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Survey Finds Employers Remain Committed to Health Benefits, Focused on New Payment Strategies and Open to Government Reforms

National Alliance purchaser poll found caregiving benefits have tripled since COVID-19

WASHINGTON – September 29, 2020 – Faced with record disruption in healthcare services and the economic downturn, employers are staying the course or accelerating (71% for 2021 and 63% for 2022) their health benefit strategies. These are among the findings of a survey of employers and other private purchasers of healthcare conducted by the National Alliance of Healthcare Purchaser Coalitions (National Alliance) and its members.

When asked about their impression of health reforms related to their organization’s health benefit strategies, employers are open to a myriad of potential reforms with the majority indicating drug price regulation (94%), hospital price transparency (90%), surprise billing regulation (81%) and hospital rate regulation (79%) to be very or somewhat helpful. Employers also indicated a Medicare public option (50%) could be very or somewhat helpful, while 21% felt it could be very or somewhat harmful. When asked about Medicare for All, 46% of employers indicated that would be very or somewhat harmful.

“Employers are maxed out as to what they and their employees and family members can shoulder for healthcare costs and they continue to be concerned about the sustainability of privately-sponsored healthcare,” said Michael Thompson, National Alliance president and CEO. “Looking forward, they are working to shift market dynamics to get better value for their healthcare dollars through delivery-based strategies such as advanced primary care and centers of excellence, and there is also an increasing openness to government action.”

Additional survey findings:

  • Caregiving benefits such as leave (30%) and protected time to support employee caregiving needs (28%) have tripled since the start of the COVID-19 pandemic. While not as common today, some employers are considering expanding allowances for emergency day care (13%) and home tutoring or teachers (12%).
  • When asked what threatens the affordability of employer-provided health coverage for employees and their families, respondents stated the following market forces present a significant threat: drug prices (90%), lack of transparency (73%), hospital prices (71%), surprise medical bills (58%), and overuse of low-value services/waste (53%).
  • The top delivery and payment reform strategies employers are currently doing: reducing waste and inappropriate care (61%) and steerage within networks (47%). Top strategies being considered over the next two years include hospital quality transparency (44%), hospital pricing transparency (43%), regional centers of excellence (39%), and advanced primary care (36%).
  • The most prevalent medical and pharmacy drug strategy employers are currently doing is medication therapy management (49%). One in three will be considering strategies in medical and pharmaceutical drug transparency and pass through pricing (33%) the next two years.
  • Top health and wellbeing strategies currently being implemented: flexible work week (65%), total person health and wellbeing (63%), navigation and advocacy services (55%), and enhanced mental health support (49%).
  • Related to race, health and equity, a majority of employers indicated current efforts to encourage community volunteerism (71%) and engagement in community improvement (70%), and 58% said they are currently doing anti-racism education and cultural competency training (52%), with 40% indicating they are considering over the next two years programs for transparency and education for healthcare disparities, and access to aggregate health data by race/ethnicity.

“Rising healthcare costs continue to burden our businesses and employees, and they are crowding out jobs, wages, and in the age of COVID, our economic recovery,” said Elizabeth Mitchell, president and CEO, Pacific Business Group on Health. “The results of this survey reinforce employers’ justified concerns about how high drug and hospital prices, surprise medical bills and continued overuse of low-value healthcare services threaten the health and economic security of American businesses and workers. Employers well understand that healthcare is broken and that they can no longer wait for the system to fix itself.”

The online poll was conducted in August and September 2020 with 165 employers that are members of coalitions affiliated with the National Alliance responding. Link to full survey results.

Additional insights and implications for employers will be shared during a COVID-19 Employer Town Hall on October 1 from 5:00-6:00 pm ET. Joining Michael Thompson will be Cheryl Larson, president and CEO of the Midwest Business Group on Health. Register for webinar.

About National Alliance of Healthcare Purchaser Coalitions

The National Alliance of Healthcare Purchaser Coalitions (National Alliance) is the only nonprofit, purchaser-led organization with a national and regional structure dedicated to driving health and healthcare value across the country. Its members represent private and public sector, nonprofit, and Taft-Hartley organizations, and more than 45 million Americans, spending over $300 billion annually on healthcare. To learn more, visit and connect with us on Twitter and LinkedIn.

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Media Contact

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Telephone: 972.649.4707