first question ("where do I even start?") has an obvious answer. That's what turns a rich benefits package from a binder of underused options into something people actually use.

Taking back control of the plan

Underlying all of this is a broader shift in posture: education employers moving from passively absorbing trend increases to actively designing the plan. At Oklahoma State, that has meant beginning to unbundle the health plan, a significant undertaking Bain frames as an opportunity:

"To put us better in the driver's seat of what our health plan is and what it can do for our employees, including things with direct contracting and a little more control over our PBM strategies."  - Susan Bain, Director of Benefits at the Oklahoma State University

Unbundling and direct contracting aren't the goal in themselves. They're what lets a benefits team choose partners that actually fit their workforce, rather than inheriting whatever network and terms come bundled by default. That control is what makes the rest possible — putting access, primary care, and a simpler experience at the center of the strategy instead of treating them as line items to trim.

What benefits leaders can take into the next enrollment cycle

Three takeaways stand out for any education benefits leader planning ahead:

1. Start with access, not price. Better front-door access to primary care is what shapes cost, experience, and outcomes downstream. Coverage without access doesn't move the needle.
2. Connected beats fragmented. A coordinated model — virtual and in-person primary care plus real care navigation, reduces the point-solution sprawl and gives employees one obvious place to begin.
3. Fit the strategy to your workforce. The right approach reflects your people, your geography, your budget, and your enrollment timeline. What works for a rural, distributed university won't look identical to a dense urban employer, and it shouldn't.

As Bain summed it up, the job isn't just caring for one employee today; it's "building a sustainable healthcare system that our employees can rely on for years to come." For education employers facing the steepest cost trend in a generation, that starts with a quieter, more durable idea: make good care easy to reach, and most of the rest follows.

Sources: Mercer National Survey of Employer-Sponsored Health Plans; AMN Healthcare 2025 Survey of Physician Appointment Wait Times.

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