Employers are facing a changing landscape when it comes to healthcare, whether it’s in regards to mental health concerns for their employees, cancer driving up health costs or the increase in prescription drug prices.

To understand employers’ key concerns and their strategies to address these concerns, the Business Group on Health surveyed 152 large, self-insured employers who cover more than 19 million people in the U.S. About 80% of the respondents have more than 10,000 employees. The survey, released Tuesday, revealed these eight insights: 

1. Mental health concerns continue to rise: About 77% of employers said there has been an increase in the prevalence of mental health challenges among employees this year, up from 44% of employers who said the same thing last year. These challenges include depression, anxiety and substance use disorders.

As a result, employers’ top mental health focus area is access to care. To improve access, 70% of employers said they will offer no or low-cost virtual counseling in 2024, 37% said they will offer coverage of out-of-network treatment for mental health and substance use disorder services and 30% said they will provide no or low-cost on-site mental health counselors.

“Mental health access is by far the top focus area for employers,” said Brenna Shebel, vice president of Business Group on Health, during a call to discuss survey findings. “They’re really looking to ensure that employees who need mental health support are getting the support they need through different networks [and] availability of programs.”

2. Cancer continues to be the highest driver of healthcare costs: Half of employers said cancer is the number one driver of healthcare costs, and 86% said it is among the top three highest drivers of healthcare costs overall. Last year’s survey revealed that cancer surpassed musculoskeletal conditions as the top driver of healthcare costs for employers for the first time.

Now, about 53% of employers plan to offer access to centers of excellence for cancer in 2024, and 76% plan the same for 2025 or 2026. In addition, 77% of large employers will have at least one cancer screening method in place for 2024, like colon cancer screenings, breast cancer screenings or skin cancer screenings.

3. Employers are battling prescription drug costs: About 91% of employers said they are concerned about pharmacy drug costs. Respondents reported that pharmacy costs represented 24% of their overall health spend in 2022, up from 21% in 2021.

4. Virtual health isn’t quite in the limelight anymore: When asked if virtual health will have a significant impact on healthcare delivery in the future, 64% of employers said “yes” in this year’s survey. This is down from the 74% who said “yes” last year, 85% in 2021 and 80% in 2020 (though still higher than 52% who said so before the pandemic in 2019). Employers’ biggest concern around virtual health is the “siloed care experience” for employees because of the disjointed care between virtual and community-based providers.

The decrease in interest for virtual health is “not incredibly surprising,” Shebel said. “When we were in the heat of the pandemic [with a] lack of in-person care, virtual health was really seen as the go-to for many employees. There was a lot of optimism and hope for virtual health. But at the same point, 64% of our members feeling strongly about something is still a very strong number. We’re just interpreting it as the potential outcome of having more years of experience with virtual health and almost a tempering of expectations.”

5. Health equity continues to be a priority: 95% of employers will implement at least one strategy to improve health equity by 2024. Top strategies include working with employee resource groups, requiring health plan and navigation partners to maintain provider directories and expanding provider networks to include more diverse providers.

6. Total healthcare costs are increasing: Employers estimated that total healthcare costs on a per capita basis will be $17,201 in 2023, a $1,339 increase from 2022 at $15,862.

7. Employers want price transparency: When it comes to transparency, employers’ top priorities are supporting employees so they can “make informed healthcare decisions” (87% of respondents said this), requiring PBMs to disclose compensation and pricing (73%) and requiring more reporting on provider quality (58%).

8. Employers have several initiatives they’re planning to implement in 2024: Next year, many employers plan to expand access to mental health services (36%), add more virtual health options (35%), have a more focused strategy on high-cost claims (22%), reduce health inequities in health plans (18%) and consolidate their number of vendor solutions (16%).

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