Rising Health Care Costs, Surging Prescription Drug Pricing, Acute Focus on Chronic Conditions Among 9 Trends to Watch in 2024, Says Business Group on Health

Heightened vendor accountability, expanded access to mental health and substance use disorder services also cited

WASHINGTON, DC, Nov 28, 2023 — Rising health care costs, a sharper focus on prescription drug programs, and expanded access to mental health and substance use disorder services are among the nine health and well-being Trends to Watch in 2024, Business Group on Health announced today. 

Other top trends include increased concerns about cancer and other chronic conditions, heightened employer expectations of vendor partners, and greater consistency for global employers’ benefit offerings, according to the Business Group, the largest non-profit organization representing employers on critical health, well-being and workforce strategy issues.

“We live in a complex and interconnected world, and diverse factors impact employers as they seek to evolve benefit offerings for their workforces,” said Ellen Kelsay, president and CEO of Business Group on Health. “It will be increasingly important for their vendor partners to deliver in light of heightened expectations and accountability. Staying ahead of these trends will be paramount.”

The full list of the Trends to Watch in 2024:

1 | Health care costs are climbing, bringing heightened vigilance by employers.

Soaring U.S. health care costs show little sign of abating in 2024, and concerns about the affordability of medications and medical services continue to grow, despite investments in technology, clinical innovation and efforts to manage utilization and waste.

Employers, who now face a forecasted higher-than-historical cost trend, also have a greater sense of urgency concerning pricing, fueled by factors that include general inflation, labor pressures on health care systems, growing concern over provider shortages, burgeoning mental health needs, missed and deferred preventive screenings leading to more late-stage cancer diagnoses, and worsening of chronic conditions.

Expensive cell and gene therapies, along with a projected high demand for and widespread use of GLP-1s for managing diabetes and obesity, represent current and future cost drivers for self-funded employers, who seek to promote value in health care and quality of services for their members.

2 | Access to mental health and substance use disorder services remains a priority, with a growing focus on emerging areas of concern.

Rates of depression are at an all-time high, according to a 2023 Gallup Poll, and employers seek to expand offerings within their plans and programs to keep up with patient support and care.

Mental health access remains an area of focus for 2024, say 70% of employers, according to Business Group on Health’s 2024 Large Employer Health Care Strategy Survey. Employers will turn to virtual mental health providers, among other measures, to meet that need.

Employers also are becoming more concerned with several subcategories of emerging need, including youth and adolescent mental health, substance use disorder treatment and suicide prevention. As such, vendors will be expected to collaborate in creating integrated approaches that address mental health quality, access and range of services.

3 | Employers double down on cancer and other serious or chronic conditions.

Cancer remains the No. 1 cost driver for employers. Moreover, nearly half of employers expect a higher prevalence of late-stage cancers due to delayed screenings, exacerbating an already challenging scenario. In response, employers are prioritizing prevention by introducing enhanced screening options while stepping up efforts in cancer patient navigation.

Further, employers expect to see higher needs for chronic condition management; for diabetes, cardiac health and musculoskeletal conditions, a higher number of cases may be coupled with greater severity. Physician shortages and burnout further complicate matters.

In 2024, employers will emphasize a “back to basics” approach to physical health, with a renewed emphasis on prevention and primary care, to help to avoid deferred care and the associated late-stage conditions and costs. Meanwhile, advances in medical treatment may result in more personalized, precise care for employees. Employers may increasingly look to approaches such as biomarker screenings, pre-treatment genetic testing and cell/gene therapies as paths to boost patient experience and outcomes.

4 | Employers express growing alarm over the sustainability of and lack of transparency into drug pricing.

One hundred percent of employers surveyed have some level of concern related to prescription drug trend, which is greatly fueling overall health care trend, according to Business Group on Health’s 2024 Large Employer Health Care Strategy Survey.

