A Ticking Timebomb? The Risks of Ignoring the ‘Apparently Healthy’

When employers talk about healthcare costs, the focus often turns to the most unwell employees — the comparatively small group managing cancer, heart failure or multiple chronic conditions that drives the lion’s share of spending. While supporting these individuals is vital, there is another group of employees, the “apparently healthy,” who may suddenly and unexpectedly contribute to a spike in healthcare spending and lost productivity. 

Most employers assume their workforce is generally well — yet beneath the surface, hidden health risks are quietly growing. Without proactive care, these risks often go undetected until they escalate into serious, costly conditions. These can include:

• Common undiagnosed chronic illnesses (e.g., high blood pressure, prediabetes);
• Mental health challenges (e.g., stress, anxiety); and,
• Personal habit shortcomings (e.g., poor diet, a sedentary lifestyle, a lack of sleep). 

Who Are the ‘Apparently Healthy’?

Castlight Health’s analysis of $13.1 billion in annual healthcare spend across its digital clients found employee populations consistently fall into three distinct segments: 

• High risk and rising risk. These individuals account for approximately 20% of your population but the majority (82%) of your healthcare costs. These are typically polychronics (those with multiple chronic conditions) or those with early or underlying conditions that require management.
• The apparently healthy. Those with hidden risks, who make up another 20% of your population. They are not actively using the healthcare system and may appear well until a hidden issue surfaces, skyrocketing them to the top of your high-risk list.
• Well-being and prevention. The last 60% of your population is active in their care, utilizes self-service options and has an established primary care provider. 

Looking more closely at financial impact, Castlight found that, within its client base, high- and rising-risk employees had average “per member per month” (PMPM) costs of $3,784, which resulted in $45,000 per person annually spent in paid claims costs. Those in the hidden-risk or well-being category, by comparison, had an average PMPM of $180. But for the apparently healthy, that’s not necessarily a good thing. The difference might be a $2,000 preventive screening or a six-figure (or more) diagnosis and disability leave.

Because apparently healthy employees tend to skip preventive care, they may quietly develop conditions that go undetected until they escalate. Once that happens, costs — and the human toll — can rise dramatically.

Why Employers Should Pay Attention

When employees skip preventive visits and screenings, opportunities for early detection are lost. Over time, some apparently healthy employees inevitably move into higher-cost categories. For employers, this can mean steep increases in claims, as well as ripple effects like absenteeism, disability and lower productivity.

Focusing on this group while they are still lower-cost healthcare consumers pays dividends. Detecting cancer earlier, preventing diabetes or addressing mental health needs before they worsen can save lives and money. For example, those with prediabetes who enrolled in the U.S. Center for Disease Control and Prevention’s National Diabetes Prevention Program had an average reduction of $4,552 in medical costs over two years, with savings in fewer hospitalizations, outpatient visits and emergency department visits.

What Employers Can Do

Employers are uniquely positioned to engage the apparently healthy before health issues escalate. The goal is to remove barriers, create touchpoints and foster a culture of prevention. Here are some actions employers can take: 

• Make preventive care easy. Employees are more likely to act when care is accessible and affordable. Cover screenings, annual visits, labs and vaccines at 100%. Offer flexible access through onsite or near-site clinics, same-day appointments, and telehealth or mobile screenings. Proactively close gaps in care with reminders for mammograms, colonoscopies and other routine tests.
• Incentivize early engagement. People often delay care until something feels urgent. Employers can flip this dynamic by creating positive triggers. Offer health savings account (HSA) contributions, premium reductions or gift cards for completing annual exams or biometric screenings. Tie prevention into broader wellness programs (e.g., step challenges) so it feels less like a medical task and more like part of everyday life. Recognition — from raffle drawings to leader shoutouts — helps normalize participation.
• Focus on whole-person health. Physical, mental and social health are deeply connected. Integrate behavioral health into benefit offerings with embedded counselors, digital therapy or partnerships that reduce stigma and wait times. Address social determinants by supporting financial wellness, caregiving and stress management. Health coaching and peer support programs can help employees turn medical advice into sustainable lifestyle changes.
• Personalize care plans. Generic advice doesn’t stick. Encourage providers to collaborate with employees on realistic personal health goals. Use digital tools to send reminders or health tips tailored to age, risk profile or claims history (while protecting privacy). Celebrate small wins (e.g., lowering blood pressure, sticking to a fitness plan) to build trust and momentum.
• Communicate consistently. Apparently healthy employees may tune out benefits messaging because they don’t see themselves as needing care. Counter this with consistent, relatable outreach. Send reminders about preventive visits and screenings through multiple channels (e.g., emails, texts, apps, mailers). Frame care as prevention, not reaction. Messaging like “protect your energy for your family” is more compelling than “manage your cholesterol.” Engage managers and leadership to model preventive behaviors, signaling that it’s valued at every level.

The Long-Term Payoff

The payoff isn’t immediate, but it is exponential. Every year an apparently healthy employee avoids becoming a high-cost case is another year of avoided six-figure bills, preserved productivity, and reduced stress on families and teams. 

And, here’s the real risk: In the next two to three years, the biggest cost spikes for employers won’t come from those already in care; they’ll come from the people they assumed were fine. The risk is silent until it isn’t.

Investing early doesn’t just prevent claims, it can prevent surprises. Employers that act now increase the likelihood that they can control their cost curve before it controls them. 

Editor’s Note: Additional Content

For more information and resources related to this article, see the pages below, which offer quick access to all WorldatWork content on these topics:

• Employee Benefits
• Finance and Budgeting
• Well-Being