The latest projection from the National Business Group on Health is a number every benefits leader needs to internalize: a 6.5% average jump in employer health care costs for 2026. That’s well ahead of general inflation, and it was the central topic of conversation at the Employee Health Care Conference in Chicago. The pressure to get creative with benefits strategy is intense. So what did the data from the conference actually show, and what can you do about it now?
Key Takeaways
- Mental health is getting serious investment, with 78% of employers set to expand virtual behavioral health access by Q3 2026.
- The move to value-based care is picking up speed, as 45% of large employers are in active negotiations for bundled payment deals.
- Pharmacy benefit management (PBM) is a major headache, with over 60% of benefits leaders unhappy with the lack of PBM transparency.
- Onsite and near-site clinics are growing, with a projected 15% increase in use by companies with more than 1,000 employees by the end of 2026.
The Staggering 78% Surge in Virtual Mental Health Investment
The number that really jumped out at the Chicago conference was that 78% of employers plan to expand virtual behavioral health access by the third quarter of 2026. This is a fundamental reorientation of how companies see mental health support, finally moving it out of the dusty corner of low-utilization Employee Assistance Programs (EAPs). For years we’ve seen data from groups like the Kaiser Family Foundation showing rising anxiety and depression, especially after the pandemic, and the switch to virtual platforms is a direct attack on the old barriers of access, stigma, and sheer inconvenience.
I talked with a few benefits consultants on the conference floor, and they all said the same thing: this isn’t just about bolting on another vendor. The real work is integrating these platforms into primary care networks for smooth referrals and using analytics to actually track if people are getting better. Smart companies are now negotiating directly with providers for dedicated therapists and shorter wait times for their people, which is a world away from the old EAP model. This proactive investment should improve well-being and reduce long-term health costs by catching mental health issues before they become expensive physical ones. It makes sense, since untreated mental health conditions already cost employers billions a year in absenteeism and presenteeism.
45% of Large Employers Embrace Bundled Payments: The Value-Based Shift
Another big number from the conference: 45% of large employers are now negotiating bundled payment arrangements for specific medical procedures. This massively accelerates the move to value-based care and away from the chaos of fee-for-service. Bundles are simple in concept, one single payment for an entire episode of care like a knee replacement or childbirth, which forces providers to be efficient and focus on quality to protect their margin. It’s a direct counterattack against the unpredictable and ever-rising costs of traditional billing.
This is all about getting control over costs. We’ve seen the federal government do it, the CMS report on its Bundled Payments for Care Improvement (BPCI) Advanced model showed it could cut spending without hurting quality, and now employers are finally catching on. At the conference, we heard from companies right in Chicago’s Loop that are saving 10% to 15% on orthopedic surgeries with bundled contracts versus their old fee-for-service bills. This whole approach aligns incentives for everyone involved in a patient’s care, from the first consult to the last day of rehab, which means better outcomes and fewer expensive complications. Yes, it demands good data sharing and real partnerships with provider networks, but the results in cost predictability are getting too big to ignore.
The 60% Dissatisfaction Rate with PBM Transparency: A Call for Reform
It was no surprise, but still shocking, to see the number: over 60% of benefits leaders are unhappy with their Pharmacy Benefit Manager’s (PBM) reporting. The frustration is hitting a boiling point. We all know PBMs manage drug benefits and negotiate prices, but their black-box business model around rebates and formularies has been a problem for years. Most employers I talk to have no real idea where their pharmacy dollars are going or if they’re getting a decent deal.
The message in Chicago was loud and clear: employers want total transparency. That means seeing every revenue stream, every drug cost breakdown, and every reason behind a formulary decision. I heard multiple stories from benefits pros who only found hidden fees or rebate games after they paid for a painful, independent audit. You just can’t run a partnership that way. This is why we’re seeing a huge shift toward pass-through PBM models where the employer gets all the rebates and just pays a flat admin fee. It’s not a perfect solution, but at least the money is easier to follow. PBMs will have to adapt or watch their clients walk away to more honest brokers or even try to manage pharmacy benefits themselves.
15% Increase in Onsite/Near-Site Clinics: Bringing Care Closer
The last big projection was a 15% jump in the adoption of onsite or near-site clinics among companies with over 1,000 employees by the end of 2026. This shows larger employers are tired of waiting and are taking direct control of primary care for their people. These clinics can do everything from basic checkups and preventive screenings to managing chronic conditions, all right there where people work or live.
The upsides are clear. Employees get easy access to a doctor, often with no copay, so they don’t put off getting care. Employers see lower costs because they’re focused on prevention and catching problems early, which keeps people out of the ER. A clinic can also be designed for a specific workforce. I’ve seen this work at a manufacturing plant near O’Hare Airport where a well-run clinic cut workers’ comp claims dramatically just by handling minor injuries on the spot and providing good occupational health support. It’s an upfront investment in a building and staff, but the payback in productivity and lower long-term costs is usually worth it.
Challenging the Conventional Wisdom: The Myth of “One-Size-Fits-All Wellness”
Even with all this data flying around the conference, I couldn’t shake the feeling that too many people still believe in the myth of the “wellness program” as a cure-all. The old playbook of offering a gym discount and a generic health portal just doesn’t move the needle anymore, and the engagement data proves it. The problem is these programs ignore reality: a 25-year-old software engineer in downtown Chicago needs completely different support than a 55-year-old warehouse manager out in Cicero. How can one program possibly serve them both?
Wellness isn’t a program you buy. It’s a culture you build. Real engagement comes from personalized support, resources that understand different cultures, and leaders who do more than show up for the annual biometric screening photo op. Instead of a “steps challenge,” maybe your people need a financial wellness program because, as the American Psychological Association points out, money stress makes people sick. Or maybe they need better support for chronic conditions or more generous parental leave. We need to stop with the superficial stuff and build solutions based on the actual demographics and risks of our specific workforce. Anything less is just checking a box.
The main takeaway from the 2026 Employee Health Care Conference in Chicago is that you have to be proactive to get ahead of rising costs. The strategies that work, investing in virtual mental health, shifting to value-based care, demanding PBM transparency, and building accessible onsite clinics, all require a real commitment. Incremental changes won’t cut it anymore. It’s time for a complete overhaul of benefits strategy if you want a healthy organization.
Projected 2026 health care cost increase:
The National Business Group on Health projected an average increase of 6.5% in employer health care costs for 2026, putting more financial pressure on companies.
Employer strategy for mental health in 2026:
A large majority (78%) of employers are expanding access to virtual behavioral health platforms by Q3 2026, making a major investment in accessible mental health support.
The role of bundled payments in health strategies:
With 45% of large employers negotiating them, bundled payments are a growing strategy to get cost predictability and better quality by paying a single, fixed price for an entire episode of care.
Reasons for employer dissatisfaction with PBMs:
Over 60% of benefits leaders are dissatisfied because PBMs lack transparency around drug prices, rebates, and their financial models, which is driving demands for reform.
The function of onsite or near-site clinics:
Projected to see a 15% adoption increase among large companies by late 2026, these clinics give employees convenient access to primary care and preventive services, which improves health and lowers total costs.
