Healthcare spend is on an unsustainable trajectory. Medical loss ratios (MLRs) for health plans are up — ranging from 88% to 95% for national health plans at the end of 2024.¹ The top medical cost drivers for health plans in 2025, as identified by Advisory Board, are drug spend, higher utilization, increases in the prevalence of chronic conditions, and new medical technologies and treatments.

As health plans strive to optimize medical spending while simultaneously enhancing the care quality, clinical leaders consistently seek robust benchmarks. Below are clinical benchmarks for both commercial and Medicare Advantage populations, derived from Optum Advisory’s Clinical Benchmarking Toolkit.