Specialty medications, as well as recent innovations in the pharmacy space, have contributed to the surge in cost. Curative treatments such as cell/gene therapies come at a steep cost to employers and patients alike, while specific drugs such as GLP-1s, indicated for Type 2 diabetes and increasingly for obesity, may have more widespread use. 

Most employers do not dispute the drugs’ benefit for those for whom they are appropriate; their concern has to do with the cost of the therapies for both the plan and patients. Increasingly, employers have also demanded greater transparency for prescription drug pricing as well as alternative economic models including “rebate-free” programs. Without transformation within the pharmaceutical market, employer plans – and the broader health care system – may crumble under the weight of unsustainable drug pricing.

5 | Employers place heightened expectations on their partners to deliver.

Employers will become more discerning in terms of vendor partnerships, in large part because of persistent concerns regarding cost, quality and outcomes. For an array of reasons many vendors and partners have struggled to deliver on the promise and potential of their solutions and capabilities.

In 2024, as employers demand greater transparency, reporting and measurement of impact, many will revisit contracts with existing partners and potentially consider changes to partner relationships. A related factor is the need to reduce fragmentation and streamline partnerships as a way to improve the employee experience and ultimately, patient outcomes.

6 | Global employers implement strategies focused on greater consistency across countries, while adapting to local regulations and cultural appropriateness.

In 2024, more global employers will prioritize consistent offerings to their employees around the world, in an effort to advance key health and well-being priorities that include access to primary care, emotional well-being, coverage for family-forming services and programs in support of LGBTQ+ populations.

Increasingly, employers will look to leading-edge mechanisms such as captive insurance arrangements to create a platform to deliver consistent programs across borders. This approach will likely play out over multiple years, as employers balance consistency and governance.

As employers embark on enhancing and expanding their global health and well-being strategies, they do so as national health systems around the world face economic challenges that threaten long-term viability. In addition, as new treatments and coverage options emerge for medical conditions, employers will need to be mindful of potential shifts in responsibility from the public sector to the private sector.  

7 | The role of well-being continues to evolve.

Many employers now incorporate mental health, financial well-being, social health, community and job satisfaction in their well-being strategies, in addition to physical health. Simultaneously, there has been a steady increase in the number of employers that view well-being as a fundamental part of workforce strategy. As employers plan for the future, they will need to balance a continued commitment to well-being against mounting cost pressures. Also, employers are considering well-being strategies through a regional or global lens, adopting globally consistent guiding principles with relevant local-market program modifications.

8 | The U.S. presidential election is impending, and it is uncertain how health care will be impacted.

The run-up to the U.S. election in November 2024 will undoubtedly impact a constellation of issues connected to employee health and well-being.

As voters head to the polls, issues that will be top of mind include the economy, taxation of benefit plans, prescription drug pricing, affordability, provider consolidation, reproductive rights, transgender care, mental health and health equity, among others. 

9 | ERISA turns 50 – preemption is even more important for self-insured employers.

Since 1974, ERISA (the Employee Retirement Income Security Act) and its preemption provisions have had a major role in creating an efficient and consistent structure for employer plan sponsors. By avoiding state-by-state design and administration limits and variability, preemption allows employers to curate consistent and equitable benefits packages for employees and their families, regardless of work location. However, recent state-based legal battles have brought preemption into question.

Fully 93% of employers have indicated a sense of urgency in preserving ERISA preemption, not only for consistency and administrative reasons, but also to deliver on health equity efforts in a comprehensive and nationally consistent manner.

About Business Group on Health

Business Group on Health is the leading non-profit organization representing large employers’ perspectives on optimizing workforce strategy through innovative health, benefits and wellbeing solutions and on health policy issues. The Business Group keeps its membership informed of leading-edge thinking and action on health care cost and delivery, financing, affordability and experience with the health care system. Business Group members include the majority of Fortune 100 companies as well as large public-sector employers, who collectively provide health and wellbeing programs for more than 60 million individuals in 200 countries. For more information, visit www.businessgrouphealth.org.