Preparing for Open Enrollment: Reviewing Participation, Utilization, and Medical Trends

Open Enrollment always seems to sneak up on us. One minute you are closing out the current plan year, and the next you are building timelines, confirming rates, and preparing materials for employees. It can feel like a rush toward the finish line, but a strong enrollment cycle starts with reflection.

Before jumping into the next Open Enrollment period, take time to review how last year actually performed. The goal is not just to confirm renewal numbers. It is to understand how employees participated, how they used their benefits, and how broader cost trends may influence the year ahead.

Looking at participation, utilization, and medical trends together gives you a clearer picture of what worked and what needs attention before enrollment begins again.

 

Review Prior Open Enrollment Participation Rates 

 

Participation data shows how well your Open Enrollment process worked from the employee perspective. Start by looking at how employees have engaged in the enrollment process historically. Data from the prior year often highlights strengths and gaps in communication that may not have been obvious at the time or are not yet obvious.

Be sure to review:

• Overall enrollment completion rates
• Percentage of employees who actively made elections or changes
• Time spent during the enrollment process
• Plan-by-plan enrollment changes
• Dependent coverage elections
• Voluntary benefit participation
• Late enrollments or corrections

These numbers help you understand how employees moved through the enrollment process. If large numbers of employees did not make any changes, that may point to confusion or a lack of engagement. If employees on average spent over 30 minutes completing their enrollment, you may want to see what hurdles they faced. If enrollment shifted between plans, plan communication, pricing, or contributions may have influenced employee decisions more than expected.

 

Evaluate Benefit Utilization Patterns

 

After reviewing participation trends, you will want to look at how employees used their benefits during the year. Utilization patterns not only add context to enrollment decisions but also help identify whether benefit plan designs match employee needs.

Review utilization across your benefit program:

• In-network vs out-of-network usage
• Preventive care participation
• High-cost claim activity
• Primary care versus virtual care usage
• Emergency room versus urgent care usage
• Voluntary benefit claims activity, when available

You are not looking for every detail. The goal is to identify patterns that stand out.

Strong enrollment with low utilization may suggest employees do not fully understand how to use their benefits. Strong enrollment with heavy utilization, i.e., high claims are good indicator of growing needs within your workforce or areas where carrier, plan design, or network changes may deserve another look.

When you compare utilization with enrollment patterns, the story starts to come together.

 

Keep Medical Trends in Mind

 

While Open Enrollment includes all benefits offered, medical benefits drive most of the cost, and need to be reviewed closely and carefully. Medical trends do not tell the whole story, but they help explain why rates are moving and what pressures may be coming. Reviewing these trends early makes it easier to set expectations with leadership and prepare employees for potential changes.

Look at:

• Year-over-year medical cost changes
• Renewal projections
• Large claim activity
• Prescription drug trends
• Contribution changes over time

Reviewing medical trends early helps you prepare for the conversations that come with renewal planning.

 

Bringing It All Together Before Open Enrollment

 

Like many things, historical data is key to preparation. Open Enrollment is no different. Participation shows how employees engaged in the process and made decisions. Utilization shows how those decisions played out during the year in terms of usage and cost. Medical trends help explain where costs are heading – and areas of concern. 

When you review these areas together, it becomes easier to spot gaps in communication, shifts in plan value, and areas that may need program enhancements and/or strategic adjustments before the next enrollment cycle begins.

For Arizona school districts, municipalities, and other public entities, this review is crucial. It supports better budgeting, clearer communication, and a smoother enrollment process for everyone involved.

 

How VSMG Helps Arizona Public Employers Prepare

 

Preparing for Open Enrollment takes more than setting deadlines and distributing materials. It requires a clear understanding of how your plans performed and how employees engaged with their benefits.

VSMG works exclusively with Arizona public sector employers to review participation, analyze utilization patterns, and interpret medical trends before Open Enrollment begins. This approach helps employers make informed decisions and build enrollment strategies that improve each year. Contact VSMG today at 623-594-4370 to learn how our independent consulting approach can support your next Open Enrollment cycle.

About VSMG

Built by and for Arizona public sector employers, VSMG is a leading employee benefits consultant, dedicated exclusively to serving the needs of Arizona’s school districts, municipalities, and other public entities for over 20 years. We are the largest provider of employee benefits consulting services to Arizona school districts, serving over 40,000 benefit-eligible employee lives, and the only nonprofit consultant offering these services.