15th Annual Employer-Sponsored Health and Well-being Survey: Full Report

Well-being programs have evolved to address a more diverse set of employee needs around the globe.


May 29, 2024

Survey of 160 large employers that focused on how well-being is evolving for 2024 and beyond.


Employers have gained tremendous ground in supporting employees’ well-being. When Business Group on Health and Fidelity began surveying employers on their efforts 15 years ago, the top initiatives were limited to tobacco cessation, employee assistance programs (EAPs), flu shots and nurse lines. Fast forward to 2024 and it is clear that employers have expanded their definition of well-being beyond physical health to include an array of initiatives spanning mental, financial, social and community well-being as well as job satisfaction and purpose in life.

Based on the strategies of 160 employers, the 15th Annual Employer-Sponsored Health and Well-being Survey explores the changes within employer well-being offerings and provides insights on the direction employers will be taking with their well-being investments over the next 3-5 years.

The following seven insights were gleaned from the survey that was conducted in January-February 2024.

1. Employers have entered a period of assessment and scrutiny as they revisit approaches.

In numerous areas of well-being, the survey found little change between 2023 and 2024 in both employers’ overall strategy and individual initiatives. This suggests employers’ continued prioritization of employee well-being within their workforce strategy. However, it’s important to reflect on the ongoing macroeconomic, cost and affordability pressures that employers face; for some, it may limit their ability to further expand well-being offerings.

In addition, in 2023, after years of adding a variety of well-being resources to their portfolios, employers may have reached a plateau; in 2024, many are assessing the effectiveness of those programs. This is consistent with two main trends: 1) the Business Group’s prediction in its Trends to Watch in 2024, which forecast that employers will begin to place heightened expectations on their partners to deliver and 2) an emerging theme of benefits optimization to improve the employee experience.

The survey results give an impression of how this may play out for employers and their partners. For example, employers may be looking to streamline and rationalize the number of vendor partners, seeking more comprehensive and holistic offerings—for instance, newer EAP models that go beyond the traditional referral engine—to fill roles previously assumed by multiple point solutions. As seen in Figure 1, newer EAPs are on the rise amid declines in siloed well-being initiatives. Employers pursuing this approach appear to be prioritizing programs that deliver outcomes, simplify the benefits experience for employees and optimize the benefits portfolio.

Employee Assistance Programs, 2023-2025
Figure 1: Employee Assistance Programs, 2023-2025

Many employers are approaching this period of assessment using data. Figure 2 shows that nearly four in five employers either have a well-being dashboard or are working to create one by 2025. These dashboards can be monumental in showing if well-being is improving and correspondingly, where vendor programs are succeeding or failing to provide value. Participation rates and employee outcomes are the main focus of these tools, which are commonly shared with other internal health and benefits professionals and with the C-Suite.

Figure 2: High-Level Well-being Dashboards, 2024-2025
Figure 2: High-Level Well-being Dashboards, 2024-2025

2. Employer dollars invested in well-being continue at the same level.

The average amount employers budgeted for well-being did not fundamentally change between 2023 and 2024 when viewed on a per employee basis (Figure 3). Additionally, for the 75% of employers that provide incentives for well-being activities in 2024, the amounts will also stay consistent from the prior year. Beyond 2024, a majority of employers plan to either maintain or expand their incentive amounts (Figure 4).

The stable level of employer investment in well-being may well be the function of two competing realities. Employers have viewed—and continue to view—these initiatives as vital to workplace health and well-being and count them as a key aspect of their overall workforce strategy. However, as health care costs continue to climb, employers must devote resources to medical and pharmacy expenditures; balancing these realities necessitates a maintenance, not expansion, of well-being budgets.

Figure 3: Well-being Budget
per Employee per Year, 2020-2024
Figure 3: Well-being Budget per Employee per Year, 2020-2024
Figure 4: Financial Incentive/Disincentive Amounts for Participating in Well-being Programs, 2022-2024
Figure 4: Financial Incentive/Disincentive Amounts for Participating in Well-being Programs, 2022-2024

3. Global employers press forward with key priority areas.

While employers in the U.S. are maintaining well-being programs in 2024, global well-being strategies are making incremental gains in key priority areas. Responding to the critical need to reduce employee health risks, increase engagement and reduce costs, employers are looking to key areas such as striving for consistency in offerings between countries/regions and expanding mental health supports with counseling and newer forms of EAPs.

Zeroing in on global consistency, Figure 5 depicts the gain in support from employers. Seventy-nine percent of global employers either have a global consistency approach for well-being or are developing one. However, it’s important to recognize that implementation of a global consistency approach will differ by company, with some striving to offer the same programs to all employees (regardless of location) while others are allowing more leeway so that they can adapt to regional and/or local country needs.

