More self-insured employers want to hit health care costs in the gut

Digestive health condition management programs help people with conditions that affect the esophagus, the stomach, the intestines and the bowels. The conditions include problems with swallowing, irritable bowel syndrome and celiac disease.

Lockton asked plan sponsors to rate four types of buy-up condition management programs. Digestive health programs were the only ones with "considering" rates higher than the current offer rates.

Musculoskeletal programs are the most popular programs today, with 32% offering them now and 14% considering them.

The kinds of cardiometabolic programs that might help people facing obesity, diabetes or heart failure had a 30% offer-now rate and a 13% considering rate.

What it means: Digestive health programs are still less common and less visible than the musculoskeletal and cardiometabolic, but they might be starting to get more attention.

The Lockton survey: The condition management offer statistics come from the full version of newly released results from a recent Lockton survey of 1,705 U.S. employer plan sponsors. Most of the sponsors had 250 or more plan participants.

Digestive health condition management programs: Interest in digestive health buy-up programs may be rising because efforts by Cylinder, a digestive health management company, to participate in a digestive health program impact study.

Related: GI health programs reduce sick days by 17% among older workers, research finds

Researchers concluded, in a paper that was published in May 2025 in a peer-reviewed medical journal, that a digital digestive care management program had reduced the participants' symptoms by an average of up to 42% and had saved $672 in direct salary costs per participant over 50.

Alternative plans: Lockton asked about employer use of two widely discussed types of unusual health plans: reference-based-pricing plans and individual coverage health reimbursement arrangement plans.

Reference-based pricing plans operate like Priceline: The plan says what it will pay, and patients look for doctors willing to take that price.

ICHRA plans provide employer cash that workers can use to buy their own individual or family coverage.

This year, about 7% of the self-insured employers that participated in the Lockton survey are using name-your-own price plans; only about 1% of all of the employers surveyed are using ICHRA plans.

Other Lockton survey findings: The broker also found that:

◆ Two-thirds of the employers had self-insured health plans, but one-third still had fully insured plans.

◆ Most self-insured get outside help with the stop-loss insurance that protects their plans against catastrophic losses: 43% use stop-loss from insurers separate from the organization that administers the health coverage, and 40% buy the insurers that administer their health coverage. Only 12% use their own captive insurer, and just 5% operate plans without stop-loss protection.

◆ How employers weigh cost and the need to attract good workers has changed. In 2022, 20% of the employers surveyed said cost was the most important consideration, and 43% said attracting talent was the most important consideration. This year, just 19% of the survey participants said attracting talent was the top priority, and 54% said controlling costs was the top priority.