2018 Trends to Watch

As the new year begins I’d like to take a moment to reflect on some of the employer trends we are tracking in 2018.[1] 

  • We are seeing a gradual shift by employers to focus more on the supply-side of health care delivery through alternative payment and delivery models. More than 20% of employers are experimenting with high value networks and ACOs in select markets. That number is expected to grow to over 50% in the next few years. 
  • Bundled payments are replacing fee-for-service in COE contracts. Bundles and other alternative payment models account for 21% of COE arrangements for Cancer COEs and as high as 40% to 50% of reimbursements for Orthopedic and Transplant COEs.
  • Telehealth is universally offered by employers and gaining traction with employees as an alternative pathway to access. Nearly 20% of employers are experiencing utilization rates of 8% or higher. Fifty-six percent of employers will offer tele-behavioral health services in 2018; more than doubling the number this year.
  • There is a greater focus on employee experience with the health care system. More companies will offer medical decision support, employee advocacy and high-touch concierge services in 2018 to help employees navigate the health care system, understand their treatment options and where to go for care.
  • The percentage of employers focusing on site-of-care management for specialty drugs rose nearly 50% between 2017 and 2018.
  • Point-solution fatigue is settling in as employers are struggling with bandwidth to contract with the number of solutions in the market available to address virtual engagement for condition and lifestyle management. Health Plans and enterprise engagement platforms are picking up the slack playing the role as  point-solution aggregators.
  • Wellness programs that focus solely on improving employee physical health are becoming a thing of the past. Workplace initiatives that address multiple areas of employees’ lives are the new norm.
  • Workforce strategy is becoming the new health care strategy  as a growing number of employers are looking at the relationship of health and well-being to business performance and a key aspect of an overall workforce strategy.
  • The impact of the opioid epidemic on workforce productivity and health benefits is a concern among 80% of employers who participated in the NBGH Health Care Strategy and Plan Design Survey. Employers are taking steps to assure sufficient coverage of treatment, counseling, and other support services; working with health plan partners and providers to reduce inappropriate use and misuse; and putting restrictions in place for prescription opioids.

An article in Plan Sponsor goes into more detail on these trends.

NBGH will be convening large employers for two events early in the year. At our annual Employers’ Summit on Health Care Costs & Solutions in Washington, DC January 24th and 25th employers gathered to discuss these topics and others. Our Employers’ Forum on Pharmacy Management in San Francisco, CA takes place February 21st and 22nd and will focus on the current state of the pharmacy supply change and innovative approaches to change. I hope you can join us at one of these events.

Thank you for your membership,



President & CEO
National Business Group on Health

 [1] 2018 Large Employers' Health Care Strategy and Plan Design Survey

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