Obesity, Women’s Health, Health Equity Among Top Benefit Focuses for Employers in 2024

Employers are ready to put a greater benefit focus on obesity, women’s health, and health equity efforts in the new year and beyond, according to a recent survey from the National Alliance of Healthcare Purchaser Coalitions.¹

The Pulse of the Purchaser survey was filled out by 172 private and public employers and purchasers between November and December 2023.² The study gauged concerns and views of employers regarding workforce environment, health strategies, fiduciary perspectives, hospital price strategies, pharmaceutical drug strategies, high-cost claims strategies, and potential health reforms.

Among the recipients, 26% had less than 1000 employees, 36% had between 1000 and 5000 employees, and 38% had over 5000 employees. The recipients also represented several industries, including government (18%), educational services (18%), manufacturing (14%), health care and social assistance (11%), retail/wholesale trade (8%), and finance and insurance (7%).

Employers reported that the most common obesity benefits that their employees receive included lifestyle programs (79%), bariatric surgery (69%), and obesity medications with conditions (54%). Over the next 1 to 3 years, employers are considering several additional strategies for obesity management, including a phased approach to medication-assisted support (45%), obesity care through the collaborative care model (37%), and coverage of obesity medications (35%).

Other key strategies for obesity management that employers are considering include offering specific programming to address those diagnosed with obesity (34%), using centers of excellence to address those with higher levels of obesity (33%), and reducing bias and stigma through communications and messaging in programs (31%).

Concerning women’s health, the most common benefits included mental health support (90%), parental leave (76%), and maternity support services (69%). The highest upcoming considerations over the next few years included menopause support (43%), caregiving assistance (33%), and reproductive health (22%).

Employer health equity strategies are gaining momentum, and key growth areas from 2022 to 2023 include improving accountability in service provider contracts, up by 38%, evaluating program participation by relevant subpopulations, up by 15%, and analyzing access to and quality of services, up by 13%.

Over 70% of employers provide mental health support resources, mitigate stigma, and discuss affordable access and quality issues with vendors. The highest areas being considered in the next few years include promoting cultural competency (37%), establishing vendor accountability (29%), and integrating behavioral health into primary care (27%).

Additionally, the survey revealed that less than half of employers are confident in the integrity of services and fees charged by hospitals (8% to 10%), pharmacy benefit managers (22% to 26%), third-party administrators (39%), and brokers and consultants (43% to 49%).

Eighty-eight percent of plan sponsors believed that hospital prices were indefensible. Common mitigation strategies implemented included the establishment of centers of excellence (41%) and the adoption of site of care strategies (37%). In considering future strategies, employers contemplated advanced primary care (57%) and the integration of tiered networks (56%) within the past few years.

In the realm of PBM relationships, employers took assertive steps to ensure greater financial control. This involved initiatives such as prioritizing data ownership (63%), eliminating conflicts with advisors (57%), and securing full audit rights (55%). Past considerations in this domain included a focus on full disclosure of all revenue streams (63%), transparency regarding net cost by drug (59%), and the establishment of a comprehensive definition of rebates (49%) within the preceding 1 to 3 years.

Within the pharmaceutical landscape, a majority of employers, at 69%, believed that their formulary effectively promoted biosimilars. Additionally, 50% asserted that their formulary successfully eliminated low-value drugs. In looking ahead, key areas of focus within the past few years included the implementation of a value-based formulary (49%) and the introduction of customized formularies (43%) to further enhance the efficacy of health care strategies.

“Employers are frustrated that the healthcare system is designed to enrich the middlemen and is not delivering improvements in affordability, access or quality for purchasers or employees and their families,” said Michael Thompson, National Alliance president and CEO. “Increasingly the fox is guarding the henhouse, and both are exploiting a dysfunctional system at the expense of making it better. Employers are starting to take actions, both on the market and policy fronts, to realign the system to reduce conflicts and improve value.”

References

1. Lack of confidence in service providers, healthcare affordability among top employer concerns per National Alliance survey. News release. National Alliance of Healthcare Purchaser Coalitions; December 13, 2023. Accessed December 19, 2023. https://www.nationalalliancehealth.org/news/lack-of-confidence-in-service-providers-healthcare-affordability-among-top-employer-concerns-per-national-alliance-survey/

2. Pulse of the Purchaser 2023 Survey. National Alliance of Healthcare Purchaser Coalitions. Fall 2023. Accessed December 19, 2023. https://www.ebgadvisors.com/content/uploads/2017/01/EBG-Advisors-Population-Health-Management-White-Paper-May-2014.pdf