A recent article covered by Captive International spotlights our VP, TJ Scherer, being appointed to the Texas Captive Insurance Association (TxCIA). Check out the full article here.

Spring Consulting Group is pleased to announce that T.J. Scherer, Vice President, has been appointed to the Board of Directors of the Texas Captive Insurance Association (TxCIA).

Since joining Spring Consulting Group, T.J. has played a key role in the growth and execution of the firm’s alternate risk practice. This appointment highlights his leadership and expertise within the risk management community.

In his role on the TxCIA Board, T.J. will collaborate with industry peers to support the association’s mission through strategic oversight, regulatory guidance, and industry advancement, as Texas continues to strengthen its position as a leading captive domicile.

T.J. brings more than 10 years of experience advising organizations on complex risk management and captive insurance programs. His background in financial reporting and program governance provides a strong analytical perspective aligned with TxCIA’s commitment to fostering a stable and effective captive insurance environment.

Spring Consulting Group congratulates T.J. on this appointment and looks forward to his contributions to the TxCIA and the broader captive insurance community.

In a recent article featured on the New England Employee Benefits Council (NEEBC)’s blog, our Consultant, Grace Giannattasio, provides a state-by-state update on PFML changes in 2026 in the New England area. You can find NEEBC’s full article here.

Choosing employee benefits can feel overwhelming. There are more options than ever, rising costs, and constant changes to laws and regulations. The challenge for employers is not offering everything, but rather offering benefits that actually support employees as their lives change, while still making sense for the organization.

Looking at benefits through a life-stage lens can help. Instead of grouping employees by age or job title, this approach focuses on what people need at different points in their lives. It also recognizes that employees don’t move through these stages neatly—someone might be growing their career while caring for a parent or starting a family all at the same time. Benefits should be flexible enough to keep up while balancing cost, compliance, and operational impact.

Early Career and Entry Level Employees

Employees early in their careers are often enrolling in benefits for the first time while also navigating work-life balance and the challenges of a new workplace. While nearly all employers offer health coverage, many younger employees do not fully understand how to use it or what it costs them.

At this stage, affordability and simplicity matter. Employees tend to value preventive care, mental health support, and basic financial tools that help with budgeting, emergency savings, and student loan repayment. Clear education is critical, as communicating benefits is often rated poorly by employees, which directly affects utilization.

Time off also plays an important role. Flexibility to manage personal needs helps early career employees build healthy work habits and reduces the risk of burnout or early turnover in an already competitive labor market.

Employees in the Family Building and Caregiving Stage

As employees progress in their careers, many begin juggling work with caregiving responsibilities. More than one in six U.S. workers provides unpaid care to a family member, and most caregivers report difficulty balancing those responsibilities with their jobs.¹

Healthcare and leave benefits become especially important at this stage. Coverage often expands to include partners and dependents, along with increased use of maternity care, fertility services, pediatric care, and postpartum support. Leave programs are critical, and employers face the added challenge of ensuring employer-sponsored leave coordinates appropriately with federal, state, and local mandates.

Without adequate support, employees are more likely to reduce hours, postpone advancement, or leave the workforce altogether. Additional benefits such as dependent care, flexible scheduling, resource navigation, and financial planning support can help employees remain engaged and productive. Manager awareness is also key, since employees often turn to their direct manager first when life events arise.

Mid-Career Employees

Mid-career employees often hold deep institutional knowledge and occupy key leadership or technical roles. Losing them can be expensive, with turnover costs estimated at roughly one-third of an employee’s annual salary, factoring in hiring, training, and lost productivity.²

Benefits at this stage often center on balance and long-term health. Preventive care, screenings, condition management, and strong benefit navigation tools help employees manage growing responsibilities inside and outside of work. Time off remains important, whether for caregiving, family needs, or rest.

Retirement planning also becomes more significant. Access to education and financial guidance can help employees make informed decisions about both their careers and their future financial security.

Employees Entering Late Career and Retirement Planning State

As employees approach retirement, healthcare usage typically increases, and coverage becomes more important than cost alone. Strong provider networks and condition management are common priorities.

Most U.S. workers have access to employer-sponsored retirement plans, but participation often lags behind access, highlighting a need for better education and guidance.³ Financial counseling, retirement readiness programs, and phased retirement options can support smoother transitions while helping employers plan for workforce changes.

What Matters At Any Stage

Some benefits are important regardless of career stage. Flexible work arrangements, family care support, and professional development consistently rank among top workforce priorities.⁴ Technology also plays a major role: benefits that are difficult to understand or access are less likely to be used effectively.

Ongoing communication is essential. When education occurs only during open enrollment, employees are more likely to feel confused and make rushed decisions. Year-round education in multiple formats improves understanding and utilization.

