Health care 2023: What does the new year hold?

Health benefits have long been one of the most appreciated perks of employment – and with good reason. Nothing is more important than one’s health and that of one’s family. But health care is expensive and confusing, often leaving employees frustrated and overwhelmed. Ensuring an employee and their family have access to quality, affordable health care, along with personalized guidance, is a critical component of attracting and retaining talent. Yet soaring health care costs, a once-in-a-century pandemic, and a growing recognition that employees need support with all aspects of wellbeing have brought employers, providers, and brokers to a tipping point.

The past two years have been fraught with challenges, mostly directly or indirectly related to the COVID-19 pandemic. In addition to the basics of needing to ensure the safety of employees – through transitions to remote work, when possible, and stringent COVID protocols for in-person workers – employers gained invaluable, often disheartening insights into the lives of their people. From the recognition of substantial disparities in health equity to the need for more mental health support, employers observed significant challenges that ultimately resulted in a new clarity and a reassessment of their benefits strategy.

Looking ahead, 2023 will be a major pressure test for many employers, but it will also be a year of transformation in health care and the employee benefits space. From addressing rising medical costs and improving health equity to expanding behavioral health solutions, employers are finding they need to be more purposeful in their benefits design.

Fortunately, there are ample opportunities to adopt new strategies for streamlining health and wellbeing solutions, creating personalized journeys, and connecting those journeys through data to increase utilization, drive value and bend the cost curve.

Delivering value

As employers and employees grapple with the highest inflation in a generation and rumblings of a potential recession, skyrocketing health care costs are an even greater concern than they may be in a healthier economy. Employer health care costs are expected to increase 6.5% to more than $13,800 per employee in 2023. It’s no wonder more than two-thirds of employers say that controlling rising health care benefits costs is one of their top priorities over the next three years.

With many employees finally getting back on-track with routine exams and treatments after two years of deferring doctor office visits due to COVID, the last thing employers want is for their people to delay or think twice about seeking care due to unmanageable costs. That will only exacerbate existing problems or impede the discovery and treatment of new problems, resulting in poor outcomes for the employee and higher costs for the employer.

Historically, employers have adopted multiple point solutions to address these issues, but in the coming year, the employee benefits space will undergo a major transformation.

Employers will be laser-focused on driving employees toward care that not only delivers the desired outcome but creates value as well. This will be accomplished through the adoption of health care navigation services, tech-enabled personalization and high-touch (human) guidance that empowers employees to make smart decisions for themselves and their loved ones.

Adopting new strategies

Employers also may wish to consider thinking about population health strategies to inform benefit design. For example, the Centers for Medicare and Medicaid services (CMS) have demonstrated that strategies like Accountable Care Organizations (ACOs) which address population health have shown better outcomes, reduced ER visits and unnecessary care and have encouraged better longitudinal care. In adopting this population health approach, employers provide medical decision support and guidance to cost-effective, high-quality care options. Additionally, employee incentives that reward seeking high-value care can help align plan participants.

A good primary care relationship is also key. If employees can get in early, their primary care provider can manage their health in a way that has the potential to avoid any downstream high-cost situations. If a patient is diabetic and has kidney disease, for example, their primary care doctor can stay on top of their situation so they don’t progress to worsening kidney disease and dialysis. Likewise, ensuring compliance with medications – and perhaps even generic medicines for free – can prove highly beneficial in terms of bending the cost curve because their disease may not progress to the point where they need advanced, specialized care.

Ensuring equity

Accessing health care and achieving one’s highest level of health is easier for some people than others and this has a direct impact on outcomes. In 2022, large employers were concerned about ways to improve health equity by way of their company’s health and wellbeing initiatives. In fact, 3 in 4 employers felt this way.

Employers are also continuing to evaluate programs and benefits to address the circumstances that employees and their families are born into and live, which have an impact on their ability to live healthy and fulfilling lives.

In rural areas, for example, there is an 8% higher mortality rate from cancer. Meanwhile, the overturning of Roe v. Wade is having a significant impact on women’s access to abortion and reproductive health. With most abortions now banned in 13 states, some employers are looking at ways to help employees and their dependents access reproductive care. A majority are considering expanded fertility benefits as well, like services to cover all types of families.

Transgender employees are also facing a similar situation either because they live in a state like Florida where transgender care is being restricted, especially for minors, or because they are concerned about being stigmatized if they seek care in a traditional setting.

In 2023, a growing number of employers are likely to cover travel and lodging benefits for those that must travel for abortion or transgender-related services. However, there are legal considerations related to obtaining medical services that are banned in one’s home state. Employers will need to watch closely as state and local legislation evolves.

The pandemic exposed these and other inequities in health care. This helped usher in solutions, like telehealth, that improved access for people across the spectrum – from those in rural and minority areas where providers are few and far between to those who face cultural or discriminatory barriers. Increasingly, employers will look to implement health care delivery alternatives such virtual solutions for primary care, mental health and urgent care as they seek to improve health equity for their workforce.

Addressing food’s impact on health

Expanding beyond the demographics of women, LGBTQ+ and rural populations, you also have a large portion of workers, particularly those in the hospitality and service industries, who are making just enough to get by. They may be experiencing housing insecurity or food insecurity. With the growing momentum around “food as medicine,” this is especially relevant because they may live in a so-called “food desert” where their primary options are processed foods. This is not an easy problem to solve, but employers can begin by opening a dialogue with their carriers for this kind of data and taking steps to improve education and availability when it comes to maintaining a healthy, balanced diet.

Prioritizing mental health

By the end of 2023, nearly 95% of employers are expected to offer virtual care solutions for medical and behavioral health issues, as the recognition of the importance of mental health continues to grow. No longer is it sufficient to simply care for the physical being. A holistic approach to caring for the whole person, including their mental and emotional health, has become table stakes.

The mental health crisis has existed for decades. In the aftermath of the pandemic, however, we’re seeing unprecedented levels of anxiety and depression. According to the 2022 Alight International Workforce and Wellbeing Mindset Study, nearly three-quarters (73%) of workers are experiencing high or moderate levels of stress, while 34% are suffering symptoms of burnout. While all employees are feeling it, stress seems to be a particular problem for employees who are women, parents or caregivers, employees of color, young and working remotely or in hybrid arrangements.

Behavioral health visits are up 17% from pre-COVID levels, but ongoing provider shortages are leaving many without care. In fact, 30% of large employers say their networks don’t have enough providers to ensure their employees have timely access to care, according to a recent Kaiser Family Foundation report.

Erasing the stigma

Telehealth has been a massive help in getting employees and dependents the mental health assistance they need. However, it’s incumbent upon employers to erase the stigma around mental health by creating a culture where people feel comfortable discussing their mental health challenges without fear of scorn or retribution. Make it okay to open up about struggles and teach managers and employees to recognize signs of distress, respond compassionately and encourage their colleagues to take advantage of mental health resources.

In 2023, employers will look to solutions that identify members at risk for behavioral health issues early on in their health care journeys, whether they present with symptoms or not. Solutions that provide access to teams of multidisciplinary behavioral health clinicians to offer guidance, education, and a safe place to be vulnerable will help break down barriers, reduce stigma around experiencing mental health challenges and help people get the right care.

Related: Health care 2023: The next big step needs to be health improvement

As we look to the coming year, we have a tremendous opportunity to do better for our employees. New solutions and models will be tested, but through meaningful partnerships and innovative strategies and solutions, employers will deliver long-term value and improve health care for all stakeholders.

Bipin Mistry, MD, Chief Medical Officer, Alight Solutions