Centivo’s survey shows that the costs associated with healthcare are significant stress factors in the troublesome state of employee mental health.


The COVID-19 pandemic has shined a light on mental and behavioral health in the workplace as never before. To meet demand, employers are rapidly expanding access to mental health services.

Ironically, their health benefits are contributing to the strain and worry that most likely drives many employees to seek mental health services in the first place. And, as we all know, their strain and worry predate the pandemic.

These points are among the key findings in the Centivo Healthcare and Financial Sacrifices Survey, 2021. Centivo hired the research firm SSRS to gain an understanding of the financial sacrifices people make to pay for unexpected medical expenses. The study surveyed 805 U.S. adults, age 18-64, who had employer-based private insurance continuously throughout the last two years.

While the full survey results will not be available until late December of this year, a preliminary analysis regarding mental health and health plan affordability revealed findings of concern for employers who sponsor health plans.


  • More than one-quarter (27%) of survey respondents who incurred significant medical expenses said the expenses had a major impact on their mental health.
  • 16% indicated they had a major impact on their family’s well-being.
  • Fully 20% said they skipped or delayed needed mental healthcare/counseling due to cost concerns.
  • The less respondents had in savings, the more likely they were to report that medical expense caused mental health issues.

Here at Centivo, we believe these stunning and troubling results call for a comprehensive re-examination of the very structure and design of employer-sponsored health plans. Here’s how.

‘Highly’ or ‘extremely’ stressed – the context for employer action

Let’s first put Centivo’s survey findings in some broader context. Fully one-quarter of U.S. workers surveyed in a 2021 report by Mercer said they feel “highly” or “extremely” stressed in their everyday lives.

Employers are listening and reaching out to the marketplace for help. In 2021, 76% of respondents from another Mercer survey of employers with 500 or more employees say that addressing employees’ mental and emotional health will be a top priority over the next 3-5 years – that compares to just 44% that considered it a priority in Mercer’s 2019 survey.

And things are happening. Overall, 12% of employers with at least 50 workers that offer health benefits reported an increase in their enrollees’ use of mental health services, according to the 2021 KFF Employer Health Benefits Survey released in early November. Among the largest employers (1,000 or more employees), more than a third (38%) reported such an increase.

To meet demand, solution providers across the spectrum – from startups to healthcare systems to major health insurance carriers like Blue Cross Blue Shield, United Healthcare, Cigna and Anthem – have proposed various add-ons or expansions of mental and behavioral health benefit offerings to help employers address this crisis. And given all the access and coverage issues surrounding mental health that well predate the pandemic, we here at Centivo certainly do NOT consider this “bad” or “unnecessary.” In the short term, coverage add-ons and expanded services are viable options to open doors to services for employees who need them. But ….

Employers need to ask tough questions

For longer-term solutions, employers and the advisors that serve them must step back and examine their core health plan offerings and ask some fundamental and hard questions:

  • How affordable are the plan options for employees at all income levels?
  • Are our deductible levels and co-insurance rates a leading cause of the mental health problems we are trying so hard to lessen?
  • Are we doing everything we can to steer members and their families to the highest quality, lowest cost providers available?
  • Are we emphasizing enough the many cost and health benefits of strong advanced primary care relationships?

Employers will be relieved to find that they can in fact offer access to high quality healthcare – including mental health services – while also addressing the overwhelming need to make healthcare more affordable.

The Centivo health plan gives employers the opportunity to do just that. Of particular interest to so many employees struggling with out-of-pocket expenses: With Centivo, all primary care is free all the time and not just for wellness visits. Specialty care that is coordinated by the primary care team is covered by a clear, easy-to-understand copay schedule that gives members an up-front view of what they will need to pay. All with no deductibles for in-network care.

Let’s be part of the big picture fixes, before we bolt on another point solution

The stress of paying for healthcare or the consequences of skipping care because of costs are key sources of strain on employees’ mental health. And, as mentioned, hard questions need to be asked about your plan design like if it is helping your workers’ mental health – or hurting it.

The severity of the mental health crisis among the American workforce only reinvigorates our sense of urgency and commitment to providing solutions as we continue our journey. To learn more about Centivo and how we can help you create a plan to reduce your employees’ stress and anxiety, contact us today.

To receive a complimentary Executive Summary of the Centivo Healthcare and Financial Sacrifices Survey, 2021, please complete the form here.



Wayne Jenkins