Making Practical Decisions

Rising healthcare costs and benefit expenses require difficult decisions each year. While most employers view health benefits as a top priority, offering too many options can overwhelm employees and increase costs without improving outcomes.

A life-stage approach helps employers focus on what delivers the most value, regardless of where employees are in their careers. Investing in preventive care, wellness programs, financial education, comprehensive leave offerings, and clear communication can reduce long-term costs and turnover. At the same time, staying compliant remains essential as leave laws and healthcare requirements continue to change.

A benefits strategy built around real-life needs, not just demographics, is more sustainable and more impactful for both employees and employers.

¹Caregiver Statistics: Work and Caregiving, Family Caregiver Alliance, https://www.caregiver.org/resource/caregiver-statistics-work-and-caregiving/
²Average Turnover Rate by Industry (2026 Update), Corporate Navigators,  https://www.corporatenavigators.com/articles/recruiting-trends/average-turnover-rate-by-industry-in-2024/
³Worker Participation in Employer-Sponsored Pensions, https://www.congress.gov/crs-product/R43439
⁴30+ Employee Benefits Statistics in the U.S. (2024/2025), https://high5test.com/employee-benefits-statistics/

To attract and retain top talent, employers continue to invest heavily in comprehensive employee benefits programs. While offering a wide range of health and well-being options is well-intentioned, an unintended consequence often emerges: choice overload. Employees may appreciate having options, but without the time, expertise, or clarity to evaluate them, navigating benefits can quickly become overwhelming.

This is where care steerage and smart navigation come into play. Together, these strategies are designed to simplify healthcare decision-making, improve the benefits experience, and help employees access high-quality, cost-effective care with greater confidence.

What Is Care Steerage?

Care steerage is a benefit design strategy that guides employees toward higher-quality, more cost-effective providers and care settings based on objective measures, such as quality outcomes, cost efficiency, and an individual’s specific healthcare needs.

Rather than leaving employees to navigate complex provider networks on their own, steerage uses data and structured pathways to support better decisions. At a high level, steerage typically falls into two categories.

Active Steerage

Active steerage involves real-time, personalized support. Employees may interact with nurse navigators, care concierges, or trained benefits coordinators who engage employees by phone, chat, or online portals. These experts help identify appropriate providers based on medical history, new diagnoses, upcoming procedures, and geographic preferences.

Passive Steerage

Passive steerage empowers employees with self-service tools, including online provider directories, mobile apps with cost and quality transparency, and provider and facility comparison tools. By making pricing and quality data more visible, employees are better equipped to make informed choices independently.

Why Steerage Matters

The primary goal of care steerage and smart navigation is to encourage quality-based and cost-conscious healthcare decisions that improve outcomes while reducing unnecessary spending. Many benefit plans reinforce these choices through design features such as tiered provider networks that highlight high-value options, lower copays or out-of-pocket costs for preferred providers, and incentives for using primary care or outpatient settings rather than higher-cost inpatient care.

For employees, this often translates into lower costs, better care experiences, and greater confidence in using their benefits.

Common Features of Smart Navigation Programs

Smart navigation complements care steerage by leveraging technology, often enhanced by AI, to make benefits easier to understand and use. Common design elements include:

1. Personalized communications that deliver targeted guidance based on life events, care needs, or upcoming decisions.
2. Digital decision-support tools, such as mobile apps and online platforms with cost calculators and provider comparison features tailored to individual and family needs.
3. Value-based plan integration, where navigation tools are embedded within Tier 1 or value-based networks that reward employees for choosing high-quality, cost-effective care.

Benefits for Employees and Employers

When smart navigation and care steerage work in tandem, they deliver meaningful benefits for both employees and employers. For employees, these programs help reduce search fatigue and the frustration that often comes with trying to find the right healthcare resources. With access to expert guidance through personal concierge services and decision-support tools, employees are better equipped to make informed healthcare decisions and identify lower-cost providers that still deliver high-quality care.

For employers, this approach can drive stronger returns on investment, help control unnecessary and wasteful claims spending, improve overall benefits engagement, and positively impact employee recruitment and retention, ultimately contributing to a healthier and more satisfied workforce.

Sources:
– Wellness360 Blog, Benefits Navigation: Simplifying Healthcare with Technology, September 2025
– 10 Best Benefits Navigation Platforms for 2026, Recruiters Lineup, October 2025
– Best Employee Benefits Navigation Companies, CBINSIGHTS

What is Nurse Navigation?

A nurse navigator is a registered nurse who guides patients through the often complex healthcare system, coordinating care and serving as an advocate. Navigating healthcare independently can be overwhelming, time-consuming, and costly, particularly for employees managing chronic conditions, complex treatments, or new diagnoses.

