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1、Employers seek more value as they face historically high medical inflation Findings from WTWs 2024 Best Practices in Healthcare S1SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmploye

2、rs take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesitySummary 03Cost trends reach decade highs 04Affordability is the top priority 06Assessing vendor partnerships 10Embracing alternative plan designs 11Supporting clinical con

3、ditions 14Coverage of GLP-1s for obesity 15Employers take a critical view of their PBMs 16Opportunities to expand the use of AI 20Key actions for employers 212TABLE OF CONTENTSSummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative pla

4、n designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity3Summary Cost trends are the highest they have been since 2011.Healthcare cost trends are rising at the fastest pace in over

5、a decade and are expected to reach nearly 8%in 2025.Despite these historic highs,actual cost trends could be as high as 10%for the current year,as nearly half of companies are on track to realize costs above their original budget forecasts.Top priorities.Affordability,workforce wellbeing,the employe

6、e experience and enhanced resources to address employee needs are the highest priorities for companies to address.Employers are prioritizing ways to reduce the companys costs while also balancing the financial impact of any changes on their employees.Employers remain focused on supporting employee w

7、ellbeing,specifically helping to address the mental health challenges and financial issues gripping the workforce.Employers are also looking for new pathways to deliver greater value from their healthcare programs by expanding programs to better support employee needs and taking steps to enhance the

8、 employee experience.Embracing alternative designs.Cost pressures are causing employers to look beyond traditional cost reduction levers to solutions that can lower the total cost of care.While many employers continue to shift costs to employees via premium increases,plan changes and incentives to m

9、ove to account-based health plans(ABHPs),employers are concertedly looking beyond these traditional means toward alternative plan designs,enhanced healthcare delivery and more critical evaluations of vendor partnerships.High-cost clinical conditions.High-cost clinical cases remain a main driver of h

10、ealthcare cost trends.Employers are increasing their investment in programs to support employees clinical conditions,including mental health,diabetes and obesity,musculoskeletal conditions,cancer and digestive conditions.Reevaluate pharmacy benefit manager(PBM)partnerships.Employers are keeping a cr

11、itical eye on their PBM partners.There is growing interest in alternative PBMs and pricing models,and companies are exploring new ways to manage prescription drugs,including alternative drug channels and pricing.Expanding use of artificial intelligence(AI).Uptake of AI in healthcare strategy is in i

12、ts infancy,but companies see the biggest opportunity for adopting AI tools in supporting their healthcare navigation solutions,enhancing communication and conducting medical claims audits.SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alt

13、ernative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity4Cost trends are at their highest levels in a decade Rising healthcare costs have been a long-standing challenge

14、for employers.But the issue has become even more acute today than at any point over the past decade.General inflation increases in prescription drug costs,provider and hospital system consolidations and multiyear contract renegotiations have been key drivers of recent cost trends.Further,drug costs,

15、particularly for diabetes and obesity treatments(GLP-1s)and specialty cancer medications,are continuing to push healthcare costs higher.The cost of prescription drugs and pharmaceuticals has been growing at twice the rate of any other healthcare service category over the past decade.1 Healthcare cos

16、ts are surging,with employers expecting average cost increases(before plan changes)of 7.7%in 2025 compared with 5.0%in 2022.1 This is the highest healthcare cost increase since 2011.Even after plan changes,healthcare cost increases are expected to be 7.0%in 2025 compared with 4.0%in 2022.Key finding

17、s of WTWs 2024 Best Practices in Healthcare Survey1 See Health Care Cost Institute,“2022 Health Care Cost and Utilization Report,”https:/healthcostinstitute.org/images/pdfs/HCCI_2022_Health_Care_Cost_and_Utilization_Report.pdf10.3%14.7%13.0%11.3%9.2%8.3%6.4%5.3%6.8%6.8%5.5%5.5%4.2%4.9%4.0%4.4%4.0%4.

