WASHINGTON — Shifts in the U.S. healthcare system have employers looking to new solutions in coming years, officials at the National Business Group on Health (NBGH) told reporters at a press briefing announcing the release of the organization's annual survey of large employers Tuesday.

"Companies are making more investments in the health and well-being of their employees," Brian Marcotte, NBGH's president and CEO said. "They're looking at investments in employee health and well-being much in the way that they look at investments in training and development and safety within their organization."

Moreover, the issue of healthcare spend isn't just about rising costs — it's also about ensuring an engaged and productive workforce, Marcotte said. NBGH's survey included responses from 147 of its 440 member companies, representing more than 15 million covered persons.

"Medicare for All" featured prominently in the discussion of the study's results, which may be a reflection of the number of policy proposals made by U.S. presidential candidates in recent months. On the whole, NBGH-member employers have many reservations about Medicare for All, Marcotte said. A key issue on employers' minds, he added, is subsidization; employer-sponsored coverage pays providers at times much more than what Medicare does, Marcotte said, and there's concern about what provider payments will be in a single-payer system.

Concerns also stem from a lack of detail in Medicare for All proposals, Ellen Kelsay, chief strategy officer at NBGH, said at the briefing. "There's just quite a lot of concern about employers and the devil in the details, about whether these proposals would actually lead to an improvement in cost, quality and outcomes for covered family members."

Respondents were slightly more positive about Medicare expansion generally. A majority of employers (51%) said that Medicare should be expanded, but those responses diverged when discussing specific age groups: 23% said it should be expanded to people ages 60-64, 23% to people ages 50-64 and 9% to people ages 55-64.

When it came to changes within their own healthcare plans, employers indicated increased interest in advanced primary care strategies as a way to address the whole-person aspect of healthcare, Kelsay said. Strategies like switching to a physician-based accountable care organization (ACO) or creating an on-site primary care center are partly a move away from fee-for-service models toward a whole-person approach to employee health that factors in social determinants of health, she noted.

"Healthcare is local, and employers are really looking to do things differently to engage their population at the primary care level," Kelsay said, adding that a key consideration is the cost that primary care can have on a person's overall care.

Virtual care continues to proliferate in the U.S. as employers seek more and more solutions, Marcotte said. Sixty-three percent of employers said these solutions would have a significant impact on healthcare delivery next year, an 11 percentage point increase from NBGH's survey last year.

Much of the growth has been in musculoskeletal treatments like physical therapy, which is still challenging for health plans and patients given the time and financial investment needed to follow treatment plans, Kelsay said. Virtual solutions could provide remote physical therapy treatments for employees, who can do them either at home or in the workplace.

Mental and emotional health is already a high-growth area for virtual care: 73% of respondents said they had already implemented a virtual care solution for mental and behavioral health in 2019, and 9% planned to do so in 2020. Marcotte and Kelsay said this could address some of the access issues that employees in diverse parts of the country experience when seeking this type of care.

"Particularly [in] rural areas, mental health is a significant access issue," Marcotte said. "Virtual solutions can really help address mental health, not only for rural areas, but also for people who are not comfortable going to see someone face-to-face."