Nurse navigation provides personalized, end-to-end support—from diagnosis and treatment planning to recovery—by unifying benefit utilization, provider coordination, and cost-efficient clinical care. This approach ensures employees receive the right care, at the right time, at the right place, while reducing confusion and delays.

Employer adoption is growing rapidly. Currently, 37% of self-insured employers implement a healthcare navigation solution, helping employees access the most appropriate care and resources. ¹

The Role of a Nurse Navigator

Nurse navigators offer a variety of services tailored to patient needs:

Education

• Helps employees understand diagnoses, treatment options, and benefits, bridging gaps in healthcare literacy.

Fast-Tracked Care

• Streamlines the care process by handling prior authorizations, scheduling appointments, coordinating labs and tests, and ensuring all prerequisites are met for timely care.

Advocacy

• Acts as the employee’s primary point of contact and advocate, providing guidance and support throughout the care journey.

Care Logistics

• Assists with travel arrangements (car services, hotels, flights), financial or insurance issues, and access to other support resources.

Emotional Support

• Provides empathy and guidance, offering a trusted relationship for patients and their families to navigate fears, questions, and concerns.

Why Nurse Navigation Matters

Healthcare is increasingly complex, and employees often face multiple challenges when trying to access care. Navigating between multiple providers, understanding specialty networks, and deciphering benefit structures can be confusing and time-consuming. Rising deductibles and out-of-pocket costs add financial stress, while care gaps, particularly for chronic or high-acuity conditions, can lead to delays, complications, and unnecessary expenses.

Nurse navigation addresses these challenges by providing personalized, proactive support throughout the healthcare journey. By coordinating care, assisting with benefit utilization, and guiding employees through complex treatment plans, nurse navigators reduce barriers and ensure employees receive the right care at the right time. Clinical evidence demonstrates the effectiveness of this approach. For example, patients with advanced pancreatic cancer who had access to a nurse navigator had a 104% higher probability of survival after one year compared to those without navigation support. ² Similarly, oncology patients using nurse navigation services reported an increase in satisfaction from 66.5% to 87.4% and a drop in no-show rates from 3.8% to 0.4%. ³

Beyond clinical outcomes, nurse navigation also improves employee engagement and benefits utilization. Employees are more likely to understand their coverage, attend necessary appointments, and make informed care decisions when they have a dedicated resource guiding them. This support not only improves health outcomes but also generates measurable value for employers through reduced unnecessary spending and higher ROI on benefits programs.

Different Models of Nurse Navigation

Employers have several options when implementing nurse navigation:

1. Standalone point solution vendors – specialized navigation services that can be added to existing benefits.
2. TPA-integrated navigation – larger third-party administrators offer nurse navigation as part of their platform, creating seamless integration with claims, wellness, and leave management.
3. Hybrid approaches – combining internal case management with external navigation support to meet the needs of specific employee populations.

Choosing the right model depends on the population served, plan structure, and organizational goals.

How Nurse Navigation Supports Employers

Nurse navigation is more than a benefit perk; it is a strategic tool for addressing key employer challenges. By proactively coordinating care, nurse navigators help manage rising medical costs, increase engagement, and reduce fragmentation in the healthcare system. Employees experience better outcomes and higher satisfaction, while employers benefit from reduced unnecessary spending and improved ROI.

Employers considering nurse navigation should assess their current plan offerings, population needs, and integration options to ensure the solution complements their existing benefits ecosystem without disruption.

As the healthcare landscape becomes more complex, nurse navigation has emerged as an essential solution for modern employers. Providing employees with expert guidance, care coordination, and emotional support reduces barriers to care, improves outcomes, and increases engagement. Whether implemented as a standalone solution or integrated into existing plans, nurse navigation delivers measurable value for both employees and employers.

¹State of Healthcare 2024, Employee Benefit News (EBN) National Employer Study, sponsored by Quantum Health, which found 37% of employers are offering healthcare navigation services to support employee access to care. https://www.businesswire.com/news/home/20240410953008
²Cruz, Z. (2025, September 15). Impact of nurse navigation on overall survival and timeliness to care in patients with pancreatic cancer in advanced stages. Journal of Oncology Navigation & Survivorship. https://www.jons-online.com/issues/2025/september-2025-vol-16-no-9/impact-of-nurse-navigation-on-overall-survival-and-timeliness-to-care-in-patients-with-pancreatic-cancer-in-advanced-stages
³Strengthening oncology patient navigation enhances outcomes and access to care. Oncology Nurse Advisor. (2025, May 13). https://www.oncologynurseadvisor.com/reports/strengthening-oncology-patient-navigation-enhances-outcomes-treatment/

When we think of travel, many of us envision picturesque beaches, historical sites, or national parks. For others, travel is driven by healthcare needs, often combining treatment with tourism activities or recovery time. This practice is commonly referred to as medical tourism.

