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Survey Report

2020 Health Care Delivery Survey

Highlights of key findings, United States

October 16, 2020

Are organizations shifting to lower-cost, higher-value health care models? We examined options to drive cost savings and achieve improved results.
Benefits Administration and Outsourcing Solutions|Health and Benefits|Wellbeing
COVID 19 Coronavirus

About the survey respondents

These research findings are based on responses from 397 organizations in the U.S. representing 7.1 million employees. The survey fielded August 11 through September 9, 2020.

Respondent profile

  • 47% for profit, publicly traded
  • 34% for profit, private
  • 16% government/nonprofit
Breakdown of participants by industry: 15% manufacturing, 5% public sector and education, 15% health care, 10% IT and telecom, 13% financial services, 8% energy and utilities, 12% wholesale and retail
Respondents by industry


Employers embrace value-based health care delivery models to improve access and affordability

Our 2020 Health Care Delivery Survey explored emerging opportunities and strategies around the continuing shift to value-based health care delivery models and how employers are adapting benefits and programs in the current environment.

Our findings reveal that nearly three-quarters of employers (73%) intend to adopt and expand different types of health care delivery models, such as centers of excellence (COEs) and high-performance narrow networks, over the next three years. Employers’ key concerns include access to comprehensive, high-quality mental health services (84%) and substance abuse treatment (77%) as well as the affordability of specialty drugs (85%), mental health services (78%) and specialty care medical services (77%).

Despite their concerns, employers indicate perceived barriers to adopting emerging health delivery solutions, including the impact of change (e.g., in health plans and networks) on employees (61%) and the time and resources required to implement a strategy involving new vendors/focused solutions (43%).

However, with a better understanding of their options and potential strategies, employers have the opportunity to rethink how and where health care is delivered — including through telemedicine and virtual care services — with the goals of improved health outcomes and lower cost.

Highlights and trends

Centers of excellence

In an effort to provide access to high-quality health care, employers are embracing COEs.

  • Over half (53%) offer members access to COEs within their group health plans. The use of COEs is optional in 70% of these organizations and mandatory in another 21%.
  • More than four in five (82%) believe that COEs will effectively reduce annual health care costs per employee, while 92% say that COEs will effectively improve the quality of care provided to employees.

High-performance networks/narrow networks

Employers are also offering high-performance networks (HPNs), which provide access to a narrow network of higher-value and lower-cost providers. Most employers (90%) that offer or plan to offer an HPN solution do so through their health care carrier. Where offered, approximately three-fifths of employees (59%) have or will have access to HPNs.

  • Regional versus national solution. Seventy-two percent of employers offer or plan to offer a regional/local HPN solution instead of a national solution.
  • Locations. Nearly one-fifth (18%) offer a high-performance/narrow network solution in one or more locations, and 40% of employees with access are enrolled.
  • Cost savings and quality considerations. Cost savings are the key consideration in adopting a more restrictive, narrow network. To consider adopting a narrow network with less than 25% of providers, half of respondents indicated that costs would need to decline to a great extent, and a third indicated that quality would need to improve to a great extent.

Network and provider strategies

Employers are utilizing various network and provider strategies to better manage cost:

  • 22% reduce out-of-pocket costs for use of high-value services supported by evidence, while another 33% are planning or considering taking this action.
  • 10% increase out-of-pocket costs for use of specific services that are commonly overused, and 29% are planning or considering doing so.

Condition-based strategies

Employers offer third-party digital, virtual or coaching solutions for the following condition areas as a means of improving member health and reducing costs:

  • Mental/behavioral health: 51%
  • Metabolic syndrome/diabetes: 37%
  • Maternity: 29%
  • Musculoskeletal: 19%
  • Cardiovascular: 19%

Many employers say third-party interventions reduced costs and improved quality in the following areas:

  • Mental/behavioral health: 32%
  • Metabolic syndrome/diabetes: 51%
  • Maternity: 47%
  • Musculoskeletal: 45%
  • Cardiovascular: 45%

Provider steerage

A quarter of employers use data on provider quality and costs to steer members toward higher-value providers; this figure may rise to 59% by 2023. To establish a high-value network, employers partner with:

  • Their health insurance carrier: 67%
  • A third-party vendor: 26%

Opportunities to watch

Telehealth and virtual care services

Employers are looking at benefit delivery mechanisms that make greater use of technology to improve access and affordability.

  • Telemedicine. Most (84%) offer telemedicine through their health insurance carrier; 21% partner with a third-party vendor, and only 3% don’t offer telemedicine.
  • Tele-behavioral health services. Employers are increasing their focus on mental health by offering coverage of tele-behavioral health services. Approximately two-thirds (66%) provide such services through their health insurance carrier; 14% partner with a third-party telemedicine vendor, and 10% partner with a third-party behavioral health vendor.
  • Virtual care services. A large majority of employers offer telephonic (76%) and video-based virtual care visits (72%); 77% think virtual visits will decrease the cost of health care.
  • Telemedicine/virtual medicine during the pandemic. Most employers (90%) report that their focus on telemedicine/virtual medicine increased during the pandemic.
    • Many (81%) said their employees had no difficulty accessing virtual care this year.
    • Over half (52%) think telemedicine/virtual medicine will be an important priority within their organization’s health care activities in the period following the pandemic.

Moving to high-performance/narrow networks

Employers are looking to better manage overall costs and improve quality by offering alternative networks.

  • Percentage of providers. Almost two-fifths of employers (38%) have adopted or are planning to adopt an HPN with between 25% and 49% of providers included. Roughly a third (33%) have adopted or are planning to adopt an HPN with 75% or more providers included.


Some employers are using care navigation services where a third party (other than a medical carrier) performs customer service functions and uses the resulting information to better manage care.

  • One-sixth of employers (17%) offer navigation services, while 26% are planning or considering doing so.
  • Of those currently offering or planning to offer navigation services, 62% indicate that their vendor partner performs some customer service functions, while 34% say that their vendor partner performs all customer service functions.
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