Caitlin Clement|1/18/2024|6 min read

5 PEPM Programs Employers Should Add to Their Benefits Package

Increase employee health and wellness with these five PEPM programs

two co-workers laughing and fist bumping while working on a project

If you’re interested in starting a PEPM benefits model (which is probably the case if you’re reading this), but aren’t sure what programs to include for your employees—you’re in the right spot. The attractive bit about PEPM as a benefits model for both parties involved is that it isn’t an all or nothing benefits plan. Employees can choose to opt-in or opt-out of certain offerings instead of being automatically enrolled into a one-size-fits-all plan. 

Why is this beneficial? It allows employers to offer a wider variety of benefit options to meet their employees’ diverse health needs without spending an arm and a leg. But what programs should you include in your PEPM model? A great place to start is by looking at U.S. population health data. (Lucky for you, we already did some of this legwork!)

Understanding our biggest health issues

Looking at what health issues have the biggest footprint in the United States can help you determine what programs to include in your PEPM benefits plans. Here are the top health issues concerning the U.S. right now.

Heart disease and stroke

The number one killer of both men and women in the United States is heart disease. Due to poor diet, lack of nutritional knowledge and food deserts in lower income areas, it’s become a huge health problem. Heart disease can be caused by various factors such as high blood pressure, diabetes, obesity, smoking, alcohol abuse, as well as being genetically predisposed. 

Thankfully, many of these can be prevented and even reversed by adopting healthy lifestyle habits like eating a healthier diet and increasing physical activity. 


While obesity and heart disease are often considered synonymous with each other, heart disease can still occur in someone who appears thin but lives an unhealthy lifestyle. Nearly 1 in 3 adults are considered obese and overweight in the U.S. Obesity can lead to health issues like heart disease, diabetes, high blood pressure and more if left unchecked. Thankfully, obesity can also be reversed or avoided through healthier habits and preventative medicine. 


Currently, diabetes affects 30 million adults and children in the United States according to the National Institute of Medicine. While this includes both type 1 and type 2 diabetes, the vast majority of Americans suffer from type 2. This form of diabetes can be caused by several factors such as being overweight, eating a diet high in fat and sugar, low physical activity and being genetically predisposed. 

Unfortunately, diabetes can cause additional health complications if not managed properly. These can include vision loss, nerve damage, chronic kidney disease and even cancer. Individuals with diabetes also rely on access to insulin medication and RPM devices like glucometers to manage their blood sugar as well as regular communication with their endocrinologists. Consequently, the treatment of diabetes requires continuous chronic care management.  

Mental health and substance use disorder

1 in 4 or about 26% of Americans 18 years and older suffer from some type of mental health disorder, and it’s only been trending up in recent years. Often, these patients suffer from multiple mental health disorders, like depression and substance use, at once. Anxiety and depression are also two disorders commonly experienced together. Offering mental health support through benefits programs could increase access to much needed services and support a healthier, more productive workforce in the long run.


5 Types of PEPM programs to consider for your employees

Now, having seen the data, here are five types of PEPM programs that your HR department should consider offering your team members. 

Primary/Preventative Care

Prevention and precision medicine are key to limiting healthcare spending for businesses. By preventing major illnesses like heart disease, diabetes, cancer and even safe guarding against minor illnesses, businesses can see a reduction in sick days and a faster return to work.  A happier and healthier workforce means productivity goes up and so does the stability and success of your business. When you give your employees the tools to be proactive about their health, the ROI will follow.

Mental Health

The overall mental health and well being of your workforce should be a high priority for any company and HR department. When your employees are at their best mentally, companies experience higher performance and increased innovation. Let’s take a look at the current state of the mental health impact in the workplace.

According to a study done by the One Mind At Work initiative:

  • 5 days of work every three months are lost by employees that are depressed

  • 62% of missed work days are attributed to burnout, depression or anxiety

  • $15,000 is lost in productivity, healthcare costs and turnovers by employers every year

  • 86% of employers now list mental health as a top concern

By prioritizing workplace mental health and offering resources to employees struggling with a mental health disorder, you’re investing in a stronger workforce and more resilient business. 

