Access and Affordability

Clinical physician talking to patient on computer

As concerns about health and well-being become the new standard, the pandemic will likely have a powerful effect on members and plan sponsors for years to come.

Clinical physician talking to patient on computer

The Uncertainty Continues

As we enter the third year of the pandemic, many employees remain less than enthusiastic about the ways employers have attended to their needs and concerns. A majority of workers at 62% report their employer has implemented policies and practices to ensure workplace safety in the face of COVID-19. But it’s important to note that this number leaves a substantial minority who don’t feel safe at their workplace. At the same time, employees’ responses grow considerably less favorable when it comes to their personal health and well-being.

Doctor taking patients temperature

Consumers’ perception of organizational support throughout the pandemic:


Considering that only 44% of members report any modification of their benefits plan in response to the pandemic, it’s understandable that less-than-satisfied members are voicing their concerns to plan sponsors. 44% of HR decision-makers and 45% of health plan leaders report receiving new requests from members who identify benefits as an essential resource. However, these audiences are less decisive about what specific benefits their employees and members need.

Plan sponsors aren’t ignoring the problem, nor are they ignoring their members. In fact, enterprise stakeholders are working to implement a wide variety of changes. The question is: Will these changes be enough to solve for members’ varied demands and concerns?

Consumer requests received by HRDMs/HPLs over the last 1-2 years:

Consumer Concerns: Perception vs. Reality

Consumers remain deeply concerned about the current costs of health care, even with employer-provided health plan benefits. Those concerns have only grown more urgent since the early days of the pandemic. These findings are surprising, given that today’s tight labor market is advantageous to employees who might prioritize a job with the right benefits. Even though many workers have the power to “upgrade” to a new job with better benefits, this overwhelming anxiety about costs makes them feel uncertain.

Woman on phone discussing her medical benefits with clinical expert

Consumers’ concerns about their current health insurance plan:


An effective network solution can help solve for concerns about affordability while maintaining access. Our Optimized Network Efficiency (ONE) Method, helps clients realize maximum savings while registering minimal change for members.

Given the uncertainty about affordability, it’s becoming increasingly common for consumers to adopt measures to minimize health care costs. On one hand, the fact that they are taking steps to make the most of their health plans suggests that plan sponsors are doing a good job of educating and engaging their members. However, the increase in deferred health services and/or care (up from 18% to 21% in 2021) is concerning, especially in context of the ongoing pandemic.

Consumers’ active cost-reduction efforts (and the need to dip into savings accounts) suggest that they are not just reactively deferring care, but also pre-emptively bracing for significant medical bills to come.

Steps taken by consumers in the past 12 months to manage health care costs:


Seeing a provider who is in-network matters more to women, while convenience in terms of location and access to a provider who is like them matters more to men. Going with the lowest priced option is most likely to drive the decision for Gen Z, compared to all other generational groups.


When consumers’ health care plans fail to meet them where they are, they are willing to look elsewhere, including outside their plans. A number of digital, direct-to-consumer (D2C) health care solutions have emerged, allowing consumers to bypass the health care system and get what they need directly from these services. In the past, D2C health care enterprises have been limited to skincare, dental products and over-the-counter medications.

More recently, digital entrants have begun shipping generic medications directly to consumers. Others offer virtual provider visits, including both medical and behavioral health. For current users of D2C solutions, the primary motivator is convenience. But the potential for cost savings also remains attractive to persuadable consumers.

Consumers’ reasons for having used digital D2C health care solutions:

Of those consumers who have not used a digital D2C health care solution, factors that would motivate them include:

Among consumers, 19% report having used D2C solutions for specific types of care, while 44% of those who have not used D2C solutions indicate that they are likely to do so. This indicates an imminent shift in consumer behavior if traditional benefits fail to solve ongoing challenges regarding access to care, convenience and cost.

HR decision-makers and health plan leaders express deep concerns about the disruptive potential of digital D2C health care solutions. However, they remain unclear about which of those options poses the greatest threat to traditional benefits.

Plan sponsors’ level of concern about employees seeking treatment outside of employer-sponsored benefits:


Plan sponsors who are concerned about using health solutions outside of their employer-sponsored benefits should ensure the needed cost-saving solutions are in place to address members’ concerns. Through the Patient Assurance ProgramSM, we work directly with pharmaceutical manufacturers to ensure people who need insulin get the access and affordability they need, lowering copayments to $25 at the point of sale.

Consumers are seeking expansion of their benefits at the same time as they voice concerns about those benefits being reduced. Consumer pessimism about health care costs includes predictions about the future, suggesting these trends are likely to continue without an active correction from benefits providers.

Top three consumer concerns about future reduction in benefits:

Two clinicians discussing patients care

The Search For The Right Solution

HR decision-makers are receptive to many employee concerns and rightly anticipate a variety of challenges in the post-pandemic era. But benefits-related areas—particularly budgeting—tend to take lower priority relative to workplace policies and concerns. HR decision-makers are actively looking to improve benefits and to augment member experience. Cost—to members and to organizations—remains a consideration, but hardly the primary one.

Top three consumer concerns about future reduction in benefits:

“We intend to mitigate costs by offering higher deductible plans, and to expand benefits offerings to make our company more attractive to future hires and keep those who already work for us.”


Plan Sponsors’ Description of Their Organization

“We have seen tremendous growth in direct to customer health care services. We can provide plan sponsors with the insights and clinical support members need to navigate and connect to the right level of care, which in return, leads to greater plan savings.”




Plan sponsors have an opportunity to collaborate with members, rather than simply reacting to the uncertainty in the health care benefits environment. By entering into a dialogue with members, plan sponsors can both prioritize health care cost-savings and offer them reassurance that there is no imminent reduction in benefits.

Looking Ahead

While the past few years have been marked by disruption and unpredictability, the patterns that Evernorth has identified indicate the start of greater consistency—and the evolution of a new standard in the delivery of health care benefits.

Informed by insights, we can continue to drive progress. Through close collaboration and communication, we can unlock new potential. Elevating health for people, for businesses—for all.

Man looking optimistic about his future with healthcare
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