Key Insights: Health Care Trends in 2021

Highlights of a recent conversation among employers on findings of the 2021 Large Employers’ Health Care Strategy and Plan Design Survey, and ways they are changing their health care strategy and benefits for the coming years.


October 09, 2020

On September 16, 2020, employers came together to share their reactions to the findings of the 2021 Large Employers’ Health Care Strategy and Plan Design Survey, and ways they are changing their health care strategy and benefits for the coming years. Thirty employers across a variety of industries participated in the call.

This Key Insights shares examples in the following areas:

  • Virtual care
  • Health care cost drivers
  • Mental health strategies
  • On-site services
  • Priorities for 2021

Virtual Care

Virtual care includes telehealth, telemental health, app-based programs that address conditions like musculoskeletal problems and diabetes, or even provide nutritional guidance for employees looking to improve their lifestyle. Employers on the line were focused on all different types, which is reflective of the survey offerings:

  • A number of employers indicated interest in virtual musculoskeletal solutions, with some stating that these conditions are one of their top drivers of costs.

And the survey says…

Telehealth, mental health, emotional well-being and health and lifestyle coaching are the most prevalent virtual services offered by employers. Significant growth is forecast for virtual solutions addressing specific conditions, such as musculoskeletal, cardiac, diabetes and fertility care.

  • Numerous employers offer free telehealth visits to employees during the pandemic. One employer plans to continue offering this benefit through the end of the year. Another employer has been actively promoting free telehealth visits but doesn’t see doing so into 2021. See Figure 1 for polling results on this approach.
  • Two employers shared their virtual programs to address diabetes. One is currently offering the Omada program, and another is rolling out the same program next year for those with type 1 or type 2 diabetes.
  • Another employer is investigating virtual primary care as part of its virtual care scope. At this point, virtual primary care appears to still be in its early stages, so the employer is meeting with providers and researching its employees’ needs for virtual primary care.
2021 trends 
Figure 1: Large Employers’ Continuation of Lowered/Eliminated Cost Share for Telehealth During the Pandemic, 2020

Number of responses = 21

Health Care Cost Drivers

The COVID-19 pandemic has introduced a lot of uncertainty into health care cost management. With employees staying at home, providers scaling back their breadth of services and many health care interactions going virtual, the traditional health care cost trendline has gone off course for many employers. Employers on the line shared their perspectives:

And the survey says…

In 2021, employers are anticipating an increase of 5.3% in health care costs, after plan design changes are taken into account. The top conditions driving these increases include musculoskeletal conditions, cancer and cardiovascular disease.

  • One employer closely monitoring 2020 claims has observed a significant decline in preventive care visits and trips to the emergency room. These changes can likely be traced to expanded coverage of virtual care. This employer is anticipating that claims will rise toward the latter half of 2020.
  • Another employer has adopted the mindset that it is “no longer betting on certainty around health care costs.” Due to the pandemic, this employer is just under budget for 2020 and padding its budget with a little extra for 2021. A second employer agreed with the approach of adding a little extra for 2021 to accommodate for the cost of the COVID-19 vaccine and pent-up demand carried over from 2020.
  • An employer shared that it is thinking about costs beyond just health care – factoring in money spent on the expansion of other benefits like employee assistance program (EAP) services and job flexibilities for working parents.
  • One employer shared that it is up about 4% in health care costs in 2020 and is planning for a 5% increase in 2021.

Employers also shared the condition that they are most focused on in 2021. The results can be seen in the word cloud below.

word cloud- what conditions employers are most focused on in 2021

Mental Health Strategies

Employers have been steadily expanding their mental health offerings for the past several years, and the pandemic did nothing but accelerate that. With a focus on resilience, stress and anxiety management, sleep and treatment access, employers described the following mental health initiatives put into place this year:

  • One employer rolled out virtual counseling service TalkSpace, which offers services at the same cost as an in-person visit. Utilization hasn’t been extremely high, although there are more options for virtual counseling from other providers who didn’t previously offer it. Another employer also offers TalkSpace, but through its EAP and health plan.

And the survey says…

In 2021, more employers (88% total) plan to offer online resources such as apps, articles, videos and webinars, compared to 69% who have them in place this year. Manager training on mental health and low-cost telemental visits are also top strategies for the coming year.

  • A few employers commiserated about low utilization rates of mental health tools and resources. One employer is looking to virtual and video resources to boost employee use. Another employer had success with its multipronged approach: cross-linking mental health resources, manager trainings and virtual events, as well as highlighting mental health observances globally.
  • On-site Services

    Providing needed services – such as acute care, vaccinations, primary care and counseling – directly to employees working at a company location has been a long-heralded method for engaging employees. While the pandemic has restricted this access point to care, employers remain committed to keeping these programs in place. Two examples include:

    And the survey says…

    In 2021, 61% of large employers will have an on-site clinic. This number may grow to 72% in the next 2-3 years.

    • Despite the fact that employees are working at home, there is still employer interest in bringing counseling services on-site. One employer has had on-site mental health staff for a while, but the team pivoted to doing their visits virtually during the pandemic. Another employer echoed a similar sentiment – espousing the benefit of using on-site staff for televisits.
      • One employer overcame the stigma of using on-site counselors by designing the on-site clinic so that counselors sat among other clinic staff, preventing visitors from knowing that an employee was there for therapy.
    • One employer is exploring pop-up dental services but won’t implement this until employees are back on-site.

    Priorities for 2021

    In looking to the coming year, COVID-19 is still on the minds of large employers and their employees alike. However, employers are keeping their focus on other important areas of employee health and well-being:

    • One employer is focused on what employees really want, with a significant emphasis on benefits. Through an employee survey, this employer is looking to evaluate programs, come up with ways to better promote opportunities and improve the overall employee experience. Another employer remarked that it did a similar survey in February 2020 but is questioning if the data still holds true or if another survey is needed.

    And the survey says…

    The top three priorities for large employers in 2021 are:

    • Implement more virtual care solutions;
    • Expand access to mental health services; and
    • Develop a more focused strategy on high-cost claims.
    • Another employer is continuing its quest to promote high-quality health care, specifically in labs, imaging and treatment of specific conditions. This employer is also exploring ways to address health inequities through its benefit plans.
    • Preventive care is on the docket for one employer, who is promoting it through a campaign in 2021.

    To learn about more key findings from our 2021 Large Employers’ Health Care Strategy and Plan Design Survey, view the full report.

More Topics

Health Conditions and Risk Factors icon_right_chevron_dark Physical Health icon_right_chevron_dark Cost Management icon_right_chevron_dark Pharmacy icon_right_chevron_dark
More in Benefits Strategy


  1. Virtual Care
  2. Health Care Cost Drivers
  3. Mental Health Strategies
  4. On-site Services
  5. Priorities for 2021