With new companies and
That said, despite the large number of options burdening employers, there are a breadth of pain point-solving solutions that meet the
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In: Pricing guarantees | Out: PEPM models
The PEPM (per employer per month) model will be one of the past with employers preferring solutions that put their money where their mouth is. Over the past few years, we've seen the proliferation of digital health solutions and employer-sponsored platforms, many of which have been able to skate by despite low adoption rates and unclear impact. While there is greater consolidation happening with employers opting for fewer benefits offerings, employers are also beginning to put more pressure on their partners to prove their value.
Given the macro climate and pressure on benefits budgets, employers are taking a hard look at their benefits ecosystem and determining which are actually generating return on investment (ROI) for their company and holding up to their promise. As a result, employers are beginning to demand more aligned pricing models from digital health partners, and are prioritizing those that put their money where their mouth is and guarantee outcomes and savings. Companies offering a risk-free model are purpose-built to drive health outcomes and generate a return on investment through medical and pharmacy savings, which is what employers need
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In: Recognizing invisible illnesses | Out: Focusing on more traditionally acknowledged illnesses
Following the pandemic and the rise of conditions like Long COVID, we're starting to see greater recognition and acknowledgment of "invisible illnesses" and the toll they take in the workplace — both in terms of absenteeism and presenteeism in addition to direct costs.
Historically, these are conditions that have flown under the radar due to stigma. Sources show that a staggering
However, employers are beginning to take notice of "invisible" conditions that typically fly under the radar because they don't show up in claims reports, like menopause and migraines. These are conditions that are starting to be identified in the claims data to understand not only prevalence, but also cost and acknowledgment for the impact they can have from a physical perspective.
For example, there are
Furthermore, these diseases often fly under the radar in terms of the impact they have from a workplace productivity perspective. For some of the other high-spend chronic conditions, the impact on your employees may be more obvious or visible. For example, with an MSK injury, an employee might need to have surgery and would be out of the office for a set period of time for recovery. Whereas with a condition like autoimmune disease, it is often a bit more gray — an employee might experience a flare up in symptoms, which means they need to take a few more sick days here and there, or perhaps their chronic symptoms are getting in the way of them feeling 100% and bringing their full self to work.
Given the hidden nature of these conditions, employers might not have visibility into the toll this is taking on their employees in terms of their quality of life but also the impact on indirect costs, as they aren't as readily obvious in claims reports.
In addition to providing supplemental healthcare benefits to support employees with hidden illnesses, companies are beginning to implement flexible workplace policies in addition to promoting a culture of awareness to combat the stigma and discrimination their employees face.
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In: Whole person care | Out: Fragmented, siloed care
There has been a major shift away from fragmented care to whole-person care, meaning looking at a patient as not just separate organs or body systems, but rather understanding how their seemingly disparate symptoms are all interconnected. This old way of thinking is likely a remnant of the way the care delivery is set up and how it's segmented for patients based on their diagnosis.
In the case of autoimmune disease, there's no "autoimmune-ologist." If you have Type 1 diabetes, you see an endocrinologist. If you have rheumatoid arthritis, you see a rheumatologist. If you have celiac disease, you see a gastroenterologist, and the list goes on. This siloed approach leads to suboptimal outcomes with providers who are focused on addressing a specific body part or symptom rather than thinking about the body as a whole.
What patients truly need is care that considers their unique health needs and looks at them as whole people, not just a collection of symptoms. This type of care strays away from the traditional healthcare approach that is siloed to a more comprehensive approach that considers multiple factors that either prevent or promote physical or mental health or disease.
In 2025, employers are beginning to seek solutions that treat the "whole person" in order to improve clinical outcomes and avoid wasteful spending, as employees go from seeing multiple specialists to one, ultimately saving both employees and employers time and money. They're also assessing their healthcare and well-being providers to understand and evaluate whether they are truly taking an individual's whole health into the picture — both mental and physical — when delivering care.
The macro environment is putting more pressure on employers to spend wisely and opt for working with vendors who will put fees at risk based on outcomes and savings. As they look deeper into their claims, what they're finding is that employees with hidden chronic conditions are having a disproportionate impact on spend as high-cost claimants, leading to growing awareness of invisible illnesses. While searching for solutions to solve these issues for their populations, employers are turning to whole person care, which is a less expensive way to bend the cost curve while also providing a better patient experience.
