Rising employer healthcare costs are sharpening the business case for preventive care and the numbers are stark.
"We've looked at our own populations through claims analyses, and we see when you keep people healthy, you can avoid them progressing into these high-cost claimant categories," Mansur told Insurance Business Benefits. "There's about 10 high-cost claimants per 1,000 people; we can keep that to about half if you implement the program and we deliver on the program in the right way."
High-cost claimants, defined by EHE as individuals generating $100,000 or more in annual claims, represent one of the fastest-growing cost pressures on employer health plans.
Mansur described the drivers as largely preventable: cancers, major cardiovascular events, and unmanaged chronic conditions such as diabetes.
"If you don't get your arms around that ahead of time, what can you do?" he said. "You can't manage high-cost claimants once they're there. You can, but you're not going to have as much of an impact as avoiding it in the first place."
The stakes are rising with employer healthcare costs climbing steadily in recent years, driven by specialty pharmaceuticals, hospitalizations, and an aging workforce. Prevention programs can be part of the conversation, though Mansur noted that employer appetite often stops short of the long-term commitment the strategy requires.
"The trend is so pronounced and they're looking for the quick fixes, the ones that think there may not be enough time to solve that problem," he said. "But that's actually not in their best interest over the long haul; you do need to act on these things now to be able to get ahead of them over time."
The business case for preventive care rests on a troubling baseline.
According to commercial health plan data that EHE has analyzed, only one in three adults currently uses preventive care on an annual basis as recommended, leaving roughly two-thirds of an employer's population disengaged from the healthcare system until a problem forces their hand.
That engagement gap is precisely the challenge benefits brokers face when presenting prevention-focused solutions to employer clients. Mansur said it is the question he hears most often from employers. "It's like, how do I get people to use this? It's free. Why aren't they using it?"
EHE's approach which Mansur described as prevention designed as a structured program rather than a standalone wellness benefit, bundles all recommended adult screenings with health coaching around diet, physical activity, and sleep, and adds a health navigation layer for the roughly one in three members who present with follow-up needs.
For employers with shift worker populations, on-site pop-up preventive clinics remove access barriers entirely.
On engagement, he acknowledged the gender disparity: "men are worse than women" in taking up preventive care, but said the program's multi-channel communication approach, on-site promotion teams, and incentive structures achieve a relatively balanced gender split in practice.
With the market crowded by programs ranging from genuine population health interventions to repackaged wellness benefits, Mansur outlined three criteria brokers should use when evaluating vendors on behalf of employer clients.
First is accessibility - the ability to actually get members in front of a clinician. "The real problem is people can't get in to see doctors. We've done tests in different markets: you call the docs in a directory of a health plan and half of them don't pick up the phone," he said. "If they say they're accepting new patients, you can't get in to see them for two months. So the first thing to really look at is, is there an accessible product here that actually is going to be used?"
The supply-side reality is severe. Mansur cited figures indicating that of approximately 500,000 US physicians who trained in primary care, only about half are actively practicing it, in part because primary care ranks among the lowest-paid physician specialties on the Medicare reimbursement scale. "Primary care is not valued," he said, "and that's not the right system."
The Health Resources and Services Administration (HRSA) has projected ongoing primary care shortages across large parts of the country, a structural constraint that prevention programs must work around if they are to deliver on their promises.
Second, Mansur said brokers should assess whether a vendor's program is integrated with the employer's existing point solutions.
He described what he calls "clinical authority" or physicians within a prevention program directly recommending condition management resources that the employer already offers.
"The engagement rate we get with our employers' point solutions is dramatically higher than what they get just going through the traditional system, because the everyday physician doesn't know what employer X and employer Y is offering to their population," he said.
That integration matters increasingly as employer benefits landscapes have grown fragmented.
"When I started out in this industry, over 30 years ago now, all these big employers had HMOs all over the place," he said. "Over time they started adding in all of these point solutions, and some of them have like 20, 30 different solutions. An employee would have to work full time to figure out what all of those things do for themselves."
Third is engagement infrastructure; the tactical portfolio a vendor can deploy to move disengaged employees into the program over time. Measurement, Mansur noted, is "table stakes."
Beyond the direct cost argument, Mansur highlighted a retention benefit that benefits brokers can use when building the business case with plan sponsors.
EHE, which has been operating in the preventive healthcare space for more than a century, has internal data shows that employees who engage in the company's preventive program stay with their employer longer than those who do not.
"They're not only getting the benefit of the employee getting value out of this benefit, that, by the way, they pay out of pocket for too," Mansur said. "It's thousands of dollars employees are paying out of pocket just to have access to employer health insurance." The retention gain, he argued, compounds the health cost savings over time because the employer is present to realize both.
The objection he most commonly hears is that prevention's benefits are too delayed to justify near-term investment. But he says this misses that dynamic. "If you do the program the right way, the employer can reap that benefit because that employee will be there."
For brokers, his rebuttal to brokers’ employer clients who say preventive care is already covered in their health plan is equally direct. "Only one out of three is doing it," Mansur said. "Wouldn't you rather it be two out of three or north of that number?"
