Dave Guilmette, Alight

Jan. 16, 2025 | Employee Wellness

Employer-sponsored healthcare has long been a highly valued benefit for over 60% of employees—and with good reason. Healthcare is expensive and can lead to financial hardship in the absence of a comprehensive, affordable health plan. Yet, navigating the U.S. healthcare system has become increasingly challenging for employees, leading to widespread frustration and lack of understanding in the investment employers are making to help workers improve their wellbeing. 

Rising costs for medical treatments, prescription drugs, and specialty surgeries, combined with primary care shortages are making it difficult for individuals to access necessary care. And for the majority of employees enrolled in an employer-sponsored health benefit, they are subject to large deductibles and out-of-pocket maximums that create a significant care affordability challenge. While the core insurance provides meaningful protection against catastrophic healthcare financial risks, it has become a barrier to accessing everyday care. Consequently, many defer treatments or struggle to navigate their options, creating widespread health challenges that impact individuals and employers alike. The situation is so pervasive, it led the Journal of the American Medical Association (JAMA) to proclaim that “complexity in the U.S. health care system is the enemy of access and affordability.”

Take, for example, the growing primary care shortage. Nearly one-third of Americans don’t have a relationship with a primary care physician. This gap leaves many unprepared when unexpected medical events occur, such as an injury or sudden illness. In their moment of need, many seek emergency care, racking up unnecessarily high bills and clogging an already overwhelmed system.

This lack of understanding also leads to low utilization, with just 66% of people using their employer-provided health benefits. That number falls to 37% for mental health benefits and 40% for wellness programs. As they seek to navigate a maze of benefits and options they may not fully understand, many end up rushing into treatments without asking the right questions or taking advice from someone who is not a healthcare professional. As a result, nearly 60% of employees say they regretted a health decision they made in the past year, according to the 2024 Alight International Workforce and Wellbeing Mindset Study.

The consequences are catastrophic. A 2024 study by The Commonwealth Fund comparing the healthcare systems of 10 wealthy nations found that Americans “live the sickest lives” and have the “most preventable and treatable deaths,” despite the U.S. spending the most on healthcare. As one of the co-authors of the report stated, “The data makes it clear: spending more doesn’t guarantee better health outcomes.” The conclusion: “The status quo…is not sustainable.”

Looking ahead, prospects for a brighter future look bleak, with healthcare spending in 2025 and 2026 expected to grow 10% or more. What’s more, access to healthcare is expected to become even more difficult, with the Association of American Medical Colleges (AAMC) projecting a shortage of up to 86,000 physicians—both primary and non-primary care—by 2036. The intensifying crisis will force many people to delay or forgo necessary treatments, leading to poorer outcomes for the individual and an inability for the employer to achieve the desired return on investment.

It is unlikely that employers will spend more on richer health benefit programs that lower or eliminate cost-sharing elements such as deductibles and coinsurance—these changes have costly price tags. But what if instead, employers were to focus on reducing the complexity of the benefits portfolio in place today—assume a role that goes beyond offering benefits to actively building employees’ understanding and use of the great benefits that already exist?

Creating a connected benefits ecosystem, simplifying usability, prompting the right next best action for an employee or family member at time of need, encouraging employees to purchase inexpensive supplemental benefits products or services and engaging in high-impact wellbeing programs are all a direct means toward improving health outcomes and optimizing the significant investments being made to improve workforce health and wellbeing. In doing so, employee disposition also changes as their trust in their employer and appreciation for the investment their employer is making in them grows substantially.

Employers can—and must—play a transformative role in bridging healthcare gaps by delivering benefits that are personalized, intuitive, and easy to understand and utilize. Offering a comprehensive benefits package is part of the answer—focusing on simplifying the experience for individuals, addressing accessibility, and providing decision-making support year-round unlocks the full value of the benefits package.

Imagine a young professional who doesn’t typically interact with the healthcare system. If this individual suffers an injury, they might face challenges like navigating leave administration, determining what’s covered, or even realizing they have benefits like an accident policy that could provide significant financial support. By connecting them to the right resources and making it easy to utilize their benefits, the process shifts from frustration to empowerment.

By leveraging digital tools and targeted support, companies can guide employees to the right resources, encourage proactive health management, and ultimately enable healthier, more financially secure lives. From artificial intelligence to machine learning, technology will play a critical role in this new benefits model. Organizations will also need to leverage data and partner with benefits providers, consultants, and other stakeholders to provide them with expertise, guidance and support.

Technology is merely the enabler, however. The guidance, empathy, and high-touch support delivered by highly trained consultants is a key component of this strategy. Providing such assistance anytime, anywhere via phone, email, or chat enables employees and their families to navigate the simplest or most complex issues—from appointment setting and provider recommendations to procedure cost estimates and coordination of care.

The trends are clear: healthcare spending is climbing unsustainably, projected to reach 30% of GDP by 2028. Many Americans face affordability crises despite having health coverage, with high out-of-pocket costs creating barriers to essential treatments. Add to that the growing complexity of the U.S. healthcare system, which is leaving many employees without the resources or guidance needed to navigate their health journeys.

Addressing these issues will require systemic changes focused on value, affordability, and accessibility. Employers are best positioned to drive this shift to help employees and their families navigate and succeed in this landscape. For HR leaders, this means prioritizing initiatives that provide genuine support across physical, mental, and financial health. In doing so, they will create a workplace culture where employees feel valued and empowered, while addressing critical deficiencies in the broader healthcare landscape.

Dave Guilmette is the Chief Executive Officer at Alight.

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