National Alliance Releases Purchaser Survey


Employers Expect Stabilized Business Environment Starting in Q2 and are Doubling Down on Efforts to Support COVID-19 Vaccinations and Health Reforms

National Alliance purchaser survey also shows growing efforts to address health equity


WASHINGTON – MARCH 31, 2021 – Over the next few months employers are looking at better delivery reform strategies such as mental health access with a growing number focused on advanced primary care and centers of excellence. 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.

“Employers are working to get back to normal operations which most expect by the third quarter of 2021,” said Michael Thompson, National Alliance president and CEO. “While the vaccination efforts are currently job one, plans are shaping up now for employers to improve health, equity and healthcare value over the next few years.”

Additional survey findings:

  • COVID-19 business environment
    • Over half of employers anticipate a more stabilized business environment (25% by Q2 and 27% by Q3) with education and healthcare industries indicating a faster return than most, and finance and public administration sectors estimating longer time to return to normal operations
    • Among benefit offerings for the remainder of 2021 – 83% will continue to allow people to work from home; 76% have expanded virtual meeting capabilities; 60% offer flexibility to cover employee home demands; and about two-thirds will continue to restrain business travel
    • When asked about efforts to support the COVID-19 vaccines 81% are providing information on benefits of the vaccines, 76% are offering education for employees about eligibility, 69% on safety and efficacy and 67% on how to access and over 80% of very large employers anticipate providing onsite COVID-19 vaccines before the year is up
    • Very few (8%) employers anticipate mandating the vaccine for employees and only 10% have implemented or are considering for higher exposure employees
  • Health reform
    • Employer support for potential health reforms continues to grow since the last survey conducted in fall 2020 with 87% indicating that drug price regulation is very or somewhat helpful, 79% for surprise billing regulation, 75% for hospital price transparency, 75% for hospital rate regulation
    • Related to the Medicare public option 44% of employers believe it could be somewhat or very helpful, while 15% indicated it could somewhat or very harmful
  • Health benefits strategy
    • Over 90% of employers have or anticipate expanding telehealth for both physical care and behavioral health care and 8 in 10 employers are expanding virtual wellbeing programs and investing in other care management solutions and even small employers are currently using (61%) or considering (31%) telehealth
    • About 2/3 of employers are already doing or considering value-based design approaches. Over half are considering pre-deductible coverage of chronic conditions. 45% anticipate increased employee cost sharing to mitigate cost increases, while 55% are not considering
    • About 9 in 10 are implementing or considering delivery reform-based strategies with the most common being virtual care delivery and improving mental health access
    • Related to payment reform – significant focus is being invested in hospital pricing and quality transparency efforts and 7 in 10 employers will be considering strategies to high-cost claimants as well as bundled payment
    • There is a significant focus on Total Person Health as it relates to mental health integration, people with multiple chronic conditions, recognizing diversity within the employee population and emphasis on more personalization of health interventions
  • Health equity
    • About half of survey respondents (49%) currently integrate equity into their values and objectives, and of these organizations:
      • Almost half are engaging various departments to discuss company strategy, with 9 in 10 anticipating doing so in the next few years
      • Almost 8 in 10 expect to be assessing their vendor’s strategies
      • Other approaches include tailoring workforce health education and establishing equity metrics to assess improvements going forward
    • Only 8% of employers indicated that they have established equity metrics for health and wellbeing programs, but 70% have integrated or plan to integrate health equity into their organizations’ values and objectives


The online poll of 151 employers and other healthcare purchasers that are members of coalitions affiliated with the National Alliance was conducted in March 2021. Organizations represented included manufacturers, educational services, public administration, finance and insurance, and healthcare and social assistance institutions. Purchasers ranged in size from very large (26%, 10,000+), large (14%, 5,000-9,999) to mid (33%, 1,000-4,999), with 76% self-insured, 15% fully insured and 9% hybrid. The full Pulse of the Purchaser results can be found here. This study was partially funded through a Patient-Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award (12856).


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:
Cary Conway