Obesity is not a choice or a moral failing. It is a chronic, multifactorial disease with metabolic, behavioral, psychological, and environmental underpinnings. As employers, benefits managers, and health plan stewards, you must ask: Do you have all the pieces you need to manage obesity effectively? Offering a single tool will rarely suffice.

What Is a Weight Management & Metabolic Health Program?

A weight management and metabolic health program is a coordinated intervention set designed to address obesity and its underlying metabolic irregularities over time. These programs typically combine:

• Clinical evaluation of metabolic markers (for example, insulin resistance, lipid profiles, inflammation) ¹
• Nutritional counseling customized to metabolic needs
• Frequent and ongoing monitoring, follow-up, and adjustment
• Behavior change support, including coaching and psychological or mental health resources
• Physical activity and exercise guidance to preserve muscle and improve metabolism
• Medication support when clinically appropriate (including GLP-1 or including obesity GLP-1 agonists and other weight loss agents) ³

A high-performing program does not treat obesity simply as excess weight. Instead, it views obesity as a chronic disease that requires continuous management and adaptation.

Direct Primary Care

Obesity affects more than 40 percent of U.S. adults and is a major contributor to type 2 diabetes, cardiovascular disease, nonalcoholic fatty liver disease, certain cancers, osteoarthritis, and sleep apnea¹. Recognizing obesity as a disease rather than a behavioral failure shifts the paradigm. It demands a coordinated multi-pronged strategy, not a simplistic “eat less, move more” approach.

The causes of obesity are complex. Genetic predisposition, hormonal dysregulation, gut microbiota, psychosocial stressors, sleep disruption, food environment, and socioeconomic factors all play roles². Because of this complexity, no single solution such as a pill or injection can resolve the disease in isolation.

GLP-1 medications such as semaglutide and tirzepatide have demonstrated promising results in clinical trials for weight loss and improvements in metabolic health markers³. However, real-world adoption, drug discontinuation, and weight regain remain significant challenges. One analysis found that more than 50 percent of patients using GLP-1s for weight management stopped treatment within 12 months³. After discontinuation, biological adaptations lead many to regain much of the lost weight within a year. These patterns underscore that GLP-1s are powerful but only one piece of a broader strategy.

The Cost and Employer Dilemma

Employers contemplating coverage for GLP-1s face a difficult tradeoff. On one hand, these medications are expensive and can significantly increase pharmacy spending. A recent survey indicated employers are rethinking their strategy and many employers covering these medications today are considering a change. High discontinuation rates and uncertain long-term value make ROI calculations complex.

On the other hand, effective obesity management and improved metabolic health can reduce downstream costs associated with diabetes, cardiovascular disease, joint issues, and productivity loss⁴. Employers must decide whether to cover GLP-1s, and if they do not, how else to invest in comprehensive wellness and chronic condition management programs.

Benefits to Patients and Providers

For Patients

• Improved metabolic outcomes, including better insulin sensitivity and blood pressure
• Sustainable weight loss when combined with behavioral interventions
• Reduced risk of obesity-related comorbidities
• Enhanced quality of life, mobility, and mental well-being
• Lower likelihood of requiring invasive procedures such as bariatric surgery

Programs that integrate behavioral and psychological support help patients address emotional eating, stress, and motivation, which are often critical to long-term success.

For Providers

• Structured care pathways for chronic obesity management
• Data and feedback loops that allow for continuous monitoring and early intervention
• Clearer alignment with evidence-based best practices
• More efficient coordination between primary care, nutritionists, and behavioral specialists

Providers participating in holistic programs are better positioned to support patients in achieving sustainable outcomes rather than focusing solely on short-term weight loss².

Key Questions for Your Point Solution

When evaluating or designing a weight management and metabolic health program, consider the following questions:

1. Does the program address underlying metabolic dysfunction rather than just weight loss?
2. Are healthy behaviors supported over time, not only during initial engagement?
3. Is psychological or behavioral support part of the design?
4. If medications such as GLP-1s are offered, are they integrated within a structured clinical framework?
5. Does the program emphasize preservation of lean muscle mass through physical activity and nutrition?
6. Is there flexibility to adapt the program as patient needs and results evolve?
7. Do providers have sufficient training and resources to sustain engagement?
8. Is there a clear cost-benefit analysis and a defined measurement strategy for ROI?

Takeaways & Recommendations

Effectively addressing obesity requires viewing it through the same lens as other chronic diseases, with a long-term management strategy rather than a quick fix. Employers, providers, and health plan leaders must recognize that no single intervention can succeed in isolation. A comprehensive weight management and metabolic health approach combines medical treatment, behavioral support, nutrition, and ongoing engagement. While GLP-1 therapies have shown promise, they are only one component of a multifaceted solution. Without lifestyle changes and behavioral health integration, the long-term success of these medications is limited. Employers evaluating whether to cover GLP-1s should consider both the financial implications and the broader care framework necessary for success. Those that do offer coverage can maximize outcomes by ensuring these medications are paired with coaching, nutritional counseling, and continued follow-up. For those unable to include them, investing in alternative wellness initiatives and chronic condition management programs can still demonstrate support for employee health. Ultimately, effective obesity management depends on aligning all available tools (clinical, behavioral, educational, and organizational) to create a system that promotes sustainable metabolic health over time⁵.

¹FAIR Health. (2024). Obesity and GLP-1 Drugs: A FAIR Health White Paper. Retrieved from https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/Obesity%20and%20GLP-1%20Drugs%20-%20A%20FAIR%20Health%20White%20Paper.pdf
²McKinsey Health Institute. (2025). The Path Toward a Metabolic Health Revolution. Retrieved from https://www.mckinsey.com/mhi/our-insights/the-path-toward-a-metabolic-health-revolution
³American Journal of Clinical Nutrition. (2025). GLP-1 Clinical Trial Findings. Retrieved from https://ajcn.nutrition.org/article/S0002-9165%2825%2900240-0/fulltext
⁴Cigna/Evernorth. (2024). Employer Strategies for Sustainable GLP-1 Coverage. Retrieved from https://newsroom.cigna.com/employer-strategies-for-sustainable-glp1-coverage
⁵Luminare Health. (2025). GLP-1s and the Cost of Obesity. Retrieved from https://www.luminarehealth.com/site/media/Files/LH-3270-White-Paper_GLP-1s.pdf

High-cost claims, and the claimants incurring those expenses, are arguably the biggest cost pressure self-insured employers face within the healthcare ecosystem. Solutions are complicated, multi-faceted, and ideally implemented before a claim occurs. Although these solutions only impact a small percentage of the population, their overall effect is significant, and once established, the savings compound.

Employers should begin by defining high-cost claims for their organization and verifying the clinical drivers. From there, solutions can be considered that will directly impact current claims and future cost mitigation.

Defining High-Cost Claimants

The definition of high-cost claims is not uniform. Many employers use a targeted dollar threshold (for example, $100,000) to pinpoint high-cost claims, which are embedded in the insurance model through stop-loss contracts. While that benchmark makes reporting consistent, it is often more practical to consider plan size and risk tolerance when defining high-cost claims.

The National Alliance of Healthcare Purchaser Coalitions (2024), of which our client edHEALTH is a member, estimated that 1.2% of health plan members are high-cost claimants, making up approximately 33% of total healthcare spend. These individuals absorb 29 times the average member cost, with an average of $122,382 per claimant. By stratifying data, employers can start to pinpoint which individuals are high-cost claimants now, and who may become one in the future, and implement solutions to mitigate spend.

Clinical Drivers

When examining data across our book of business at Alera Group, oncology and specialty pharmacy conditions, such as rare diseases, are the top diagnoses associated with high-cost claims. Other common drivers are cardiovascular disease, newborn and infant care, and musculoskeletal disorders.

According to Sun Life’s 13th Annual High-Cost Claims and Injectable Drugs Trend Analysis (2024), cancer again tops the list as the most frequent and costly condition, nearly three times the cost of the second-leading condition, cardiovascular disease.

Employers should start by analyzing their own data and focusing on where they can make the most impact. Industry data, assuming the sample is broad, can serve as a helpful benchmark when developing a strategy, but understanding internal data is critical to success. In nearly all cases, specialty care is where savings will be found, and following the path of comorbidities often leads to the best outcomes. In addition, employers should implement broad market shifts and tactical actions that work together to address current costs and reshape future spending.

Cost Saving Through Broad Market Shifts

Self-insured employers seeking opportunities for savings related to high-cost conditions, claims, and claimants should consider the following broad shifts in thinking:

• Ownership of Plan Governance:
  Self-insured employers govern their plans but often do not build an internal structure, instead relying on vendor partners. Employers looking to target innovative solutions should maintain ownership of plan rules and understand the flexibility of their partners.
• Oversight of Steerage and Utilization Management:
  Plan management is complex, and vendor partners frequently revise rules related to steerage, utilization review, and care management. Understanding where flexibility exists allows employers to manage emerging therapies and carve-outs in the best interest of the plan.
• Value-Based Specialty Arrangements:
  Value-based arrangements create aligned goals and greater transparency, though they are less common in specialty care. Contract language should be carefully reviewed.
• Specialty Medication Solutions:
  Employers and their vendor partners must begin having detailed conversations about specialty medications, especially as the pipeline for these treatments expands beyond rare diseases.
• Partnering with Aligned Vendors:
  Some vendor partners may not have goals that align with employers. Those serious about managing high-cost claims should find partners willing to focus on value-based care, centers of excellence, and network management.
• Data and Analytics:
  Understanding plan data is a fundamental requirement for managing high-cost claims. It starts with utilization and baseline information but must extend to member-level analysis and predictive reviews that consider demographics and comorbidities. The goal is to establish protocols before claims are incurred so they can be proactively managed.

Tactical Actions Targeting High-Cost Claimants

At a tactical level, employers must be focused on opportunities that deliver savings at the condition level and continuously monitor results. This can be done with a partner, but if incentives are not aligned, methodology and key performance indicators should be established in advance.

Key first steps often include:

• Stop-loss design
• Prior authorization for top cost drivers
• Vendor contracting
• Centers of excellence
• Disease-state initiatives focused on prevention, care navigation, and overall management (for example, oncology, infusion site of care, cardiology, prenatal/neonatal, behavioral health, musculoskeletal, and others)

High-cost claims will continue to be a defining challenge for self-insured employers in higher education and beyond. Addressing them effectively requires a balanced approach that combines strong governance, meaningful data analysis, and proactive partnership with vendors and providers. Employers who invest the time to understand their data and align their strategies accordingly are best positioned to control costs while improving outcomes for their members. The goal is not only to manage high-cost claims when they arise but to build a framework that anticipates and prevents them wherever possible.

Sources:
National Alliance of Healthcare Purchaser Coalitions. High-Cost Claims Report, 2024.
Sun Life. 13th Annual High-Cost Claims and Injectable Drugs Trend Analysis, 2024.
Kaiser Family Foundation. Employer Health Benefits Survey, 2024.

Primary care providers—originally general practitioners who would later specialize into modern internal and family medicine physicians—served as lone practitioners for much of the 20th century, playing a central role in both the healthcare system and their local communities.¹ After World War II, the prominence of PCPs declined as specialty care expanded, influenced by changes in medical education, reimbursement models, technology, and public demand². Today, rising healthcare costs, workforce shortages, and systemic pressures have highlighted underinvestment in primary care. The market is seeking solutions that remove barriers, enhance education, and support population health management³.

Shifts in Primary Care

Primary care remains a core component of all health plans, but fee structures and market pressures have changed the patient–provider relationship. Patients often face rushed appointments, long wait times, low reimbursement rates, and high administrative burdens. These factors contribute to burnout among PCPs and have led the Association of American Medical Colleges (AAMC) to project a shortage of 17,800 to 48,000 primary care physicians by 2034⁴. Insurance requirements, market consolidation, and operational pressures limit PCPs’ ability to deliver optimal care. Patients are also demanding broader access, digital solutions, self-service options, and hybrid care models. In response to these growing challenges, Spring Consulting Group’s client edHEALTH, a captive health coalition serving educational institutions, is proactively pursuing primary care solutions to meet the evolving needs of its member schools. Direct primary care (DPC) has emerged as a strategic tool for employers seeking to improve access, enhance preventive care, reduce avoidable acute care utilization, and generate a return on investment⁵.

Direct Primary Care

At the core, direct primary care provides patients with unlimited access to a primary care team for a flat monthly fee, typically outside of traditional health plan coverage. Most DPC solutions guarantee same-day or next-day appointments, longer visit times, higher patient satisfaction, and bundled care for preventive, chronic, and acute conditions⁶.

DPC models vary depending on vendor capabilities and employer priorities. Options include onsite or near-site clinics, virtual-first networks, retail clinics, preferred-access arrangements, navigation and concierge support, digital tools such as AI and wearables, incentives for engagement, and plan design levers to drive utilization. Providers include retail brands, technology-driven platforms, and employer-focused businesses leveraging onsite, near-site, and virtual-first care models.

DPC emphasizes relationship development and improved access rather than gatekeeping. It positions primary care as a strategic entry point, controlling downstream utilization, referrals, and chronic disease management. Separating primary care from traditional insurance networks may allow patients to access the best available care, facilities, and providers. DPC models can also incorporate risk-based approaches, including capitation or partial-risk arrangements.

Patients increasingly expect convenience, engagement, and integrated behavioral health. DPC partners are responding with retail-style access, care navigation, and satisfaction-focused services. Employers can align DPC partnerships with broader human resources initiatives, such as curated networks, direct contracting, and programs addressing social determinants of health.

Virtual-First Primary Care

In addition to DPC, other access models such as virtual-first primary care and urgent care clinics are shaping the future of healthcare delivery. Virtual-first primary care models are increasingly being adopted as a complementary approach to in-person care. These models prioritize digital access by encouraging patients to connect with their care team through telehealth visits, chat, or app-based platforms before turning to in-person appointments. Virtual-first care can improve access, reduce wait times, and support patient engagement, particularly for populations who may struggle with transportation or scheduling barriers.

When integrated effectively, virtual-first models can serve as a gateway to coordinated care by addressing routine concerns, managing chronic conditions, and promoting preventive health measures. However, challenges such as continuity of care, patient trust, and integration with existing electronic health records must be carefully managed to ensure quality outcomes. For employers, virtual-first networks can complement direct primary care by expanding access and helping to balance costs without sacrificing patient experience.

Market Shifts and Employer Considerations

Employers, particularly self-funded ones, must increasingly shape their healthcare strategy to maximize value. Primary care represents a relatively small portion of overall healthcare spend, and immediate savings may be limited. However, long-term investment in DPC can yield measurable benefits over three to five years. Successful DPC implementation requires attention to challenges such as geographic coverage gaps, referral coordination limitations, regulatory uncertainty, and member education. Employers should prioritize integration with existing health plan solutions, coordinate utilization and data tracking to ensure savings are captured accurately and deploy clear communication and engagement strategies.

When implemented effectively, DPC models shift the healthcare narrative toward value-based care, improve access, strengthen care coordination, and enhance patient satisfaction, ultimately supporting both employee health and organizational objectives.

¹Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. The Milbank Quarterly, 83(3), 457–502.
²Bodenheimer, T., & Pham, H. H. (2010). Primary care: Current problems and proposed solutions. Health Affairs, 29(5), 799–805.
³Petterson, S., Liaw, W. R., Tran, C., & Bazemore, A. W. (2015). Estimating the residency expansion required to avoid projected primary care physician shortages. Annals of Family Medicine, 13(2), 107–114.
⁴Association of American Medical Colleges. (2023). The complexities of physician supply and demand: Projections from 2023 to 2034.
⁵Rosenthal, T. C. (2012). The medical home: Growing evidence to support a new approach to primary care. JAMA, 308(21), 2335–2336.
⁶Direct Primary Care Coalition. (2022). What is direct primary care? Retrieved from https://www.dpcare.org/

The political landscape has seen significant developments in healthcare reform, notably with the enactment of the One Big Beautiful Bill Act (OBBBA) on July 4, 2025¹. This legislation introduces changes that may reshape healthcare policies, employee benefits, and overall benefits packages. Understanding these changes is crucial for employers to navigate the evolving landscape effectively¹,².

What Is the “Big Beautiful Bill”?

The “Big Beautiful Bill,” officially known as the One Big Beautiful Bill Act, is a substantial piece of legislation encompassing tax, spending, and healthcare provisions¹,³. The law focuses on deregulation of healthcare, expansion of private insurance options, tax incentives for both employers and employees, and modifications to certain provisions of the Affordable Care Act (ACA)¹,⁴. At its core, the law aims to increase competition and choice in healthcare, with the objective of reducing premiums and expanding access³.

How Will the Bill Impact Employee Benefits?

Changes to ACA Compliance

The OBBBA includes provisions that modify certain aspects of the ACA²,³. While the law does not eliminate the ACA, it introduces changes, such as new reporting requirements for certain Medicaid enrollees and restrictions on federal financial assistance for those enrolled in the ACA Marketplace². Employers offering health insurance may encounter fewer regulatory requirements around employee health plans but could face challenges if employees opt out of company-sponsored coverage due to more affordable individual insurance options or if employees lose government-sponsored coverage³.

Expansion of Health Savings Accounts (HSAs)

The law expands Health Savings Accounts (HSAs) by broadening the definition of a high-deductible health plan (HDHP) to include bronze and catastrophic plans²,³. This allows taxpayers to save and invest more money tax-free for healthcare expenses². For employers, these expanded accounts present an opportunity to provide more customizable healthcare benefits, potentially reducing administrative costs while empowering employees to manage healthcare expenses more effectively³. The OBBBA also designates Direct Primary Care arrangements as qualified medical expenses eligible for HSA coverage within limits².

Shift Toward Private Insurance

The legislation includes adjustments to Medicaid and changes to the ACA marketplace, which may result in fewer individuals relying on government-run plans²,³. This shift encourages employers to refine benefit packages to provide more personalized private insurance options that better align with employee needs³. Increased competition among private insurers may also influence employer-sponsored insurance premiums².

Tax Incentives for Employers

The OBBBA introduces new tax provisions, including a permanent increase to the standard deduction¹,². While healthcare-specific tax incentives for employers are not as clearly detailed as individual tax changes, the general focus on tax relief and cost reduction is intended to encourage companies to reassess benefit offerings and consider new ways to support employee health and well-being².

Potential Impact on Wellness Programs

The law’s emphasis on individual choice and competition may encourage employers to invest more in wellness programs²,³. Health and wellness incentives, such as gym memberships, mental health services, and preventative care, could become more prevalent as employers aim to improve employee health outcomes and reduce long-term healthcare costs³. These programs can also enhance employee engagement and satisfaction².

What Can Employers Do to Prepare?

Given the significant changes brought by the OBBBA, employers should remain informed and proactive. Key strategies include:

1. Stay Updated on Legislation:
   Employers should regularly monitor updates on the law, particularly regarding ACA regulations, HSA contributions, and tax incentives²,³. Joining professional organizations or subscribing to policy newsletters can help employers stay current.
2. Review Employee Benefits Packages:
   Employers should evaluate current healthcare offerings and consider adjustments to remain competitive and cost-effective, particularly with expanded HSAs and private insurance options²,³. Supplemental private plans or partnerships with brokers may help diversify options for employees².
3. Communicate with Employees:
   Transparent communication is essential. Employers should educate employees on changes to benefits, HSAs, and wellness programs, and explain potential impacts on premiums or out-of-pocket costs²,³.
4. Consult with Benefits Advisors and Legal Counsel:
   Navigating healthcare reform is complex. Consulting advisors and legal counsel ensures compliance and appropriate plan design under the new law²,³.
5. Prepare for Tax Adjustments:
   Employers should reassess benefits strategies to maximize available tax incentives, adjust structures as necessary, and ensure overall compensation remains competitive¹,².

The Road Ahead for Employers

The One Big Beautiful Bill Act has introduced substantial transformations to the healthcare landscape¹,². Its impact on employee benefits is becoming clearer as provisions are implemented. Healthcare is likely to become more individualized, with greater responsibility falling on employers to navigate benefits packages effectively²,³. By staying informed, reassessing offerings, and planning proactively, employers can adapt to the evolving regulatory environment while continuing to support employee health and well-being²,³.

¹Congress.gov. (2025). H.R.1 – One Big Beautiful Bill Act 119th Congress (2025-2026). https://www.congress.gov/bill/119th-congress/house-bill/1
²Ballard Spahr. (2025, July 14). The OBBBA’s impact on employee benefits and executive compensation. https://www.ballardspahr.com/insights/alerts-and-articles/2025/07/the-obbbas-impact-on-employee-benefits-and-executive-compensation
³McDermott Will & Emery. (2025, July 7). Employee benefits provisions of the One Big Beautiful Bill Act. https://vitacompanies.com/blog/employee-benefits-provisions-of-the-one-big-beautiful-bill-act
⁴Johns Hopkins Bloomberg School of Public Health. (2025, July 30). The changes coming to the ACA, Medicaid, and Medicare. https://publichealth.jhu.edu/2025/the-changes-coming-to-the-aca-medicaid-and-medicare

Q1: What does it mean when a company “transfers” pension risk?

At a high level, it means the company is looking to reduce or offload the financial uncertainty tied to its pension obligations. That typically happens in one of two ways: either by offering terminated employees a one-time lump-sum payment, or by transferring the responsibility for future pension payments to an insurance company through the purchase of an annuity contract.

For the company, it’s about getting pension liabilities off the books and reducing exposure to things like interest rate swings, longevity risk, or investment volatility. It’s essentially a financial risk management strategy, but it has big implications for both the balance sheet and the participants.

Q2: Why are so many companies pursuing this right now?

The environment is favorable at the moment and has been for several years. Many pension plans are well or overfunded, partly due to the high interest rate environment, which means the present value of future liabilities has come down. That creates a window of opportunity because it’s more affordable to transfer pension obligations when the plan has a funding cushion.

At the same time, there’s increasing pressure from boards, investors, and regulators to reduce long-term financial volatility. For many employers, especially in sectors like healthcare and manufacturing, pension plans are legacy liabilities that no longer align with current business strategy. Transferring that risk, either to an insurer or through a captive, has become a compelling strategy.

Q3: What are the main ways companies transfer pension risk?

The most common approaches we see are offering lump sums to terminated vested participants or purchasing annuities from insurance companies. Both of these methods shift the liability off the sponsor’s balance sheet, but they come with different timing, regulatory, and cost considerations.

There’s also a “buy-in,” where the pension plan still holds the liability but uses an annuity contract as a hedge to match those obligations. This is often a strategic interim step as a plan approaches termination.

And now, more recently with our guidance, we’re seeing employers explore the use of their own captive insurance companies. While common in Europe, this is  a newer development in the U.S. that is gaining traction, especially among organizations with overfunded plans or illiquid assets that would otherwise be penalized in a traditional market transaction. The idea is to retain some control while still taking meaningful steps toward de-risking.

Q4: We’ve heard about using captives in this space. How does that work?

In simple terms, the pension plan purchases an annuity contract from a captive insurance company that’s owned by the employer. The captive then takes on the obligation to pay the retirement benefits, often backed by reinsurance. Structurally, it’s very similar to how employers already fund other ERISA-covered benefits like disability or life insurance through a captive.

We recently worked with a leading cancer research and healthcare institute that already had a Vermont-domiciled captive. We helped them set up a separate cell within the captive specifically for pension risk. The Department of Labor reviewed the structure and granted a prohibited transaction exemption, making it the first ERISA-approved pension transfer into a captive. That approval opened the door for other organizations to explore this approach.

Q5: What’s the advantage of using a captive insurance company for this instead of a commercial carrier?

It gives the employer more flexibility and control. In the case of the healthcare institute mentioned earlier, the commercial insurance market was uncomfortable with the shape of their pension liability and was charging significantly more to take on the risk. By using their captive, they were able to assume the liability internally, with proper fronting and reinsurance, and realize projected financial benefits of over $120 million on the premium alone.

Additionally, our client will be able to transfer the trust assets directly to the captive – avoiding significant haircuts on their illiquid assets.

And they didn’t just keep the savings to themselves. As part of the DOL-approved structure, they used some of those funds to provide a one-time cost-of-living adjustment for retirees. So the outcome benefited both the organization and its participants. That’s the power of this approach. It’s not just about risk transfer — it’s about doing it in a way that aligns with your values and financial goals.

Q6: Are there risks to going the captive route?

There are definitely risks, and the process isn’t simple. When you use a captive to take on pension liabilities, you’re retaining some of the investment and longevity risk, at least in the near term. And because you’re transferring ERISA-covered obligations to a related party, it requires a prohibited transaction exemption from the Department of Labor — which is a highly detailed and rigorous regulatory process.

That said, we had the opportunity to help a major healthcare and cancer research institute become the first organization in history to receive ERISA approval for transferring pension risk into a captive structure. That was a groundbreaking moment. It’s not just a win for that one sponsor — it opens the door for other organizations to approach pension risk more strategically and cost-effectively.

We worked closely with them through every step, from actuarial modeling and structuring the captive cell to direct engagement with the Department of Labor. A big part of the success was treating the captive like a fully functional insurer, with strong governance, appropriate capitalization, and a clear segregation of the pension risk. So yes, there are hurdles, but with the right team and a strong rationale, it’s absolutely achievable — and the precedent we helped set is already starting to shift the landscape for other plan sponsors.

Q7: How do you help clients decide whether a captive makes sense?

It comes down to modeling and understanding the broader context. We look at the plan’s funded status, the company’s risk tolerance, whether a captive already exists, and what types of assets are in the trust.

For example, in the case of the healthcare institute, they had a well-funded plan but also held a significant amount of illiquid investments. If they had gone the traditional route and purchased an annuity in the market, they would’ve needed to liquidate those assets — likely at a loss. Using the captive allowed them to avoid that inefficiency and structure a transaction that worked better from both a financial and operational perspective.

That’s why it’s so important to tailor the solution to the organization’s fact pattern. There’s no one-size-fits-all approach here.

Q8: What’s your advice for companies thinking about this?

My advice is to start with a feasibility study. Even if you’re not planning to move forward immediately, taking the time to assess your options in a structured way can be incredibly valuable. Every pension plan is different — different funding levels, investment profiles, participant demographics, and organizational goals. A feasibility study helps you understand what’s possible based on your unique circumstances.

That process should include working closely with unbiased actuaries and consultants to model out different risk transfer strategies. Whether it’s a traditional annuity purchase, a lump-sum window, or a captive structure, each approach has its own tradeoffs. The right strategy often depends on things like your plan’s funded status, asset mix, existing captive infrastructure, and long-term financial goals.

We’ve found that the earlier sponsors engage in that kind of planning, the more flexibility they have. Even simple steps like cleaning up data or segmenting your liability profile can create opportunities down the line. And if a captive solution is on the table, the earlier you start understanding the regulatory landscape — especially around ERISA exemptions — the better positioned you’ll be.

As summer winds down, the Disability Management Employer Coalition (DMEC) hosted its 2025 Annual Conference in vibrant Austin, TX, a city known for its live music, bold flavors, and innovative spirit. The dynamic setting was the perfect backdrop for this year’s conversations around the ever-evolving world of absence, accommodations, compliance, and employee wellness. Professionals from across the industry gathered to unpack new legislation, discuss workplace trends, and explore tech-driven solutions to modern challenges. Here are three key themes that emerged from this year’s conference:

1) Championing Wellbeing

Mental health has been a conference staple in recent years, but 2025 brought a more integrated, human-centered approach. Discussions extended beyond mental illness to resilience, emotional intelligence, caregiving, and holistic employee support strategies. The rise of neurodiversity, trauma-informed leadership, and care-inclusive policies showcased how employers are adapting to meet a broader spectrum of employee needs.

– In the session, “Compassionate Leave: Reimagining Employee Well-Being,” presenters explored how companies are expanding leave programs to support emotional well-being, not just physical health.

– A dynamic discussion titled “Neurodiversity in the Workplace: Employee Expectations and Employer Obligations” highlighted how organizations can create inclusive environments and meet accommodation needs for neurodiverse employees.

– In “Empowering Caregivers in the Workplace: A Collaborative Approach to Well-Being,” panelists shared strategies to support the growing population of working caregivers through benefits design and workplace flexibility.

2) Technology & AI

This year’s sessions made one thing clear: we’re at a true inflection point when it comes to technology. With AI, data integration, and digital tools maturing, organizations are rethinking how leave is managed, from predictive analytics to employee experience platforms. Several thought leaders challenged the industry to balance automation with empathy, and to ensure tech doesn’t come at the cost of compliance or care.

– In the session, “Technology Can Make All Your Absence Dreams Come True … Or It Can Be Your Worst Nightmare!” speakers tackled the pros and cons of tech platforms, with a focus on implementation pitfalls and how to avoid them.

– During “Defining the Future of AI in Absence Management: Review of Think Tank Findings,” presenters walked through key outcomes from a recent industry think tank focused on the ethical use of AI in leave processes.

– The presentation, “There’s an AI for That! The Future of Integrated Absence Management and How AI Connects the Dots,” showcased how leading employers are already using AI to streamline decisions and improve the employee experience.

3) Compliance & Accommodation Strategies

Compliance remains a foundational topic, and this year brought a new level of pragmatic guidance and real-world scenarios. Sessions ranged from ADA accommodations and “good faith” practices to FMLA audits and courtroom insights. The clear takeaway? Employers must remain agile and informed while developing repeatable, scalable compliance frameworks.

– The Preconference Workshop, “Taking Back Your Plan: A Practical Guide for Effective Policy Development,” run by Spring Consulting Group, helped employers navigate federal, state, and local leave laws as they build or update internal policies. We also explored benchmarking strategies and outlined the changes employers need to get their benefit programs back on track.

– In “Recent Jury Verdicts Involving Leave and Accommodation Issues,” a legal expert reviewed real court outcomes to help employers better understand risk and strengthen their policies.

– A panel-led session, “Getting Alice out of Wonderland: How to Address the Realities of Accommodations Management,” shared tactical guidance on how to navigate tricky and often ambiguous accommodation requests.

Final Thoughts

The DMEC 2024 Annual Conference in Nashville was a resounding success, filled with opportunities to learn, connect, and share best practices. From deep dives into compliance and mental health to exploring the latest technological innovations, the conference offered something for everyone. As always, it was a pleasure to reconnect with industry leaders and bring back fresh ideas to enhance our consultative offerings. We’re already looking forward to what next year’s conference will bring!

Title:

AVP – Absence and Disability

Joined Spring:

I joined Spring in January 2024

Hometown:

Chesterfield, MA (near Northampton)

At Work Responsibilities:

I help employers navigate complex absence and disability laws and develop customized absence and disability programs that are both compliant and strategically aligned with their goals. Simultaneously, I support absence and disability vendors in developing and launching new products, from drafting policy forms to creating marketing collateral.

Outside of Work Hobbies/Interests:

Cycling, pickleball, gardening

Fun Fact:

In high school, my summer softball team made it to nationals 2 years in a row. I was an academic all-American squash player in college.

Do You Have Any Children?

Two amazing adult humans, ages 28 and 25 – and 3 equally awesome grandchildren with a 4^th arriving at the beginning of 2026!

Favorite Band/Musician:

I have loved Melissa Etheridge since I played frisbee with her and her band on the lawn of my dorm at Smith College in 1990 and she signed my cassette of her first album! I have seen her in concert at least 20 times.

Favorite Book:

A Gentleman in Moscow

In today’s fast-paced world, the conversation around mental health has taken center stage in workplace wellness initiatives. As employers strive to create a more supportive and resilient workforce, integrating mental health resources into employee benefits and absence strategies has never been more critical.

According to the National Institute of Mental Health, nearly 1 in 5 U.S. adults live with a mental illness¹. That number rises significantly among working-age adults, especially in high-stress professions or environments lacking psychological safety and support. This increased prevalence of mental illness leads to more time away from work, reduced ability to perform while present, and an increase disability claims incidence rates.

