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Health-Care Costs a Moving Target, Large Employers Quickly Adopting Virtual Services

Large employers plan to expand virtual care offered to employees next year as well as double down on mental health and emotional well-being as they continue to address the COVID-19 pandemic.


This is according to an annual survey by Business Group on Health. Employers project health benefits costs will rise by more than 5% in 2021, although the pandemic’s impact is fueling uncertainty about overall costs.

According to the “2021 Large Employers' Health Care Strategy and Plan Design Survey,” the total cost of health benefits is expected to rise 5.3% in 2021, taking cost management initiatives into account. The increase is slightly higher than the 5% increases employers projected in each of the last five years. Including premiums and out-of-pocket costs for employees and dependents, the total cost of health care is estimated to be $14,769 per employee this year, an increase of $197 from last year. The total cost is projected to rise to an average of just over $15,500 in 2021. In line with recent years, employers will cover nearly 70% of costs while employees will bear about 30%, or nearly $4,500.

“Health care costs are a moving target and one that employers continue to keep a close eye on,” said Ellen Kelsay, president and CEO of Business Group on Health. “The pandemic has triggered delays in both preventive and elective care, which could mean the projected trend for this year may turn out to be too high. If care returns to normal levels in 2021, the projected trend for next year may prove to be too low. It’s difficult to know where cost increases will land.”

The exponential growth in virtual care is one of the major trends identified in the survey, some of which is being fueled by the pandemic. Eight in ten respondents (80%) believe virtual health will play a significant role in how care is delivered in the future, a sharp increase from 64% last year and 52% in 2018. Additionally, over half (52%) will offer more virtual care options next year.

Nearly all employers will offer telehealth services for minor, acute services while 91% will offer telemental health, and that could grow to 96% by 2023. Virtual care for musculoskeletal management shows the greatest potential for growth. While 29% will offer musculoskeletal management virtually next year, another 39% are considering adding it by 2023. Employers are also expanding other virtual services including the delivery of health coaching and emotional well-being support. These offerings are expected to increase in the next few years.

“Virtual care is here to stay,” Kelsay said. “While employers have been implementing more virtual solutions in recent years, the pandemic caused the pace to accelerate at an astronomical rate. And virtual care is now garnering growing interest and receptivity from both employees and providers who increasingly see its benefit.”

Another key trend for employer plans in 2021 is the expansion of access to virtual mental health and emotional well-being services to address provider shortages, minimize wait times and reduce the stigma associated with seeking care. More than two-thirds of respondents (69%) provide access to online mental health support resources such as apps, videos and articles, and that number will jump to 88% in 2021. Employers are also taking other steps to bolster mental health services besides expanding virtual options. Roughly half (47%) provide manager training to help recognize mental and behavioral health issues and direct employees to services. Another 18% plan to do so in 2021. Half of respondents (50%) will conduct anti-stigma campaigns in 2021.

Employers are also helping to address cost barriers by reducing out-of-pocket costs for mental health services. More than half (54%) are lowering or waiving costs for virtual mental health services in 2021.  More than a quarter (27%) will reduce the cost of counseling services at the worksite, bolstering the trend to bring services directly to employees.

Among other survey findings:

  • More employers are linking health care with workforce strategy:  The number of employers who view their health care strategy as an integral part of their workforce strategy increased from 36% in 2019 to 45% this year.
  • On-site clinics continue to grow: Nearly three in four respondents (72%) either have a clinic in place or will by 2023. Some employers are expanding services – 34% offer primary care services at the worksite, and an additional 26% plan to have this service available by 2023.
  • Growing interest in advanced primary care strategies:  Over half of respondents (51%) will have at least one advanced primary care strategy next year, up from 46% in 2020. These primary care arrangements, which move toward patient-centered population health management emphasizing prevention, chronic disease management, mental health and whole-person care are key focus areas for employers.
  • Employers remain concerned about high-cost drug therapies. Two-thirds of respondents (67%) cited the impact of new million-dollar treatments as their top pharmacy benefits management concern.


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