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Large Employer Benefits Survey Highlights COVID's Impact on Site of Care and Well-Being

Analysis  |  By Laura Beerman  
   August 30, 2021

More than 90% of employers are concerned about COVID's long-term impact on deferred care and employee mental health.

In the era of COVID, the term site of care has multiple implications. This includes not only where care is delivered but the physiological conditions that are now within telehealth's reach and employers' ability to impact. HealthLeaders has identified this site of care takeaway from the 2022 Business Group on Health employer survey and recent online press conference. Site of care's influence can be seen among the top five large employer concerns from this year's Business Group on Health survey, including:

  • COVID's impact horizon
  • Expanded social determinants of health (SDOH) benefit design, including financial programs
  • Mental health care, access, cost, and quality as well as stigma awareness.
  • Reimagined roles for, and the future of, worksite clinics
  • Anticipated cost upticks after a mixed spending year

Key highlights from each area are outlined below. The survey reflects responses from the Business Group's members, including 136 employers—mostly large and self-insured from diverse industries—that cover more than 8 million people.


More than 90% of employers are concerned about COVID's long-term impact on deferred care (particularly related to cancer diagnosis and treatment) and employee mental health. While health and well-being are either integral to or a consideration in workforce strategy for 87% of employers, this represents a surprising decrease from 2020 (94%).

And while the key reason is not surprising (e.g., COVID response overtook existing strategies), how employers dialed back is. The Business Group reports that 15% of respondents reduced value-based health and well-being efforts, such as participation in accountable care organizations (ACO), high-performance provider networks, and provider centers of excellence. Given that COVID is the equivalent of a dumpster fire for healthcare data trending and business intelligence decisions, however, these value-based program shifts may prove well-advised for the short term.


With the U.S. workforce still largely remote and the Delta variant curbing activity, site of care continues to align with site of live, work, and play. This makes SDOH's impact on health and well-being even more important and for more people, with self-insured employers challenged to address these intersections.

Emerging SDOH concerns include employee finances/income and racism, with 60% and 55% of employers respectively implementing benefits and programs to address them. Health inequities related to fertility/material care are another key focus, with 82% of employers creating solutions to target high-risk pregnancies, post-partum depression, fertility, prenatal care, C-section rates, and doula services by 2022. Transgender health needs and neurodiversity (e.g., spectrum disorders, ADHD) are two additional areas with 75% or more of employers reporting that they are addressing.


COVID has amplified another U.S. epidemic: mental health. Now, more employers are targeting a significant reason why many people do not seek care: stigma. "The year 2022 will mark the first time that a majority of employers will have an anti-stigma campaign, according to the survey," says Ellen Kelsay, Business Group on Health's President and CEO, who spoke at the organization's August 25 press conference. While mental health service access is still the prevailing focus for 76% of employers, 57% named stigma as one of their top three areas of concern for employee well-being.

A growing number of mental health tech solutions are also helping, moving site of care as close as a smartphone app or wearable and expanding the reach of companies' Employee Assistance Programs (EAP). "Health tech is a major way employers are increasing employee access to mental health," says Business Group on Health Vice President Brenna Shebel, another conference speaker. For more traditional mental health services like counseling, 75% of employers intend to offer no- or low-cost telehealth options in 2022—a significant increase compared to the 54% that currently do.


Workplace clinics aren't going anywhere anytime soon. Yes, employers report that the number of on- or near-site clinics declined in 2020 and 2021—with a return to pre-pandemic numbers not expected until 2024. But those sites have and may continue to play a role with COVID testing and vaccination, particularly if more employees are required to return to the office fully inoculated and face fees if they don't. "Employers are exploring surcharges for non-vaccinated employees. This is a hot employer topic. There are compliance and legal concerns, as well as bad PR," notes Shebel. The day after the Business Group's press conference, Delta Airlines announced that it would charge unvaccinated staff a $200 monthly insurance fee effective November 1, 2021.

Still, on-site may be the better place for the urgent and chronic, with virtual visits an ideal solution for acute and maintenance care. The Business Group reports that 76% of employers plan to maintain their telehealth expansion efforts in areas ranging from the traditional to the surprising. Among this latter group, fertility, musculoskeletal, cardiac, and kidney care are expected to see a minimum 20% increase in the number of employers planning telehealth offerings by 2023/2024.


In 2020, the coronavirus accomplished what the healthcare industry has not: bending the cost curve. Reduced spending from deferred care appears to have offset the costs associated with COVID-related care for large, self-insured employers. The Business Group reports that a spend trend ranging from -12% to +10% resulted in a net-zero overall increase.

No one expects that to continue. A 6% increase is expected in 2021, with some mitigation through benefit design in 2021. Consumer-directed health plans (CDHP), however, may not be part of that strategy. In a follow-up article, HealthLeaders will explore the Business Group's findings specific to CDHPs, which fewer employers are offering as a full replacement in lieu of other coverage options—one of many areas in which the group offers rich data.

"The Business Group's annual survey is a unique window into how large employers plan to evolve their benefit strategies and offerings in the coming year," said Kelsay. “Employers seek information about their peers' strategies, and survey findings offer collective guidance for companies to best support their workforces."

Editor's note: This story was updated on August 30, 2021, at 5:01 p.m.

“The Business Group on Health's annual survey is a unique window into how large employers plan to evolve their benefit strategies and offerings in the coming year.”

Laura Beerman is a contributing writer for HealthLeaders.


A Business Group on Health employer survey findings include five key concerns, all connected to COVID.

A focus on mental health and social determinants of health is rising, along with expanded applications for virtual health.

The findings suggest expanded definitions for site of care and the continued implications of the coronavirus impact.

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