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Survey Report

2021 Emerging Trends in Health Care Survey

Highlights of key findings, United States

May 27, 2021

Explore the latest findings around COVID-19 testing and vaccinations, social determinants of health, pharmacy plan benefits and voluntary benefits.
Health and Benefits|Employee Experience|Ukupne nagrade |Benessere integrato

About the respondents

Research findings are based on responses from 446 organizations employing 6.3 million employees. Of those total respondents, 238 that employ 3.7 million workers responded to the voluntary benefits section. The survey fielded between February 23 through March 12, 2021.

Respondent profile

Manufacturing – 23%, Financial services 14%, General services – 14%, Health care – 15% , IT and Telecom – 12%, Wholesale and retail – 11%, Energy and utilities – 6%, Public sector and education - 5
Respondents by industry


Under the spotlight: Health care benefits that fuel a healthier workforce and bottom line

The health care industry, our economy and your employees are facing extraordinary times. The diverse, complex needs of a multigenerational workforce, one shaken by the pandemic, is compelling employers to seek and deliver more personalized value through innovative, impactful health care benefits, while holding overall plan costs in check.

To help organizations assess recent issues tied to health and wellbeing programs and to keep pace with rapidly evolving practices, we conducted the 2021 Emerging Trends in Health Care Survey.

This year’s questionnaire examined hot topics including policies and communications around COVID-19 testing and vaccinations, analyzing social determinants of health and aligning programs with inclusion and diversity objectives, key considerations and trends for pharmacy plan benefits and voluntary benefits.

Highlights and trends

COVID-19 vaccination

A majority of U.S. employers believe that immunization of the workforce is essential to moving beyond current pandemic restrictions to a new normal in terms of returning to the workplace (80%) and reactivating the economy (84%). As vaccine availability ramps up, employers are taking actions to encourage and facilitate the vaccination of their employees.

  • 30% of employers expect the U.S. working population to be vaccinated by end of 2021 – but the number jumps to 55% when it comes to their own workforce.
  • Six in ten (60%) have communicated to employees the value of the COVID-19 vaccines and another 35% are planning or considering such communication.
  • More than a third (35%) have already developed policies and procedures to make it easy for workers to get the vaccines; another 50% are planning or considering doing so.
  • Roughly a quarter (23%) are helping employees get vaccinated. Some are facilitating access to vaccines through a third party while others have obtained vaccines to administer to their employees. Additionally, 55% of employers expect to take an active role in the near future.
  • 15% reported that they are offering paid time off to get vaccinated; another 18% are planning or considering such action.
  • 27% reported that they provided or are planning/considering providing additional leave for those who had adverse reactions to the vaccine.
  • Just 4% are offering financial incentives (mostly under $200); 8% are considering doing so.

Social determinants of health

Employers are beginning to look at their health and wellbeing strategies through the lens of social determinants of health (SDoH), the non-medical factors that influence health outcomes. This entails examining benefits programs, design features, network composition and access in order to align with diversity, equity and inclusion (DEI) strategies. The ability to capture and analyze key information by cohort will lead to more meaningful insights, driving both programmatic changes and employee/member engagement strategies.

  • A majority of employers indicate that SDoH are of growing importance to their health and wellbeing strategy to a moderate or very great extent – from 67% today to 83% in three years.
  • Roughly 1 in 3 employers is looking at components of access, affordability and quality of care by considering the social factors influencing health outcomes.
  • Some employers expect to increase their focus on health disparities: 1 in 10 currently review pharmacy and medical clinical programs that address health disparities; 1 in 3 plan to do so over the next 2 years.
  • Many employers are also starting to take action across these issues:
    • Benefits review: 11% currently identify design and programmatic gaps as they relate to DEI and SDoH in 2021; 47% are planning/considering doing so for 2022/23.
    • Needs assessment: Over 10% collect employee insights to support their unique needs and assess the wellbeing strategy and related programs to support various cohort needs; 50%+ are planning/considering doing so for 2022/23.
    • Program changes: 17% support LGBT+ individuals, gaps in care and broad physical and emotional wellbeing and review and update communications and education for cultural competency; 40%+ are planning/considering doing so for 2022/23.
    • Measurement: 6% compare diversity and SDoH characteristics by worksite location to community benchmarks; 33% are planning/considering doing so for 2022/23.

Pharmacy benefits management
  • Most employers (63%) carve out pharmacy benefits from their medical plan.
  • Nearly 2 in 5 employers (37%) integrate their pharmacy benefits with their medical carrier today and most of those (31%) expect to do so in three years.
  • Some are considering alternative solutions to deliver cost-savings:
    • 1 in 6 would consider allowing access to pharmaceuticals sold outside of the U.S. and imported, if available.
    • 1 in 4 would pool employee lives with other employers to participate in pilot programs that leverage scale to drive change in the industry.
  • 28% cover gene therapy. Of those:
    • 44% only under medical benefit
    • 13% only under pharmacy benefit
    • 43% under both medical and pharmacy benefit
  • 9% of employers are considering coverage for gene therapy.
  • 47% have stop loss coverage to protect against high-cost gene therapy claims (i.e., Luxturna, Zolgensma).
  • Many employers purchase programs for specific conditions from their PBM:
    • 30% use point solutions offered by their PBM; 17% are planning or considering them.
    • 37% offering point solutions via PBM report modest to very strong results; 23% are not sure of impact and 29% have not seen reporting on impact.

Voluntary benefits

Voluntary benefits (employee-paid benefits) enable employers to augment their standard benefit plans and personalize rewards to fit employees’ needs and lifestyles.

  • 85% of employers recognize the importance of voluntary benefits to their Total Rewards strategy and employee value proposition; this rises to 94% in three years.
  • It is getting easier to offer voluntary benefits. The number of employers citing administrative effort as a barrier decreased from 78% in 2018 to 57% today.
  • 43% of employers say that enhancing Total Rewards is a key reason for offering voluntary benefits to non-benefits eligible employees.
  • Other key reasons that employers agree to for offering voluntary benefits include to:
    • Enrich existing core benefit plans by offering more personalized benefits: 81%
    • Support overall wellbeing: 77%
    • Attract new employees: 74%
    • Support employee financial wellbeing: 74%

Employers look to expand their group offerings

Growth and adoption continues as employers look to expand their offerings in health and areas related to financial wellbeing.
Group offerings 2018 or prior Currently in place,
considering for 2022
Identity theft insurance 36% 78%
Critical illness insurance 43% 76%
Legal 48% 75%
Pet insurance 42% 69%
Accident insurance 37% 65%
Hospital indemnity 24% 65%
Long-term care insurance   42%
Title File Type File Size
2021 Emerging Trends in Health Care Survey PDF .5 MB
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