Figure 5: Employers with a Globally Consistent Well-being Strategy, 2024
Figure 5: Employers with a Globally Consistent Well-being Strategy, 2024

4. Employers are eyeing other rapidly evolving issues that impact employee well-being.

Employers are keeping a watchful eye on new areas to actively address in the next 3-5 years based on the changing world and evolving employee needs. As seen in Figure 6, the leading area of expansion is addressing social determinants of health (SDOH) – the circumstances in which people are born and live that contribute to their physical and mental health, their ability to be productive at work and their overall quality of life. SDOH includes early childhood experiences and educational opportunities; employment status and livable wages; housing, food, water, transportation, public safety, gender and racial equality; and health care. Some of the growth in SDOH efforts can be attributed to health plans and other vendors developing more robust capabilities, which employers can then leverage on behalf of their workforce. About half of employers have SDOH on their roadmap for the coming years.

Figure 6: Expanding Scope of Well-being Strategy in the Next 3-5 Years, 2024
Figure 6: Expanding Scope of Well-being Strategy in the Next 3-5 Years, 2024
It is anticipated that functional and integrative medicine will be included in 19% of employer well-being offerings by 2029 as interest in holistic approaches to care increases. About the same number of employers are planning to include office/workplace design as an element of well-being, perhaps due to the result of many years of research on the influence of work environments on overall employee well-being and continued efforts to make the workplace an attractive destination for employees.


5. Employers will continue to provide family-forming benefits and reproductive support.

Employers have taken note of the value that employees place on family-forming benefits and reproductive support and in turn, are working to maintain these offerings given their role in workforce strategy, including talent attraction and retention.

By 2025, upwards of 86% of employers could offer family-forming and reproductive support to their employees, making it one of the greatest areas of growth among initiatives covered in the survey (Figure 7). These services are typically provided via a standalone point solution. Employers should require that their partners work together to ensure proper navigation across the vendor ecosystem and optimal integration of care. Lastly, recent state and local laws and regulations impacting access to some reproductive services may have garnered increased attention from employers.

Figure 7: Employers’ Family-Forming and
Reproductive Support, 2023-2025
Figure 7: Employers’ Family-Forming and Reproductive Support, 2023-2025

6. On-site offerings at the worksite level out.

As employers continue to evolve their well-being strategies, on-site services and offerings remain a core component. While the early post-pandemic years revealed some uncertainty – mainly, whether employers would “bring back” certain on-site offerings – 2024 shows that employers have established that on-site offerings are an integral part of their approach to creating a healthy worksite.

Figure 8: On-site Well-being Services and Initiatives, 2024
Figure 8: On-site Well-being Services and Initiatives, 2024
As seen in Figure 8, on-site services are multidimensional and emphasize a healthy culture to help set employees up for success in their own health journey. Most offerings won’t see a tremendous increase in uptake for 2025, which signals that employers believe they are where they need to be in well-being at the worksite, at least for now.


7. Lifestyle spending accounts (LSAs) continue to generate buzz and curiosity, but many employers are still weighing implementation.

LSAs are accounts that allow employers to fund a variety of well-being activities. They have piqued employers’ interest, likely because they provide a flexible mechanism to facilitate choice across a diverse range of employee needs.

While these benefits are reportedly popular among employees who have used them, employers are still a bit reluctant about implementing them. This hesitation is primarily due to the cost of providing these benefits. Among employers who haven’t made the leap to LSAs, two in three say that costs are a hurdle. For employers who have put an LSA in place, anecdotes suggest that LSA utilization often exceeds budgets before the year is over. While this level of engagement is potentially encouraging, employers should carefully consider the assumptions used for budgeting purposes. Costs in excess of budgets pose challenges to employers overall, threatening the long-term success of these programs.

Figure 9: Lifestyle Spending Accounts, U.S. vs. Global, 2024-2025
Figure 9: Lifestyle Spending Accounts, U.S. vs. Global, 2024-2025
Some employers are offering something like LSAs to their employees outside the U.S., and interestingly, the uptake is higher globally than in the U.S. for 2024. Four percent of global employers are offering similar reimbursement accounts in most/all the countries where they have operations; 15% do so for some countries (Figure 9). The reason for this relatively high number may be that LSA-like accounts support global employers’ drive to provide well-being as a means for enhancing a globally consistent corporate culture.


Future Outlook

The 15th annual survey findings reflect a measured view of future investment and effectiveness of employer well-being initiatives. Employers remain committed to providing these services and programs to their workforce and will continue to treat well-being as an important component of their workforce strategy. Yet increasingly they are approaching partnerships and providers of these services with a more discerning view. Nonetheless, employers will continue to seek solutions that demonstrate outcomes, are cost effective and drive the appropriate level of member engagement. In all, employers remain committed to investing in their well-being strategy and potentially growing their investments in the coming years.

15th Annual Employer-Sponsored Health and Well-being Survey: Full Report

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