18、0%3.7%1.5%5.0%4.0%5.7%6.0%7.0%9.0%8.0%8.0%8.0%8.0%6.8%6.0%6.0%5.0%6.0%5.0%5.0%4.1%2.6%5.6%5.0%6.5%6.9%7.7%2001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025*Healthcare trend after plan changes(total plan costs)Healthcare trend before plan changesCPI-

19、UWage growthExpected;*ProjectedNote:Percentages of healthcare trend are median numbers.Sample:Companies with at least 1,000 employees.Source:WTW 2024 Best Practices in Healthcare Survey;Bureau of Labor Statistics,CPI-U,CES.Figure 1.Healthcare Cost increases rising but with uncertainty and variablity

20、SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity5

21、 Healthcare cost trends reflect increases in budget rates for 2024 and 2025.However,many companies over the last two years have experienced healthcare cost increases higher than anticipated when they set their budgets.In fact,half of companies report that they were over budget in 2023 and 45%of comp

22、anies anticipate being over budget in 2024(Figure 2).This suggests that the actual underlying healthcare costs trends may be even higher than the budget rates reported here.We examined the companies that were over budget in 2023 and then their subsequent restatement of health care cost trends for th

23、at year.On average,companies who were over budget reported actual cost trends of about 2.5 percentage points more than their budgets.Because many employers are again over budget,average actual trends could feasibly be closer to 10%rather than the 7.7%reported.Figure 2.Were your organizations healthc

24、are costs above,below or at-budget in 2023,and what do you expect for 2024?Note:Percentages may not sum up to 100%due to rounding.Significantly above budgetHealthcare costs exceeded annual budget by over 3%Above budgetHealthcare costs exceeded annual budget by 1%3%At budgetHealthcare costs were with

25、in 1%of annual budget Below budgetHealthcare costs were 1%3%less than annual budget Significantly below budgetHealthcare costs were more than 3%less than annual budget 3%8%14%13%28%38%25%28%25%17%20232024(expectations)Were your organizations healthcare costs above,below or at-budget in 2023,and what

26、do you expect for 2024?8%SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICovera

27、ge of GLP-1s for obesityAffordability is the top priority As healthcare cost increases reach their highest levels in a decade,its no surprise that employers are prioritizing making healthcare more affordable(Figure 3).Many actions are on the table for companies to lower costs from assessing newer de

28、sign models,technology-enabled solutions and vendor partnerships.Drug costs continue to be a large driver of increased healthcare spend,and companies are looking closely at their pharmacy benefits seeking greater cost savings.They are considering alternative drug channels and pricing and taking a ha

29、rd look at their PBMs to assess whether they are delivering value.Wellbeing has been a top priority since the pandemic and remains a primary focus.Mental health issues persist across the workforce alongside significant financial concerns following the recent cost-of-living crisis.The key to success

30、is for companies to establish and implement a range of practices,policies and programs that are connected across the wellbeing continuum to ensure the range of needs across the workforce are met.2 For more details on the most effective programs and practices for companies to implement,see WTWs 2024

31、Wellbeing Diagnostic Survey.Companies are also increasingly focused on adding a broad set of resources to their portfolios to better meet the specific needs of a diverse workforce.This includes a range of solutions to support employees with specific clinical conditions,family life solutions and vari

32、ous inclusive benefits to support greater equity within the healthcare program.But ensuring these programs add value has never been more important which makes measurement a top priority.Many employers are also focused on employee experience,and revamping how they communicate with their workforce and

33、 are establishing a regular cadence on collecting employee feedback about their experience with employer programs.Finally,legal and compliance issues have become a much bigger priority compared with previous years.This is no surprise,as the legal and regulatory environment is rapidly changing,and fi

34、duciary responsibility lawsuits have been filed against large,self-funded employer health plans.Figure 3.Please rank your top health and wellbeing priorities from 1 to 5 with 1 being the most important,2 being the next most important and so forthPlease rank your top health and wellbeing priorities f

35、rom 1 to 5 with 1 being the most important,2 being the next most important and so forth.Affordability in coverage and design1Wellbeing of the workforce2Employee experience3Enhancing resources/programs4Communication and health literacy5Compliance6Evaluating vendor partnerships7Workplace culture8Suppo

36、rting marginalized populations9Technology and AI1066%50%41%38%30%25%22%12%9%6%Note:Percentages indicate ranked top 3.Companies are also increasingly focused on adding a broad set of resources to their portfolios to better meet the specific needs of a diverse workforce.62 WTWs 2024 Wellbeing Diagnost

37、ic SurveySummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for

38、 obesity7Creating affordable and competitive plan designs Affordability concerns are leading employers to take a close look at their plan designs (Figure 4).While companies are prioritizing their own budgets and making plan design changes to reduce company costs,most employers are also attempting to

39、 balance the way that cost increases are shared between the company and employees.Many companies recognize the importance of their healthcare program as a key factor in attracting and retaining key talent.In fact,employees cited the healthcare program as second in importance only to pay as a reason

40、for taking a new job in a separate survey.3 As companies continue to grapple with challenges retaining key talent,those making changes to their plan designs are focused on ensuring their healthcare programs are competitive relative to peer organizations and that they provide a range of program optio

41、ns and choices that support the needs of their workforce.What are your organizations main objectives behind your healthcare plan designs?Please rank your top 4,with 1 as most important,2 as second most important and so forth.Source:WTW 2024 Best Practices in Healthcare SurveyAffordability of designs

42、 for employerAffordability of designs for employeeDesigns to support talent goalsRange of coverage and designsHigh-value providers and careEquitable designsValue-based designs40%21%25%6%2%2%3%27%39%13%9%5%3%2%14%19%26%18%5%7%8%9%8%16%22%16%15%9%Ranked 1stRanked 2ndRanked 3rdRanked 4thFigure 4.What a

43、re your organizations main objectives behind your healthcare plan designs?Please rank your top 4,with 1 as most important,2 as second most important and so forth.3 WTWs 2024 Global Benefits Attitudes SurveySummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partner

44、shipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity8Figure 5.What actions has your organization taken or plan to take to address your healthcare c

45、osts?What actions has your organization taken or plan to take to address your healthcare costs?Source:WTW 2024 Best Practices in Healthcare SurveyPremium cost shiftingShift costs to employees through premium contributionsOut-of-pocket cost shiftingShift costs to employees through increased out-of-po

46、cket expenses in the plan designPass premium increases to employeesPass on impact of high premium increases above certain thresholds in part or in full to employee contributionsEliminate high-cost coverageEliminate or cut back certain coverage provisions that may be more generous than average or add

47、 costEliminate high-cost plansEliminate health plan options that exceed certain overall cost or trend levels42%28%20%8%5%34%28%27%25%18%Action taken in 2024Planning for 2025 or considering for 2026 Many employers continue to change plan designs to address cost,affordability and member needs.More tha

48、n half of companies(51%)have either shifted costs through premiums or increased out-of-pocket costs in the past year,and many more are planning to do so in the next two years(Figure 5).One in five employers is establishing policies that pass on the impact of high premium increases above a certain th

49、reshold onto employee contributions,and another 27%are planning to adopt this approach by 2026.Few companies are adjusting coverage and eligibility today,although one-quarter of companies are planning or considering eliminating certain generous coverage provisions that are driving costs,and nearly 2

50、0%are planning to eliminate health plan options that exceed certain overall cost levels.18%are planning to eliminate health plan options that exceed certain overall cost levels.SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative pl

51、an designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity9Addressing affordability for employees A growing challenge for employers is striking a balance between how costs are shared

52、 between the plan and employees while maintaining a competitive healthcare program.Plan affordability for employees is a growing concern,leading some employers to limit the additional cost increases on employees.In fact,nearly one-third of companies have absorbed the increases in healthcare costs wi

53、thout passing the higher fees onto employees,and one in five(21%)are planning or considering doing so for the future(Figure 6).Many companies have adopted more robust measurement approaches to understand the impact of rising costs on various segments of the workforce;many more are looking to connect

54、 their assessments of plan affordability with their broader efforts around financial wellbeing and diversity,equity and inclusion.Using these evaluations,more than one-quarter of companies have adopted policies to limit the cost increases on certain targeted groups such as low-wage employees,with an

55、other 13%looking to adopt this approach in the next two years.To help employees defray costs and manage their risks,companies are also expanding access to various benefits and providing additional financial support through accounts.For example,two-thirds of companies have already enhanced or plan to

56、 enhance their vendor solutions and are offering voluntary benefits to help employees manage their financial risks,especially in the event of a significant healthcare episode.In addition,many employers are planning or considering lifestyle spending accounts as a way for employers to allocate funds d

57、irectly to employees to support their healthcare and wellbeing needs.Figure 6.What actions has your organization taken or plan to take to address employee affordability?Evaluate healthcare affordabilityEvaluate benefit affordability of the healthcare plan based on salary,premiums and projected out-o

58、f-pocket costsVendor solutions and voluntary benefitsAdd/Enhance vendor solutions and voluntary benefits in case of a catastrophic eventAbsorb healthcare costsAbsorb additional cost from expense without reallocating from other benefits or payOffer Lifestyle Spending AccountsOffer Lifestyle Spending

59、Accounts(LSAs)Connect healthcare with financial wellbeingConnect healthcare affordability to broader financial wellbeing and diversity,equity and inclusion(DEI)strategyReduce costs for targeted groupsStructure payroll contributions that reduce costs for targeted groups like low wage employees or cer

60、tain job classes49%47%29%12%11%27%21%23%21%30%30%13%Action taken in 2024Planning for 2025 or considering for 2026SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critica

61、l view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity10Assessing vendor partnerships Beyond the traditional levers,employers are looking closely at their vendor partnerships to seek lower-cost providers.In fact,nearly all companies have take

62、n steps or plan to take steps to implement programs or vendors with the specific focus on reducing their total plan costs.In addition,one-third of employers took their health plan vendor out for bid through an RFP in the past year,and another 43%are planning or considering over the next two years(Fi

63、gure 7).Employers are also taking steps to scrutinize their vendors performance.More than three-quarters of companies are making greater use of ource:WTW 2024 Best Practices in Healthcare SurveyWhat actions has your organization taken or plan to take to address your healthcare costs?Please indicate

64、the extent to which yourorganization takes the following actions oruses data/metrics to evaluate its health andwellbeing activities.38%34%52%43%High-level market evaluationImplement programs or vendors that will reduce total costsTake plans and vendors out for bidTake vendor/health plans out to bid

65、through RFP to seek lower-/lowest-cost providerROI evaluationRequire vendor point solutions demonstrate a financial returnon investmentEffectiveness evaluationUse data to evaluate the effectiveness of vendor point solutions Action taken in 2024To a very great or a large extentPlanning for 2025 or co

66、nsidering for 202643%35%21%Not at all or to a little extentSomewhatEvaluate costsEvaluate performance41%33%26%data to evaluate the effectiveness of their point solutions and setting stricter requirements for vendor solutions to achieve positive financial returns.Figure 7.Employers assess vendor cost

67、 and performanceNote:Percentages may not sum up to 100%due to rounding.SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employ

68、ersOpportunities to expand the use of AICoverage of GLP-1s for obesity11Figure 8.Considering your healthcare strategy today,how important of a priority is using alternative network models or financial incentives to steer members toward high-quality and low-cost providers?How important of a priority

69、will it be in three years?7%12%27%40%29%33%23%10%15%5%Not a priorityLow priorityMedium priorityHigh priorityTop priority+18Embracing alternative plan designs There are limits to cost shifting and to the amount of savings employers can extract through vendor management.Many employers are starting to

70、move beyond these traditional levers and are turning to new plan alternatives,including alternative network strategies and the use of financial incentives to steer employees to providers with lower costs and higher quality of care.This strategy is a priority for about one-third of companies today,bu

71、t more than 50%of employers are looking to make it a high priority over the next three years(Figure 8).Currently,only 29%of employers have adopted network strategies that steer plan members to lower-cost or higher-quality providers or sites of care(Figure 9).But four in five companies(80%)have adopt

72、ed such strategies or are planning or considering adopting these strategies.This includes the use of narrow networks of higher-quality or lower-cost providers(18%)or tiered network plans with different out-of-pocket costs for different tiers of in-network providers(19%).Companies are also expanding

73、their use of restrictions,such as offering plan options that restrict or eliminate out-of-network coverage for nonemergency services(27%).Alternative plan options are also emerging that build greater transparency into plan design.For example,nearly one-third of companies are offering(and another 24%

74、are considering adding)a health plan that confirms coverage and provides details on out-of-pocket costs to support employee decisions prior to scheduling an appointment.To encourage adoption of these alternative programs,many companies are offering financial incentives that reduce member cost sharin

75、g.For example,three-quarters of companies currently offer lower contribution shares or lower point-of-care cost sharing for their narrow network plan.Note:Percentages may not sum up to 100%due to rounding.SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partners

76、hipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity12Figure 9.Which network and provider strategies does your organization have in place or plan to

77、 have in place in the next few years?29%51%80%Steerage through network designAdopt plan design or network strategies that steer to lower-cost or higher-quality providers,sites of care and so on.34%18%19%27%18%24%30%19%10%33%Out-of-pocket cost transparencyOffer a health plan that confirms coverage an

78、d provides details on out-of-pocket costs to support employee decisions prior to scheduling an appointmentNarrow networksOffer a narrow network of higher-quality and/or lower-cost providersTiered networksOffer plans with different out-of-pocket costs for different tiers of in-network providers(i.e.,

79、tiered network)Out-of-network restrictionsOffer plan option(s)that restricts or eliminates out-of-network coverage for non-emergency servicesReduce cost sharingAdopt alternative plan designs or models that reduce member cost sharing for higher quality/lower-cost healthcare choicesAction taken in 202

80、4Planning for 2025 or considering for 2026SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand th

81、e use of AICoverage of GLP-1s for obesity13Offer plan advocacyOffer plan advocacy and navigation solution(s)Expert medical opinionOffer an expert medical opinion programConcierge servicesOffer access to concierge services with integrated care management programs48%37%32%22%17%21%Action taken in 2024

82、Planning for 2025 or considering for 202648%Figure 10.Which specific plan design features does your organization have in place or plan to put in place in the next few years?Beyond plan designs to steer employees,the use of plan advocacy and navigation solutions has expanded in recent years to help e

83、mployees navigate the healthcare system and provide personalized advice to support their care management.Nearly half of companies (48%)offer navigation solutions today through their health plan or vendor solutions,with another 22%planning to add in the next two years(Figure 10).Employers have adopte

84、d other solutions that provide more targeted support,including expert medical opinion programs(37%)and concierge services with integrated care management programs(32%),which many more companies are looking to adopt by 2026.These solutions can provide personal contact with a health coach or care advo

85、cate,but many new technology-based solutions are emerging to support employees with high-cost clinical conditions.48%of companies offer navigation solutions today throughtheir health plan or vendor solution.SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partne

86、rshipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity14Supporting clinical conditions Employers have made significant investments in solutions to a

87、ddress their high-cost cases,which are a key driver of healthcare spend for many employers.Many new solutions have emerged that are designed to support individuals with various clinical conditions.In the past few years,mental health has been on the radar of many companies,as emotional health worsene

88、d during the pandemic.While mental health issues have improved more recently,stress and anxiety continue to plague the workforce,especially among younger employees.4 Companies plan to continue to enhance their programs around mental health.In fact,WTWs 2024 Wellbeing Diagnostic Survey found that the

89、 growing mental health crisis was the top driver of wellbeing strategy.5 By 2026,nine in 10 companies plan to offer additional resources to their workforce to support their mental health(Figure 11).Diabetes,obesity and musculoskeletal are other areas in which companies have taken action.Companies pl

90、an to invest more in these areas over the next few years.Emerging areas where additional investments are planned include cancer,cardiovascular and digestive health;more than twice the number of companies are planning to make investments in these areas in the future compared with today.Figure 11.Whic

91、h of the following clinical areas has your organization acted on or planned to act on as a means of improving member health?(Percentage of“actions taken/tactic used”)Mental/Behavioral health1Diabetes2Obesity and weight management3Musculoskeletal4Cancer/Oncology5Cardiovascular6Digestive health790%84%

92、83%80%68%56%43%51%45%30%35%29%22%8%69%59%43%51%33%28%19%202220242026*Note:*Planning for 2025 or considering for 2026.4 WTWs 2024 Global Benefits Attitudes Survey5 WTWs 2024 Wellbeing Diagnostic SurveySummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsE

93、mbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity15Covering GLP-1s for obesity One of the most significant trends in the past two years has been the e

94、xplosion in use of GLP-1 medications for weight loss.These medications offer significant potential to meaningfully reduce the rates of obesity,which have plagued many employer populations and have been a leading driver of chronic disease and higher-cost trends.Many employers have been examining the

95、pros and cons of these medications.Today,52%of employers offer coverage for obesity medications to their members up from 38%in 2023 (Figure 12).In addition,another 12%of employers are planning or considering adding them over the next two years;however,most employers are not providing unlimited acces

96、s to GLP-1 medications.Increasingly,employers are implementing various restrictions in addition to standard prior authorizations,such as requirements to participate in a lifestyle management program or requiring members to first try a less expensive medication before getting access to the more expen

97、sive GLP-1 drug regimens(Figure 13).While many more employers have adopted coverage,some employers have decided GLP-1 medications are not a good fit for their workforce.In fact,6%of employers have decided to remove GLP-1 drugs from their list of covered treatments for obesity,and roughly 8%more are

98、considering doing the same before 2026.The biggest stated concern among those that do not currently cover GLP-1 medications is the cost of the medication(70%)and their long-term safety(49%).Figure 13.Does your organization have any of the following restrictions in place for use of GLP-1 medications

99、for obesity?Require participation in lifestyle modification programRequire trial of lower-cost medication or lifestyle management program before GLP drugs14%10%7%1%55%27%30%23%Limit duration of therapy(lifetime or other limit)Limit prescribing to a narrow network of providersAction taken in 2024Plan

100、ning for 2025 or considering for 2026Sample:Companies that cover medications for obesity.Figure 12.Does your organization cover medications for obesity?In placePlanning for 2025 or considering for 202638%52%12%6%20232024+14Removed coverage in the last yearSummaryCost trends reach decade highsAfforda

101、bility is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity16Employers take a critical view of their pha

102、rmacy benefits Disrupting the current PBM model Pharmacy costs have been a major driver of healthcare cost trends in recent years.Employers are looking at many possible strategies to reduce plan cost while continuing to offer the most advanced treatments to support the health and wellbeing of their

103、workforce.In general,employers views of the performance of their PBMs are mixed.On the positive side,66%of employers say their PBM rebate program has been working well,and more than half of employers(54%)believe their PBM obtains the most advantageous pricing for their plan.But overall,the employer

104、views are less positive.When employers were asked whether they would recommend their PBM to a colleague at another company,only 25%responded favorably,while 35%responded unfavorably.This results in a net promoter score of 10(Figure 14).Figure 14.How likely are you to recommend your pharmacy benefit

105、manager(PBM)to a friend or colleague at another company?35%40%25%DetractorsEmployers who are dissatisfiedPassivesEmployers who are indifferentPromotersEmployers who are satisfied10NPS of pharmacy benefit manager(PBM)(Promoters Detractors)Source:WTW 2024 Best Practices in Healthcare Survey.SummaryCos

106、t trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity17 Employer

107、s are looking for alternative approaches to getting more value out of their pharmacy benefits.An important trend that has been gaining momentum in the past few years has been the increasing number of employers that are carving out their pharmacy benefits from their medical carrier.In 2018,53%of empl

108、oyers carved out their pharmacy benefits(Figure 15).PBM carve-outs are up to 63%today and are expected to increase to 73%over the next three years.Employers are beginning to look at alternative PBM partnerships.These alternatives include transitioning to new and smaller PBMs and departing from PBMs

109、with large market share to gain access to emerging offerings,such as an alternate pricing model.While only 4%of companies are doing so today,this could increase to 25%of employers if companies follow through with their plans(Figure 16).Employers are also looking to enhance the member experience with

110、 their pharmacy benefits,and 19%of employers are currently looking beyond their current PBM,with another 12%planning for this in the next two years.Figure 15.Does your organization currently carve-in to the medical carrier or carve-out its pharmacy benefits and what do you expect to do in the next t

111、hree years?20182024In three years47%53%37%63%27%73%Carve-inCarve-outUse a non-PBM vendorUse a non-PBM vendor to further support member experience Partner with new PBMPartner with a new,emerging PBM in place of the PBMs with large market share19%4%12%21%Action taken in 2024Planning for 2025 or consid

112、ering for 2026Figure 16.Which of the following pharmacy benefit management strategies does your organization have in place or plan to have in place in the next few years?SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan desi

113、gnsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity1849%28%19%13%6%15%21%17%18%17%Action taken in 2024Planning for 2025 or considering for 2026Utilize a transparent and pass-through

114、contract structure for rebatesCarve out any specialty pharmacy services/solutions Allow members to purchase drugs through a retail or“cost plus”outlet Have an acquisition cost PBM contract structure Promote drug discount cards or direct-to-consumer Rx delivery to lower out of pocket costs for covere

115、d populationsFigure 17.Which of the following pharmacy benefit management strategies does your organization have in place or plan to have in place in the next few years?Alternative drug channels and pricing models Beyond changes in PBM partnerships,employers are looking for different pathways forwar

116、d,including alternative drug channels and pricing to address the high rates of increase in pharmacy spend.For example,nearly 50%of employers are using a transparent and pass-through contract structure for rebates,and another 15%are planning or considering adopting this by 2026(Figure 17).In addition

117、,the desire to disrupt the current PBM rebate model is growing.When employers were asked about potential changes to their pharmacy programs,40%of employers responded favorably to eliminating rebates to obtain a lower list price at point of service.Companies are also promoting the use of direct-to-co

118、nsumer pharmacy delivery to lower out-of-pocket costs for covered populations.Others have already or plan to carve out their specialty pharmacy(36%),and some are planning to allow members to purchase drugs through a retail or“cost plus”outlet(18%).While only a small percentage of companies(6%)are cu

119、rrently using one of the alternate acquisition cost PBM contract structures,many more are looking at this model over the next few years(17%).SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical condit

120、ionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity19Evolving pharmacy benefits to support employees While reducing costs and delivering greater value is a top priority,employers recognize the need to continue t

121、o evolve their pharmacy benefits to support employee wellbeing and the member experience.Employers are taking a variety of steps,including providing first dollar coverage for preventive drugs,offering programs to maximize copay assistance and removing prior authorization for drugs with high approval

122、 rates leading to delays in treatment(Figure 18).Like the strategies companies are embracing with the medical plan,many more companies are implementing programs to reward members for using lower-cost pharmacy products or pharmacies with lower-cost sharing.Figure 18.Which of the following pharmacy be

123、nefit management strategies does your organization have in place or plan to have in place in the next few years?Drug coverage in HDHPsMaximize copay assistanceOffer programs to maximize specialty copay assistance/optimization Remove prior authorizationsRemove prior authorizations for drugs with high

