By Kurt Cegielski, Chief Commercial Officer, MOBE
As we look down the road toward 2025, the health benefits industry continues to evolve at a rapid pace. Earlier this year, I described five predictions for health plans and employers in 2024, an analysis of the key trends expected to shape the health benefits landscape this year.
As the industry navigates through unprecedented challenges and transformative opportunities, it's clear that the paradigm shift predicted at the start of the year is indeed taking place. From the intensified focus on hard ROI to the growing emphasis on whole-person health, these trends are reshaping how health plan and employer programs are delivered, managed, and evaluated.
As change continues to accelerate in our industry, new trends have emerged in the months since these initial predictions appeared. In this update, I’ve turned to recent data from industry experts, and MOBE’s own data-backed insights, to dive even more deeply into what health plans and employers can expect for the remainder of 2024 and beyond.
At the beginning of 2024, it was clear the concept of Value on Investment (VOI) would give way to a more stringent focus on Return on Investment (ROI). This prediction has proven to be remarkably accurate as the year has progressed.
The shift toward hard, quantifiable ROI has intensified even more than initially anticipated. Employers and health plans are now demanding clear, data-driven evidence of cost savings and improved health outcomes to justify their health care expenditures. This trend has been largely driven by the continued rise in health benefits costs, particularly in areas such as specialty medications.
We know that the skyrocketing demand for GLP-1 medications has forced employers to take a closer look at their benefit program investments. These medications, while effective for diabetes and weight management, come with a significant price tag. In July, Gallagher’s 2024 US Physical & Emotional Wellbeing Report reports that 71% of employers expect these drugs to increase their overall health plan spending significantly in 2024. Obviously, this is prompting employers in particular to continue to evaluate the ROI of specific programs and overall benefit portfolios in what has been coined the Great Re-Evaluation.
Data from the Business Group on Health’s 2024 Employer Health Care Strategy Survey, which surveyed 125 employers including more than 17.1 million participants, also supports this point, stating that “Managing and reassessing vendor partnerships are at the center of employers’ plans to address costs and improve performance.”
As 2024 progresses, the emphasis on hard ROI is expected to intensify further. Health plans and employers will continue to seek solutions that offer measurable returns, focusing on strategies that reduce costs, improve individuals' health, and ensure sustainable, long-term benefits.
The second prediction made at the start of 2024 was that plans and employers would increasingly understand the value of meaningful engagement in improving utilization and ROI. Recent industry shifts have underscored the growing importance of sustained and meaningful engagement in health benefits programs. Research from MOBE Special Report that analyzed actual program data from a large health plan reinforces that deeper engagement along a continuum—not merely binary participation—yields substantial benefits for both health outcomes and cost reduction. Based on data from an actual program for a large health plan, MOBE's data demonstrated that engaging members beyond superficial levels leads to double digit reductions, as high as 16.3% in per-member-per-month (PMPM) costs for highly engaged populations.
The shift toward engagement is proving essential, as many health plans still view engagement through a simplistic “on/off” lens, which misses the nuances of deeper involvement. Data from the aforementioned MOBE Special Report found that a binary approach fails to engage more than 10% of the intended population. However, by using a more granular engagement spectrum, health plans can identify early signs of participation, even if minimal, and leverage these to foster deeper connections.
Moreover, this deeper engagement directly correlates with better health outcomes. Research from a meta study by the National Institutes of Health demonstrated that strong engagement can lead to:
In addition, the NIH data noted that programs focusing on consistent, long-term engagement are more likely to see sustained behavior changes among participants, ultimately improving utilization and reducing health care spending.
At MOBE we believe health plans and employers will continue to adopt this multi-tiered engagement model as more and more data becomes available on its impact on ROI and health outcomes. In fact, nurturing deep engagement could soon be considered mission-critical to reduce costs while still driving long-term improvements in population health.
Everyone on the MOBE team is pleased to see growing recognition of CMM to positively impact health outcomes and cost savings. This year, CMM gained significant traction in our industry and in health care overall, driven by recently published data.
As increasingly more data and actual use cases emerge, the number of physicians and practices incorporating CMM will continue to grow, providing a substantial impact on millions of people, not only those living with chronic conditions.
In my fourth prediction for 2024, I noted the industry “… would increasingly accept health improvement as a complex iterative process rather than a linear journey.” This prediction has proven to be remarkably accurate, with significant implications for how health plans and employers approach behavior change and health management.
In 2022, the US Chamber of Commerce commissioned Avalere Health to study the impacts of a whole-person approach to benefits and individual health outcomes. Data from a recent study commissioned by the US Chamber of Commerce states that by 2026, the adoption of behavior-focused programs is expected to rise by 25%, with 86% of employers seeing these programs as key to addressing chronic conditions.
