Posted: 27 Aug. 2019 5 min. read

Large employers are on board with social determinants of health and virtual care strategies

By Sarah Thomas, managing director, Deloitte Center for Health Solutions, Deloitte Services LP

Keeping employees healthy, happy, and active is essential for a productive workforce. One of my favorite perks at Deloitte is our well-being subsidy. Each year, eligible employees receive $500, which can be used for everything from gym memberships, to bike tune-ups, to 5K registrations. There are other health-focused features, too. If I don’t pack a lunch, our local cafeteria offers a wide range of healthy options—and a lovely view of the Potomac River. As a regular bike commuter, I really like having a secure room for storing my bike and a locker room where I can shower and change after a summer-morning ride. Although I haven’t used it yet, there is a new onsite fitness center on the ground floor of our building—and steps from my office is a space dedicated to meditation and yoga.

According to new report from the National Business Group on Health (NBGH),1 a growing number of large employers are doing more to address the physical, mental, and financial well-being of their workers (see the August 20, 2019 Health Care Current). This lines up well with our research and vision for the future of health.

Employers are focusing on drivers of health/social determinants

I am well aware that many hospitals, health plans, and states are implementing or developing strategies to improve people’s health by connecting them to services that address the underlying drivers of health (e.g., housing, food, transportation). What I hadn’t realized is that large employers also are making a significant push in this direction. Many of the large employers surveyed for the NBGH’s report are interested in insurance coverage that goes beyond the traditional definition of health care. For the 2020 plan year:

  • 90 percent of respondents say they are considering financial/economic issues to be part of their health and well-being strategy.
  • 84 percent are considering health care access/literacy as a part of that strategy.
  • 34 percent of employers are including food quality and access in their well-being strategy for next year, and an additional 60 percent expect to include it over the next year or two.
  • 10 percent of employers are including housing as a part of their well-being strategy for 2020, and 84 percent intend to include it over the next year or two.

As health plans begin to expand from funding community projects to designing benefit packages that take on the drivers of health and well-being, it makes sense to me that they might team up with their employer clients to address this issue. If health plans, employers, and hospitals (along with state and local governments) could work together on this issue—and leverage technology that can help identify services and track whether people’s needs are met—the impact could be powerful! One of the key takeaways from our smart health communities research is that a multi-stakeholder approach can help ensure a sustained impact.

Employers see value in virtual care

Deloitte’s Center for Health Solutions has been closely tracking the rise of virtual care, which is an important component in the future of health. One of our recent surveys found that consumers have a strong interest in receiving care virtually. This technology could help reduce care costs, expand access, and extend the reach of clinicians.

It appears that employers are more aligned with this vision than I would have thought based on some discussions I’d had with employers a couple of years ago. Back then, employers were skeptical that employees would really take advantage of these options. Fast forward to now: in the NBGH report, 63 percent of large employers expect virtual care to have a “significant” or “very significant” effect on health care in the future.

Some strategies seem familiar

When I wrote about employer strategies last fall, I noted that many employers are considering ways to enhance primary care—mostly through onsite clinics. As a supporter of primary care, I was heartened to see that employers have a strong interest in advanced primary care models and accountable-care organizations (ACOs).

According to the NBGH report, more than one-third of large employers plan to offer on-site or nearby primary care in 2020, and another 18 percent said they intend to offer it within the next year or two. Nearly 25 percent of employers said they plan to offer products that steer patients toward physician-led accountable care organizations, with another 34 percent planning to do so within the next year or two. Both of these investments are backed by evidence. Other research has found that physician-led ACOs have been more effective than peer groups at controlling costs and generating better patient outcomes.2

At the state level, recent research indicates that spending on primary care is associated with better patient outcomes.3 Minnesota, which spends more on primary care than any other state, has both lower rates of emergency-department use and fewer hospitalizations compared to other states, according to a July report from the Patient-Centered Primary Care Collaborative. The report also notes that seven states have introduced or enacted legislation—or issued executive orders—to measure and eventually increase their investment in primary care without increasing overall health spending. In California, three organizations launched a primary-care improvement program using a grant from the US Centers for Medicare and Medicaid Services (CMS)—and saved $346 million ($6 for every $1 invested) over a four-year period (see news item below).

I encourage readers to dig further into the results of the NBGH’s 2020 Large Employers' Health Care Strategy and Plan Design Survey. There are some interesting findings about expected health care cost increases and the use of high-deductible health plans tied to a health account (still offered, but employers are adding other options). The report also looks into how large employers view the idea of Medicare for All. A majority of participants said making Medicare available to everyone would likely lead to higher health care costs, more taxes, and lower quality. However, more than half of employers said Medicare should be expanded to people who are younger than 65, although they disagreed on how young beneficiaries should be.

It is also interesting to see waning interest in some of the strategies of the past, such as the more traditional wellness programs and tighter provider networks. We are in a relatively hot labor market, which might be pushing more employers to view health as an integral part of their workforce strategy.

I hope readers get out there and enjoy the last weeks of summer—hopefully with something that supports your good health!

1. Large Employers' 2020 Health Care Strategy and Plan Design Survey, National Business Group on Health, August 13, 2019
2. Half a decade in, Medicare accountable care organizations are generating net savings, Health Affairs, September 20, 2018
3. Investing in primary care: a state-level analysis, Patient-Centered Primary Care Collaborative, July 2019


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Sarah Thomas

Sarah Thomas

Managing Director | Center for Health Solutions

Sarah is the managing director of the Center for Health Solutions, part of Deloitte LLP’s Life Sciences & Health Care practice. As the leader of the Center, she drives the research agenda to inform stakeholders across the health care landscape about key trends and issues facing the industry. Sarah has more than 13 years of government experience and has deep experience in public policy, with a focus on Medicare payment policy.