The prevalence of medical tourism is difficult to quantify, but the American Association for Physician Leadership (AAPL) estimates that approximately 1.4 million Americans travel abroad each year for medical care. ¹ For employers, this does not indicate that their health plans are misaligned with benchmarks, nor is it something to control. However, it is a growing reality that benefits from education and proactive navigation. The opportunity is to frame your approach not as cost-cutting, but as an access and risk management consideration. Without thoughtful planning, organizations may face hidden costs, care gaps, and employee dissatisfaction, particularly when complications arise after an employee returns home and seeks care under an employer-sponsored plan.

Why Employees Seek Care Abroad

Risks for Employer-Sponsored Plans

Because most medical tourism occurs outside of employer-sponsored benefit plans, it typically involves no preauthorization, limited quality vetting, less structured follow-up care, and reduced cost predictability for unplanned complications. While participants generally assume these risks while abroad, employers often absorb downstream impacts once employees return home. These may include postoperative complications such as infections, additional surgeries, extended recovery periods, and related leaves of absence.

One of the most significant challenges is the lack of coordination with domestic providers, including limited sharing of medical records before and after procedures performed abroad. As Renée-Marie Stephano, JD, Chief Executive Officer of Global Healthcare Accreditation, explains,

“When patients arrange medical travel independently, without involving their primary care provider, physicians may be left out of the loop. That makes it difficult to review the treatment plan, ensure it aligns with the patient’s medical history, and properly manage follow-up care once the patient returns home.” ²

Establishing a Philosophy Around Medical Tourism

Rather than implementing rigid policies that aim to discourage or restrict international care, employers may benefit from establishing a philosophy, not a policy, regarding medical tourism. This approach focuses on governance, education, and equity rather than enforcement. Many organizations currently take a passive approach, addressing complications only after employees return home. While this requires minimal oversight, it can result in unintended inequities and inconsistent employee experiences.

In developing a philosophy, employers may consider factors such as equity and access, employee experience, cost transparency, and organizational risk tolerance. Often, the most effective approach involves modeling scenarios across health plans, disability programs, and time-off policies for employees seeking care domestically and internationally. Practical steps may include adding educational resources about risks, clarifying coverage expectations, planning for post-travel care coordination, and aligning leave and disability benefits with health benefits.

Looking Ahead

Medical tourism is expected to continue growing in the coming years. According to Forbes, the global medical tourism market is projected to grow at a compound annual growth rate of about 25.2% through 2030, reflecting rising demand as more individuals combine travel with healthcare services. ³ While medical tourism may not present immediate challenges today, establishing a clear foundation and philosophy now can help employers better manage risk as participation increases.

As with other benefits decisions, employers should apply the same attraction and retention principles when considering medical tourism. Rather than viewing it as a perk to promote, it should be treated as a plan governance consideration. While employers cannot prevent medical tourism, thoughtful planning can help reduce risk, manage complications, and support better outcomes for employees, dependents, and employer-sponsored plans.

¹American Association for Physician Leadership (AAPL), medical tourism estimates
²Physician Leadership Journal, “Medical Tourism — Who, What, and Where,” Renée-Marie Stephano, JD
³Forbes, 5 Tips Business Leaders Can Learn From The Rise In Medical Tourism, noting that the global medical tourism market is expected to grow at a CAGR of 25.2% through 2030.

Actuarial valuations form the financial bedrock of an organization’s planning, requiring both precision and reliability. An independent actuarial review provides a crucial, objective layer of verification and quality assurance. This process involves a second set of expert eyes examining the complex models, underlying data, and key assumptions used in the valuation. The goal is two-fold: to gain additional assurance that the results are reasonable and accurate, and to ensure the work adheres strictly to all relevant regulatory and funding standards. Specifically, an independent audit verifies Adherence & Alignment with the administrative reality of your plan and mandates compliance with Actuarial Standards of Practice (ASOPs). For organizations in jurisdictions with Mandated Compliance (including states like CA, NY, OR, and WA), this external validation is a legal requirement. Ultimately, independent verification serves as a safeguard, ensuring stakeholders can rely on the outcome for making sound, defensible financial decisions.

We are proud to announce Spring and our consultants have been recognized for multiple awards from Captive Review’s Cayman Awards 2025. We look forward to continuing to do excellent captive work in all domiciles, including but not limited to the Cayman Islands.

Spring has been awarded for: