Why employer health insurance costs are rising (and how to reverse the trend)

Employer-sponsored health insurance has long been a cornerstone of U.S. healthcare. But for many employers, costs are climbing faster than ever. In recent years, premiums have surged, deductibles have grown, and benefit teams are left grappling with how to sustain competitive coverage without sinking their budgets.

This article explores what’s behind the spike in employer healthcare spending, how musculoskeletal (MSK) conditions contribute disproportionately to the problem, and what practical steps benefits leaders can take to cut healthcare costs without sacrificing quality of care.

The state of employer healthcare costs in 2025

Employer healthcare spending is reaching historic highs. The average employer-sponsored family health insurance premium surpassed $24,000 in 2024, with employers covering roughly $17,000 of that cost and employees responsible for the rest¹.

Premiums are not the only challenge. Deductibles, coinsurance, and out-of-pocket maximums have all increased. With inflation continuing to push up medical costs, projections show employer health costs rising another 5.4% in 2025².

These costs add up quickly, especially for large organizations with thousands of covered lives. The challenge isn’t just the price tag, it’s the lack of predictable ROI. Many employers continue to pay more each year without seeing meaningful improvements in employee health outcomes or organizational productivity.

What drives rising employer healthcare costs?

Several forces are behind the relentless rise in costs:

• Fee-for-service structures: Most traditional plans still pay providers based on volume, not results.
• Low-value care: A large portion of spend goes to care that doesn’t improve outcomes, including excessive imaging, unnecessary surgeries, and inappropriate prescriptions.
• Chronic condition management gaps: Conditions like MSK pain, diabetes, and cardiovascular issues often go unmanaged until they escalate.
• Behavioral health trends: Mental health needs are increasing, with many plans lacking integrated support.
• Provider price variation: The same procedure can cost 2–3x more depending on where it’s delivered.

These factors make employer health benefits harder to sustain. Among them, MSK conditions stand out as the top cost driver and the most preventable.

The hidden impact of MSK conditions on employer costs

MSK conditions are the #1 healthcare spend category for most self-insured employers. Back pain, joint issues, injuries, and chronic pain affect nearly 1 in 2 adults in the U.S.³. The costs show up in multiple ways, but these three tend to be the most impactful:

1. direct medical claims
2. lost productivity from absenteeism
3. mental health issues like depression and anxiety

Despite this, MSK care is often fragmented and reactive. Employees bounce between specialists, imaging centers, and urgent care with little coordination or tracking. The result is waste. Every year, $90.9 billion is spent on low-value MSK care that does not improve outcomes⁴. For employers, this is money lost with no return.

Digital MSK care: a new lever for healthcare cost containment

Employers do not have to accept MSK costs as fixed. By adopting digital-first MSK models, they can lower spend, improve employee outcomes, and hold providers accountable.

Sword Health’s digital MSK solution offers:

• Virtual care delivered at home using FDA-listed devices
• AI care technology that adapts in real-time to member performance
• A matched Doctor of Physical Therapy (DPT) to guide recovery
• Outcome-based pricing so employers pay only when results are delivered

This model is more convenient for employees, leading to increased engagement rate. Sword achieves an 81% program completion rate (vs. 50-70% for traditional PT)⁵, and care starts within 6.3 days, improving speed to recovery. Sword members can work on their personalized care plan at any time and place to suit their needs, with the added support (and accountability) of check-ins from their matched DPT. 

Employers save an average of $3,177 per member per year, and see up to 4.4x ROI when high-risk members are proactively identified and supported⁶.

Why outcome-based models outperform traditional care

In a traditional plan, an employer pays regardless of whether a member shows up to care or recovers. Sessions, visits, and access fees all generate costs even if an employee never recovers. There is limited built-in accountability.

Sword’s Outcome Pricing flips this dynamic. Instead of charging for usage, Sword ties payments to measurable recovery milestones such as pain reduction and improved function. This ensures:

• ROI assurance: employers don’t waste money on care that doesn’t work
• Aligned incentives: vendors are accountable for outcomes
• Better health outcomes: all parties have stronger accountability to track results

This is healthcare spending with built-in accountability. Employers finally have predictable ROI and confidence that their investment is working.

Sword’s cost-saving care delivers guaranteed savings

While MSK conditions are the largest single driver of costs, they are not the only one. Employers need a comprehensive approach that tackles multiple high-cost areas under one accountable platform.

Sword is the only digital solution proven to be as engaging and clinically effective (or more) as high-intensity in-person physical therapy⁷.

Sword offers an integrated ecosystem of digital care solutions:

• Thrive: MSK care with industry-leading outcomes and guaranteed ROI
• Bloom: Women’s pelvic health, addressing overlooked but costly conditions
• Move: Prevention and long-term mobility support for posture and strength
• Predict: AI-driven identification of high-risk members before claims escalate

Together, these programs help employers reduce costs, improve employee health outcomes, and achieve sustained ROI across populations.

Managing healthcare costs in 2025: tactical steps for employers

To control costs without slashing benefits, benefits teams should follow these 5 guiding principle:

1. Invest in prevention: Identify high-cost categories (like MSK) and implement early interventions
2. Use predictive tools: AI engines like Sword Predict surface high-risk members before claims escalate
3. Adopt outcome-based vendors: Look for partners who tie payment to results, not usage
4. Simplify access: Offer digital-first care that reaches rural, hourly, and underserved populations
5. Track and report outcomes: Require vendor reporting on clinical results, adherence, and cost impact

Start offering smarter care options, with better value

Employer health plans will continue to face cost pressure. The question is whether those dollars are spent wisely. By shifting to accountable care models, employers can lower costs while improving employee health and productivity.

Sword Health delivers that assurance. With guaranteed ROI, proven clinical outcomes, and a digital ecosystem that scales across populations, Sword offers employers a smarter way to invest in healthcare. Book a demo now to see how you can cut MSK costs and improve employee health with guaranteed ROI.

FAQs

Why are employer healthcare costs rising?

Employer healthcare costs are rising due to inflation in medical services, fee-for-service payment models, low-value care like unnecessary imaging and surgeries, and the growing prevalence of chronic conditions such as musculoskeletal pain, diabetes, and heart disease. In 2025, employer costs are projected to rise another 5.4%².

What are the biggest drivers of employer healthcare spending?

The largest cost drivers for employers include musculoskeletal (MSK) conditions, diabetes, cardiovascular disease, and mental health needs. Among these, MSK conditions are the number one spend category for most employers, with nearly one in two adults affected³.

What is outcome-based pricing in healthcare?

Outcome-based pricing is a value-based payment model where employers only pay for care that works. Instead of paying for sessions or access, employers are charged based on measurable recovery outcomes such as pain reduction and improved function. This model guarantees savings and holds vendors accountable for results.

How can digital MSK care reduce employer healthcare costs?

Digital MSK care provides at-home treatment supported by AI technology and clinical specialists. This model improves recovery rates, engages more employees, and prevents costly procedures. Employers using Sword Health’s digital MSK program save an average of $3,177 per member per year with up to 4.4x ROI⁶.

How does Sword Health help employers save on healthcare costs?

Sword Health offers a digital care ecosystem including Thrive for MSK, Bloom for women’s pelvic health, Move for prevention, and Predict for early risk identification. All solutions use Outcome Pricing, which guarantees employers only pay when meaningful healthcare targets are reached. This better aligns incentives and ties payments to tracked outcomes.