Weight Loss

Adding a weight loss program to your PEPM benefits is a great way to combat rising obesity and invest in the health and longevity of your employees. Being overweight and obese can lead to future health problems such as high blood pressure, high cholesterol, diabetes and heart disease. 

Obesity also increases the chances of employee workplace injuries and workplace absence. In a 2018 medical guidance review called Obesity In The Workplace, it was calculated that obesity attributed absenteeism cost the nation $8.5 billion per year. In that same review, it states that between a BMI of 25 and 45 kg/m, medical and drug costs increased $119.70/person. 

Increasing access to weight loss programs like nutrition education and even medical weight loss intervention can have a positive impact on your healthcare costs and employees. 

Diabetes Management

As mentioned above, diabetes is one the biggest health issues facing the United States. While prevention through weight loss and health and wellness programs is where we want to start, managing diabetes is also just as important.

A diagnosis of diabetes often means frequent insulin injections, the use of RPM devices like glucometers to keep track of their blood sugar and regular communication or visits with their endocrinologist. All of this can become costly not just for your employee, but for your business too. 

According to the CDC, increased absenteeism from diabetes cost the U.S. $5.6 billion in 2022, reduced productivity $35.8 billion and other additional indirect costs totaling $413 billion for that year. By investing in a diabetes management benefits program you’re supporting the health of your employees and reducing the effects of absenteeism, presenteeism, disability, early retirement and early mortality on your business. 


While this wasn’t listed in the top health issues, it’s a very important one to consider adding to your PEPM programs. Right now in the U.S, 1 in 5 women (19%) are unable to get pregnant after one year of trying. This can be due to a variety of reasons involving one or both parties. On average, infertility treatments like IVF can cost families anywhere from $15,000 - $30,000 per round, depending on the center and the patient's individual medication needs. 

But why is this important for employers to support? The mental load that infertility can put on those involved can significantly affect their overall wellbeing and mental health. Doctors visits, medications, treatments, ovulation tracking, supplements—it can become overwhelming.

Additionally, the physical toll that medications and treatments can put on one's body can limit their ability to perform certain tasks and be present at work. By offering fertility coverage, it opens the door for many individuals to seek better fertility treatments and relieves some of the financial burden. This translates to better productivity at work and as a result, higher workplace satisfaction.

Create packages and attract new talent

An advantage to the programs listed above is they can also be packaged together and used as a hiring benefit to attract and retain top talent. Combine mental health, weight loss and smoking cessation to form a “Health and Wellness” program that prioritizes and supports the health and fitness of employees. Or create a chronic care management package that includes diabetes management and heart disease. 

There are also two ways you can present each of these packages. You could auto enroll all employees, or allow them to opt-in to each program package. If you’re looking for a more custom (and cost effective) way to offer benefits, giving employees the option to opt-in to what makes sense for them might be the better approach. That also reduces benefits going unused and becomes more affordable for the employer in the long run. 

Supporting better access to healthcare for employees

If you’re making the switch to a PEPM model, deciding what programs to offer your employees can become daunting. You don’t want to fall into the trap of the latest health trend only to see engagement plummet in a few years. But you want to start supporting the long-term health and happiness of your employees today. 

All the programs listed above are great places to start, but doing research, facilitating internal employee surveys and looking at what health issues are most prominent in your areas can offer you more insight into specific populations. Also, it’s okay to start small with one program and scale up as you grow and see success. While you certainly can, there’s no need to start offering all five right away (that would take a lot of organization and paperwork).

That being said, we’d like to take a moment to introduce OpenLoop, a white-label telehealth support company delivering a full-stack of innovative digital health solutions. Our mission is to empower healing anywhere by offering companies the digital tools and administrative support they need to expand access to care. 

We’re here to assist with the construction of your PEPM plans and would be happy to offer our industry guidance and best practices for success to get you started. Also, check out all of the other service offerings we have available below!

Interested in learning more? Get in touch here!

Our full suite of white-labeled virtual care services include: