Corporations are amping up their initiatives to take a bite out of rising health care benefit costs, according to the 2020 Large Employers’ Health Care Strategy and Plan Design Survey by the National Business Group on Health.

Top initiatives next year for the 147 large employers polled include implementing more virtual care solutions (51 percent) and devising more focused strategies to deal with high-cost claims (39 percent), while managing prescription drug benefit costs remains a high priority.

But even with these expanded initiatives, large employers still project the total cost of health benefits to rise 5 percent in 2020. They projected the same increase for 2019 in last year’s survey, though the actual increase is coming in lower so far this year, and NBGH expects the percentage increase at year-end will be lower than 5 percent. For 2018, large employers reported the actual increase was 3.6 percent.

For this year, the total cost of health care is estimated to be $14,642 per employee this year, which including premiums and out-of-pocket costs for employees and dependents. For 2020, the total cost is projected to rise to an average of $15,375, with large employers covering nearly 70 percent of the cost while employees will bear about 30 percent, or nearly $4,500.

What’s the top medical condition impacting large employer costs? Musculoskeletal issues is ranked highest for 44 percent of the respondents, while 85 percent rank it among the top three conditions. For a quarter of the large employers, cancer is the top condition.

Respondents are employing market-specific solutions to bend their cost curves, especially alternative payment and delivery models including accountable care organizations and high-performance networks.

“One of the challenges employers face in managing their health care costs is that health care is delivered locally and change is not scalable. It’s a market-by-market effort,” says NBGH’s president and CEO Brian Marcotte.

Nearly a third (31 percent) of the respondents plan to implement either or both ACO and HPN strategies in select markets in 2020, either directly or through their health plan. By 2022, the percentage of large employers implementing these strategies could nearly double to 60 percent.

Roughly half (49 percent) plan to pursue an advanced primary care strategy in 2020, and another 26 percent are considering one by 2022. One-third of large employers (34 percent) will deliver advanced primary care through an onsite or near-site health center, while 24 percent are looking to directly contract with advanced primary care models in select markets.

“Advanced primary care models move away from fee-for-service, encounter-based reimbursement to more comprehensive, patient-centered population health management,” Marcotte says.

The majority (64 percent) of the respondents believe that virtual care will play a significant role in how health care is delivered in the future, compared to 52 percent who said that in last year’s survey.

“Virtual care solutions bring health care to the consumer rather than the consumer to health care,” Marcotte says. “They continue to gain momentum as employers seek different ways to deliver cost effective, quality health care while improving access and the consumer experience. Of particular note is the growing interest among employers to offer virtual care for mental health as well as musculoskeletal conditions.”

Nearly all large employers will offer telehealth services for minor acute conditions such as the cold and flu, while 82 percent will offer virtual mental health services, and by 2022, virtually all (95 percent) might do that. While 23 percent will offer musculoskeletal management virtual services next year, another 38 percent are considering it by 2022.

The survey also found that 85 percent of respondents rate high-cost drugs as the number one or two most concerning pharmacy issues.

“Employers are very concerned about how to finance the high cost of new million-dollar drug therapies,” Marcotte says. “Some of these therapies will cost more than what an employee will earn in a lifetime.”

Next year 20 percent of the respondents will implementing a point-of-sale rebate program, with the percentage potentially tripling to 60 percent by 2022. Two-thirds of the respondents (67 percent) favor a model based on net price of medications with no rebate as an alternative.

Other key survey findings include:

The percentage of large employers offering full replacement consumer-directed health plans will shrink to 25 percent in 2020, down from 30 percent this year and 39 percent in 2018. Instead, large employers will offer more plan choices like a preferred provider organization plan.
While 72 percent of the respondents believe Medicare for All would reduce the number of uninsured, 81 percent believe the proposal would increase taxes. Moreover, 57 percent say it would lead to higher U.S. health costs – and 47 percent say it would also lead to higher employee costs. Large employers are mostly divided on whether to expand Medicare below age 65.

Instant Insights /

Employers expect to spend $15,375 per employee on health care in 2020

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