The Insurance Impact: Disability & Mental Health Claims

From a disability insurance standpoint, behavioral health-related disability claims are a major concern for Benefits and HR teams across the country. Mental health conditions like anxiety, depression, PTSD, and burnout are now among the leading causes of short term and long term disabilities.

A significant area of concern and recent discussion pertains to the common inclusion of a 24-month lifetime limitation for mental health-related claims in long term disability (LTD) policies. The consequence of this provision is that an employee whose disability stems from a mental health condition becomes ineligible for continued LTD benefits after a lifetime combined 24 months, even if they continue to meet the plan’s definition of disability. These limitations stand in contrast to individuals experiencing other types of disability, who are not subjected to an equivalent restriction. While the rationale for such limitations includes mitigating plan risk exposure by capping the duration and encouraging a return to work before prolonged disengagement, these provisions undeniably create a disparity in the treatment of individuals with different types of disabilities. Furthermore, they are frequently perceived as being at odds with the array of mental health initiatives that employers are increasingly implementing to address the escalating incidence of mental health issues within their workforce.

Tools to Help: Leveraging Absence and Benefits Strategy

Employers have the opportunity and, some would argue, the responsibility to take a proactive role in supporting mental health. Integrating meaningful mental health resources into leave and benefits programs is no longer optional. It is a critical business imperative. Leading organizations are stepping up to close the gap in several ways.

1. Employee Assistance Programs (EAPs) and Virtual Behavioral Health Programs

EAPs are often an underutilized resource, despite their potential to have a real, immediate impact. EAPs are employer-sponsored programs that are designed to help support employees’ health habits and well-being. Some common examples include counseling, substance abuse support, financial guidance, and legal advice. By actively promoting EAPs and embedding access points and reminders to employees throughout the leave process, employers can help support an employee’s mental health challenges.

To further assist employees with mental health concerns, employers can offer virtual Behavioral Health programs. These programs can significantly enhance employee mental health by expanding access to care and offering convenient and confidential support from anywhere. This accessibility helps overcome traditional barriers like stigma, travel, and scheduling conflicts, enabling earlier intervention and consistent engagement with mental health services. Ultimately, these programs empower employees to manage their well-being proactively, leading to improved overall health and productivity.

2. Financial Wellness Resources

Financial stress significantly impacts mental health. When employees grapple with issues like debt, budgeting difficulties, or unexpected expenses, they often experience heightened anxiety, reduced focus, and even physical symptoms². This direct link underscores the importance of addressing financial well-being as a component of overall mental health support.

Employers can play a crucial role by offering financial counseling, whether through specialized vendors or as part of a broader EAP. This type of support helps employees navigate their financial challenges, which in turn can alleviate the associated mental burden. When an employee takes leave for mental health reasons, integrating recovery resources with financial guidance can create a more holistic approach, promoting greater well-being and facilitating a smoother return to work.

3. Integrated Absence Management Programs

Forward-looking integrated absence management programs take a holistic view of why an employee may be absent from work, coordinating federal protections such as the Family Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA), state leave programs, and employer-specific offerings. Taking an integrated approach not only streamlines compliance, but also allows for early intervention and triage, ensuring that mental health needs are identified and addressed as part of the overall leave experience.

The Bigger Picture: Prevention and Culture

Prevention remains the most cost-effective approach. Employers can have an impact by building a workplace culture where mental health is normalized and where resources are visible and accessible. Communication is also key. In addition to formal programs and benefits, employers can provide employees with education and resources such as Alera Group’s Mental Health Awareness Toolkit, which provides employers with email templates, campaigns, and more to help support employee wellbeing and keep their colleagues informed about what resources they have.

Employers that prioritize mental well-being as part of their overall strategy are seeing positive results across the board. These include shorter claim durations, higher employee engagement, and reduced turnover. Mental health challenges are not going away, and the workplace plays a key role in both creating and addressing these issues. By utilizing tools like EAPs, virtual Behavioral Health programs, financial counseling, and integrated absence programs, employers can reduce the long-term costs and disruptions of behavioral health-related absence, while helping their employees lead healthier lives.

¹National Institute of Mental Health (NIMH), “Mental Illness,” 2023. https://www.nimh.nih.gov/health/statistics/mental-illness
²Debrosky, “Why Are Mental Health Disability Claims Denied More Often? Insights from Mark DeBofsky on Main & Wall” 2024. https://www.debofsky.com/articles/denied-mental-health-disability-claims/#:~:text=Most%20long%2Dterm%20disability%20policies,which%20creates%20an%20unfair%20distinction.
³American Psychological Association (APA), “Stress in America: The State of Our Nation,” 2023. https://www.apa.org/news/press/releases/stress

Spring Consulting Group is contracted with the State of Maine to conduct actuarial studies of the Maine Paid Family & Medical Leave (PFML) trust fund. You can read the full press release here.