When the Business Group on Health (BGH) released its 2027 Employer Healthcare Strategy Survey, most headlines focused on the familiar story: costs are rising, volatility is worsening and employers are bracing for another difficult planning cycle. But buried deeper in the report is a quieter signal. And it’s one that may matter more to benefits leaders than any single trend line.
Only 18% of employers offer advanced primary care today, yet 33% are actively evaluating it for 2028-2029. A third of large employers are now exploring a model that, until recently, was considered niche or reserved for large employers. That shift is happening at the exact moment when CFOs, CEOs and CHROs are demanding more measurable results from health benefits and more accountability from vendors. According to the survey, 88% of employers say senior leaders are paying more attention to health and wellbeing initiatives, and 79% report rising C‑suite expectations to deliver cost-cutting results.
The timing is not accidental. Employers have now endured three consecutive years of underestimating health care costs. In 2025, they projected a 6.8% uptick but ultimately saw an 8.8% increase, marking the sharpest jump in a decade, except for the first year of the pandemic. There is no relief in sight, as costs are projected to rise another 9.2% in 2027 before plan changes. Employers have faced a 76% cumulative increase since 2018, about double the rate of inflation during that time.
Against that backdrop, it’s no surprise that employers are revisiting primary care delivery. It’s a structural cost strategy. Eighty percent of downstream spend, including specialists, imaging and pharmacy, flows from decisions made at the primary care encounter.
Advanced primary care is one of the few levers employers have that can influence downstream cost before it becomes a claim. But the model is most effective when it’s paired with navigation that steers employees there at the right moment and employers account for the social determinants that prevent people from following through.
Why advanced primary care? And why now?
The BGH survey makes clear that employers are facing a cost environment that traditional levers can’t fix. Cancer is now the number one cost driver for 70% of employers, up sharply from 58% just two years earlier. Specialty drug utilization continues to climb. Chronic conditions like diabetes, cardiovascular disease, autoimmune disorders and gastroenterology issues are consuming more of the spend each year.
These are not conditions that respond to point solutions or episodic care. They require sustained relationships, longer visits, integrated behavioral health and care teams that close gaps before they escalate. They require a model that can see the whole patient, not just the claim.
That’s what advanced primary care is designed to deliver. But just offering the model doesn’t guarantee results.
The operating model and engagement matters
The biggest misconception employers bring into advanced primary care evaluations is the belief that the clinic itself is the solution. A near‑site location, same‑day appointments, longer visits and a friendly care team are all valuable. But this alone will not move cost.
Two employers can launch advanced primary care clinics in the same year, with similar populations and similar budgets, and end up with completely different outcomes. One sees rising engagement, fewer emergency department visits and measurable reductions in total cost of care. The other sees modest utilization and no meaningful claims movement.
The difference is almost never the building. It’s the operating model underneath it.
Advanced primary care is most effective when:
- The care team has visibility into the employer’s benefits ecosystem, such as understanding claims history, pharmacy options, point solutions and referral networks at the moment a decision is made.
- Navigation is embedded inside the clinical workflow, not bolted on as an app employees may or may not understand or use.
- Behavioral health is integrated, not referred out to a six‑week waitlist.
- It is designed to reach disengaged members proactively, not wait for them to walk through the door.
Offering access to a clinic is easy. It’s the engagement that is hard, and that’s the critical factor in delivering optimal returns.
The social determinants employers can’t ignore
The BGH survey highlights another reality employers must confront: Population health is declining and a growing share of employees are struggling with chronic conditions. Many of those employees face barriers that have nothing to do with motivation and everything to do with circumstance.
A transit operator on a 5 a.m. shift can’t leave mid‑route for a doctor’s appointment. A custodian may not have the flexibility to take time off for follow‑up care. A public works employee managing diabetes may not have reliable transportation to a specialist. And employees facing behavioral health challenges often struggle to navigate the system at all.
If advanced primary care models don’t account for these social determinants – through onsite or near‑site access, extended hours, virtual care, care guides and culturally competent teams – employers will see engagement plateau long before they experience the promise of lowered costs.
The employees who drive the highest costs are often the ones least likely to walk through the door. If your model isn’t designed to reach them, it isn’t designed to work.
Incentives: The missing link in most strategies
One of the most overlooked levers in advanced primary care adoption is incentive design. Many employers still rely on the familiar “$25 gift card for a physical,” but the employers seeing real movement have evolved far beyond that.
For example, many Fortune 500 employers now tie incentives to establishing and maintaining a primary care relationship, not just completing a screening. Others reward follow through on care plans for diabetes, hypertension or behavioral health. Some integrate navigation into the incentive structure, rewarding employees for using guidance tools before scheduling specialty care. And a growing number are bundling incentives across wellness, chronic condition management and advanced primary care to create a unified experience.
The trend is clear: Incentives are reinforcing a lasting relationship.
At the inflection point
BGH said its survey results offer strong evidence that the market is at an inflection point. Costs are rising faster than employers can forecast. Pharmacy spend is becoming more volatile. Hospital prices continue to climb. And, at this point, most employers won’t be able to make significant cost-cutting moves until the 2028 plan year.
In that context, it makes sense that a third of employers are now evaluating advanced primary care. It is one of the few strategies that can influence cost before it becomes a claim, improve access without increasing friction, and strengthen the relationship between their employees and the health care system.
Here’s the reality: Not all advanced primary care models are created equal. The provider you choose should design care around your people, understanding your goals, your population, your data and your ecosystem. Look for partners who are built around what matters to you, not what matters to them. The best advanced primary care solution isn’t one designed for a generic population; it’s one designed around your goals and built for your people.
Here’s what makes this work. Advanced primary care is not a plug-and-play solution solution. It is a system that must be designed, governed and integrated with navigation, behavioral health and social determinants support. It requires clear expectations, shared accountability and a multiyear view of ROI.
It requires employers to recognize that primary care is not a visit or an incentive for a gift card. Advanced primary care is about building a relationship and these relationships are what make a strong impact on employee health outcomes and the cost of health care.