Enterprise employee health benefits plans: How to deliver real ROI at scale

Large employers face an uphill climb to deliver health benefits plans that truly work. Costs continue to rise, yet many traditional solutions struggle to prove they deliver results that matter to finance leaders.

Musculoskeletal (MSK) conditions illustrate the challenge clearly. They are the top healthcare spend for U.S. employers, ahead of diabetes and cancer combined.¹ The costs extend well beyond medical claims. Chronic pain drives absenteeism, short-term disability, and turnover, all of which drain productivity when companies need their people at their best.

Recent research shows that employers in the U.S. waste an estimated $10.3 million every hour on low-value MSK care.² This waste occurs when employees skip early intervention, abandon treatment plans, or rely on fragmented, reactive care pathways.

The good news is that a modern, digital-first approach can change this pattern. Leading enterprises are shifting to predictive, outcome-based solutions that make care accessible, engage people earlier, and deliver savings that show up on the balance sheet. When plans perform this way, they stop being just another line item and become a driver of ROI.

The hidden ways traditional plans drain ROI

Many enterprise plans still depend on the same physical therapy networks they have used for decades. These outdated pathways no longer fit how today’s workforce lives and works.

Employees face long wait times before they can start care. They need to commute to clinics, take time off, and manage childcare. These barriers lead to dropouts, with more than half of patients abandoning in-person PT before completing their plan.³

For rural, shift-based, or frontline workers, access challenges are even greater. Without nearby clinics or flexible schedules, many delay treatment until minor issues escalate into costly surgeries. The MSK Money Pit report found that up to 80% of MSK spend could be avoided with better early care.²

This reactive, underused model leaves plan managers without proof of value when finance leaders inevitably ask, “Where is our ROI?”

What makes an enterprise health benefits plan perform

High-performing enterprise plans share several defining traits. They are not just about coverage, they are about measurable outcomes.

• Personalization at scale: Members receive care tailored to their conditions and life circumstances, not generic one-size-fits-all programs.
• Predictive analytics: Plans identify high-risk cases early, directing resources to prevention before costs escalate.
• Outcome-based pricing: Employers pay only for proven results, not just participation or usage.
• Virtual-first access: Care is available anytime and anywhere, ensuring equity across hybrid, frontline, and remote teams.
• Full continuum of care: Prevention, early treatment, and specialized support are integrated into one connected pathway.

Together, these features help employers get more from every healthcare dollar. More importantly, they give plan managers the data and confidence to build trust with finance when budgets are under scrutiny.

Why accessibility and engagement drive ROI

Even the most carefully designed plan falls short if employees do not use it. Engagement is the foundation of ROI.

When employees delay or avoid care because it is hard to access, conditions worsen. This leads to higher claims, more short-term disability cases, and additional lost workdays. For enterprises with tens of thousands of employees, the financial stakes are enormous.

Plan managers should regularly ask: Are our benefits easy to understand and access? Do they fit the schedules and realities of our workforce? Are we tracking not just sign-ups, but actual completion and outcomes?

Too often, the answer is no. Digital-first care addresses this gap by bringing services directly into employees’ homes or worksites. Sword Health’s data shows that 42% of sessions take place after hours and 23% on weekends.³ This flexibility makes care usable for employees in every setting, which significantly improves adherence.

When care is convenient and engaging, employees start earlier and stick with treatment. This leads to fewer costly claims and a plan that finally delivers measurable value.

Sword Health: designed for enterprise impact

Sword Health was built to close the gaps that hold enterprise benefits plans back. Its digital-first suite combines four integrated solutions to deliver comprehensive MSK and women’s health care:

• Predict: advanced analytics identify high-risk members before claims appear, enabling earlier and more effective interventions.
• Thrive: personalized MSK care with smart sensors, real-time feedback, and 1:1 support from licensed Doctors of Physical Therapy. Thrive achieves an 81% engagement rate, nearly double in-person PT.³
• Move: proactive prevention through coaching that helps members build safe movement habits to avoid injuries.
• Bloom: discreet, evidence-based pelvic health care for women, addressing a major cost and equity gap. One in three women faces a pelvic health condition.⁴

Together, these programs help employers reduce waste, boost engagement, and deliver equitable care across complex, global workforces.

Proven outcomes: real cost savings and productivity gains

Sword’s model is not just theoretical. It is backed by data and validated by independent studies.

• $3,177 saved per engaged member annually³ ⁵
• 4.4x ROI when Predict is used to prioritize high-risk members³
• 68% productivity increase, worth $2,916 per member per year in recovered value³
• Faster access, with members starting care in just 6.3 days on average³

Because Sword uses outcome-based pricing, employers only pay when members achieve measurable clinical improvement. There are no wasted fees for unused sessions or partial treatment plans.

Independent analysis confirms these results. A retrospective claims study by Risk Strategies Consulting found that Sword delivers $3,177 in savings per engaged member annually, with a 3.2x ROI.⁵ This rigorous 18-month review of over 2,700 Sword members compared against 5,100 matched controls showed clear reductions in MSK and chronic condition costs.

For plan managers under pressure to justify spend, this level of third-party validation builds confidence and eliminates guesswork.

Building a stronger business case for leadership

Enterprise plan managers understand that ROI is not just about healthcare claims. It is also about workforce productivity, retention, and employee trust. To build a compelling case for leadership:

1. Benchmark performance: measure MSK spend, disability trends, and current utilization against industry standards.
2. Choose outcome-based partners: align incentives by working with vendors that only charge for proven results.
3. Connect results to business goals: use trusted data, such as the Risk Strategies study, to show real-world savings.
4. Communicate clearly: show how accessible, digital-first care supports DEI and retention alongside cost control.

When leadership sees that your plan protects both your people and your budget, they stop viewing benefits as a cost center. Instead, they see them as a strategic investment.

Better care, lower cost, proven ROI

Legacy enterprise health benefits plans are buckling under rising costs and outdated care models that employees do not use. Predictive, digital-first, outcome-based solutions change this reality.

Sword Health’s suite of MSK care solutions gives employers a way to reduce low-value spend, engage employees wherever they work, and deliver measurable ROI at scale.

When every dollar counts, this is how you show your CFO that your plan is not just another expense, but a competitive advantage.

Set up a call with a Sword expert to see how you can deliver sustained MSK cost savings and better healthcare outcomes for your workforce.