Social determinants of health (SDoH) cannot be ignored when evaluating this trend, either. Recent data suggests that addressing SDoH, such as access to care, housing stability, and food security, is essential to fostering long-term behavioral changes. A 2024 report from the Marshall McLennan Agency found that, remarkably, 82% of health outcomes are attributed to SDoH. And these factors impact costs significantly as well. The same report states that individuals with just one unmet social need experience on average 10% higher health care costs.
As health benefits programs continue to evolve, the focus on long-term behavioral change continues to gain momentum, particularly as more organizations adopt holistic, personalized, and iterative approaches to health management.
My fifth prediction for 2024 anticipated that plans and employers would adopt a more integrated approach to health management, combining lifestyle and medication management strategies. At MOBE, we continue to see this trend play out this year as whole-person health becomes a central strategy for improving health outcomes.
Whole-person health emphasizes the integration of traditional medical care with mental health support, nutrition, lifestyle changes, and social determinants of health. The VA's Whole Health program conducts research that reinforces this, showing that veterans participating in whole-person care programs experience better health outcomes and greater satisfaction with their care. Veterans enrolled in these programs showed significant reductions in opioid use and improvements in chronic pain management—outcomes that would be difficult to achieve through standard medical treatments alone.
As 2024 progresses, whole-person health continues to grow in prominence, especially as more organizations recognize the need for a fully integrated health approach that addresses both the physical and emotional needs of their populations. The VA’s evidence-based findings, data from credible industry researchers, and MOBE’s own data analysis all suggest that whole-person health strategies lead to better health outcomes but also increased engagement and satisfaction from participants.
As the health benefits industry continues to evolve in line with the predictions made at the start of 2024, two interconnected trends have also gained significant traction: enhanced collaboration between providers and health plans, and the growing demand for GLP-1 medication programs.
The focus on collaborative care models has intensified as the year has progressed. Value-based arrangements are increasingly popular, offering mutual accountability for patient outcomes. As we found in the specific health plan program analysis covered in our aforementioned MOBE Special Report, greater provider engagement can lead to improved patient outcomes and overall cost reductions of as high as 9.5% annually.
This enhanced collaboration aligns perfectly with the shift toward whole-person health and the focus on long-term behavioral changes. By working together more closely, providers and health plans can create more comprehensive, coordinated care plans that address all aspects of a patient’s health. This approach not only improves health outcomes but also contributes to the hard ROI that employers and health plans are increasingly demanding.
Alongside this trend, the growing demand for formal GLP-1 programs is forcing employers to rethink their coverage strategies. Mercer’s report on Health and Benefits Strategies for 2025 states that 60% of employers are expected to offer GLP-1 coverage by 2025. The integration of GLP-1 programs into existing health plans requires careful consideration and strategic planning. Employers are grappling with questions of eligibility criteria, coverage limits, and how to integrate these medications into broader health management programs. Some organizations are exploring innovative approaches, such as coupling GLP-1 prescriptions with comprehensive lifestyle modification programs to maximize long-term health benefits and ROI.
The rise of GLP-1 programs also underscores the importance of the other trends discussed earlier. For instance, the whole-person health approach becomes crucial when considering GLP-1 treatments, as these medications are most effective when combined with dietary changes, increased physical activity, and ongoing medical supervision. Similarly, the focus on long-term behaviors is essential, as the benefits of GLP-1 medications are best maintained through sustained lifestyle changes.
As we look toward 2025, the interplay between enhanced provider-plan collaboration and the growth of GLP-1 programs will likely continue to shape the health benefits landscape. Organizations that can successfully navigate these trends, balancing innovative treatments with cost management and comprehensive care approaches, will be well-positioned to improve health outcomes while managing expenditures effectively.
Organizations that embrace these changes, focusing on data-driven decision making, meaningful engagement, integrated whole-person care approaches, and strategic management of innovative treatments like GLP-1s, will be well-positioned to navigate the challenges and opportunities that lie ahead. By doing so, they can not only improve health outcomes and reduce costs but also contribute to a more sustainable and patient-centered health care system for all.
Kurt Cegielski | Chief Commercial Officer | MOBE
He has more than 20 years of experience in health care technology. A co-founder of RedBrick Health (now Virgin Pulse), he has held senior leadership roles focused on transforming health care and empowering individuals. Kurt is committed to MOBE’s mission of providing innovative solutions that engage members, improve health outcomes, and reduce costs for health plans and employers.