124、 approval rates and little misuse Reward for using low-cost providersReward members for using lowest-cost Rx products or pharmacies with a lower-cost share/copay-Pharmacogenomic benefitsOffer pharmacogenomics benefits through health plan or third-party solution57%44%20%27%7%10%17%24%13%14%Action tak

125、en in 2024Planning for 2025 or considering for 2026Implement a preventive drug list to bypass the deductible and provide first dollar coverage in HDHPsSummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clini

126、cal conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity20Opportunities to expand the use of AI Adoption of AI within the healthcare plan and vendor solutions is in its infancy.Less than 10%of employers rep

127、ort that their healthcare program is using AI in any significant way.But the opportunities by many accounts are significant and have the potential to revolutionize many aspects of how healthcare programs are designed,delivered and administered today.What are the biggest opportunities?Nearly two-thir

128、ds of employers see the biggest AI opportunity in healthcare navigation solutions and personalizing recommendations to employees(Figure 19).More than half of employers(58%)believe that communication is another area in which AI will have an important impact.Employers also see an opportunity for AI to

129、 support program evaluation,administration and operation.In fact,AI is already being used to conduct medical claims audits to catch duplicate payments,missed discounts or billing errors.There is also momentum in the analytics space,with AI advancements being used to support broader predictive analyt

130、ics and vendor evaluations.Figure 19.Where do you see the greatest opportunities for AI in supporting your healthcare strategy?Select at most 3 options.Navigation solutions and personalized recommendationsCommunicationProgram evaluation and measurementPlan administration and operationsWellbeing prog

131、ramsHealthcare delivery through the healthcare systemMental health programsPerformance guarantees around the use of AI64%58%35%33%17%15%8%5%Nearly two-thirds of employers see the biggest AI opportunity in healthcare navigation solutions and personalizing recommendations to employees.SummaryCost tren

132、ds reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity21Key actions for

133、 employers 1.Evaluate new health plan designs that combine transparency and curated networks and consider network restrictions.2.Consider a PBM assessment/market check to evaluate newer solutions in the market.3.Critically review all vendors,including medical carriers,to assess whether programs are

134、adding value or lowering total medical expenditures.4.Use company-specific data and competitive position to evaluate coverage of obesity treatment.5.Limit premium costs and consider differentiated plans for lower-wage workers.6.Expand clinical priorities to include mental health,obesity and metaboli

135、c health,cancer and musculoskeletal disease.7.Demonstrate fiduciary responsibility and seek savings through careful procurement,auditing and monitoring of carriers and vendors.SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative pla

136、n designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesityAbout WTWAt WTW(NASDAQ:WTW),we provide data-driven,insight-led solutions in the areas of people,risk and capital.Leveraging t

137、he global view and local expertise of our colleagues serving 140 countries and markets,we help you sharpen your strategy,enhance organizational resilience,motivate your workforce and maximize performance.Working shoulder to shoulder with you,we uncover opportunities for sustainable success and provi

138、de perspective that moves you.Learn more at 2024 WTW.All rights reserved.WTW_164400/10/About the surveyWTWs 28th Annual Best Practices in Healthcare Survey was fielded online between June 10 and August 2,2024.The survey was completed by 417 employers with at least 100 employees in their U.S.operatio

139、ns.Respondents have an average of 5,000 employees and represent roughly 6 million employees under employer-sponsored insurance.Three-quarters of employees(78%)are enrolled in self-insured plans,with 22%enrolled in fully insured programs.The companies included in the survey represent all major indust

140、ries,and the workforces are geographically dispersed across the U.S.,with most employers(80%)located in 10 or more states.SummaryCost trends reach decade highsAffordability is the top priorityAssessing vendor partnershipsEmbracing alternative plan designsSupporting clinical conditionsEmployers take a critical view of their PBMsKey actions for employersOpportunities to expand the use of AICoverage of GLP-1s for obesity