Connect Different Function Areas of HR
Just like outside-in programs, inside-up programs can be leveraged to address pressing hiring needs. Hiring internal candidates can be more cost effective than recruiting, vetting, and training external candidates. Moreover, if an employee moves within the same department, managers may already have experience with the candidate and understand their competencies and skill sets. Connecting employee services, such as coaching and skills assessments, to workforce forecasting not only helps in planning, but it also ensures that employees are connected to training opportunities for available jobs within the institution.
Develop and Map Transparent Career Pathways
Mapping out potential career pathways can help to enhance coaching. Institutions that outline the necessary training steps for employees to advance can help employees and coaches understand the necessary steps and timeframe to pursue advancement opportunities, and evaluate whether they are realistic. Mapping pathways within the institution can also illuminate where lateral pathways might facilitate career advancement. For instance, University Hospitals has outlined specific pathways from entry-level positions to career ladders within the institution. A training participant hired into an environmental services role can participate in training that will allow them to move laterally into a patient care assistant position. From here, they can advance into higher-level patient care work, and eventually to nursing, taking advantage of tuition support and coaching resources along the way.72b
Educate Managers to Ensure Staffing Support
An important element of an inside-up strategy is creating buy-in among department managers who are on both the sending and receiving sides of a program. For managers who are being asked to release employees for training with the possibility that those employees will leave their department at the end of the training, buy-in is essential.
In this situation, not only are the long-term implications of staff moving on impending, but there are also immediate logistics to work out. When employees leave the floor for training, managers must cover that time by switching around shifts, offering overtime, or utilizing temporary workers. All of these options require time and/or resources on the part of the manager. Educating managers about the importance of career advancement opportunities can help them see the benefit of investing in their employees. When managers have a shared understanding of what growth can look like, including lateral or opportunity moves, they can be powerful champions of impact promotion programs.
Creating communication channels between the organizational learning or workforce development department and other department managers helps to ensure this education piece happens, and that managers are able to troubleshoot and find solutions when scheduling is a challenge. In addition to this logistical support, workforce development or organizational learning may also be able to provide resources such as coaches or additional funding to alleviate short-term staffing shortages while employees are in training, to reduce the burden on managers.
Another critical component to building support among managers is to ensure that there is a pool of qualified applicants who can move into positions that are vacated by current employees moving on to other opportunities once their training is completed.
Provide Benefits to Overcome Financial Instability and Build Wealth
The goal of inside-up worker training programs is to move entry-level employees into career-level jobs with higher wages, added benefits, and greater stability. One of the results of this career pathway approach is that it can create measurable impacts on employment and wages in particular neighborhoods. Given that financial status is a primary determinant of health, these efforts can help to improve the overall health of the community by increasing economic security and resilience over time. In order to further sustain the investment in their employees and communities, health system leadership should consider implementing other programs that represent long-term investments in the physical and economic health of those they serve. Examples of these long-term investments are included below.
Some people are surprised to learn that low-wage earners may still qualify for certain public benefits, even though they work full time. If wage thresholds are under a certain level, employees may be receiving SNAP benefits, childcare vouchers, and/or Section 8 housing vouchers. When the employee’s income level rises due to promotions and wage increases, they may lose eligibility for some of those benefits, and their actual household income would drop due to the loss of the benefits. This is called the “benefits cliff.”
Understanding the benefits cliff can be helpful in understanding why an employee may turn down a promotion or decline a raise. A key step is to determine at which wage level a person’s household income would be at parity with the benefits they have lost due to increased pay. Some health systems are addressing the benefits cliff with the help of policymakers and education sessions. For example, Baystate Health partners with the Western Massachusetts Economic Development Council and Springfield WORKS, which have expertise on economic development and regional workforce trends, to assess how lower-wage employees may be impacted by the benefits cliff.73
One strategy to improve benefits is to implement tiered pricing for costs associated with employment, such as parking and health insurance, so that employees pay a proportion of their wages or salaries instead of a fixed cost. Ascension, for example, has adopted a policy where health insurance and parking fees are proportional to an employee’s income.
ProMedica, headquartered in Toledo, Ohio, is the nation's first health system to operate a Financial Opportunity Center (FOC). Launched in 2016 in partnership with LISC, United Way, and the Toledo Community Foundation, the program connects low- to moderate-income individuals with job training and financial support services. The FOC offers valuable resources to help community members and employees improve their financial wellness. Financial coaches provide one-on-one guidance to address specific challenges, such as debt resolution, credit repair, navigating public benefits, free tax preparation, preventing eviction, and working toward long-term financial goals. Since its inception, the FOC has served 9,861 individuals in the community and among ProMedica’s employees.74
In Louisiana and Mississippi, Franciscan Missionaries of Our Lady Health System (FMOLHS) developed an innovative strategy to help employees avoid predatory payday lenders, which charge prohibitively high interest rates for small loans, often exceeding 100%. The Faith Fund is a micro-loan investment fund which offers low interest loans and financial education services to employees who have been members of the FMOLHS workforce for at least one year. The health system initially supported this fund by tapping into the system’s unspent Flexible Spending Account dependent care and medical spending savings account funds. Since the Faith Fund’s launch in 2018, more than 1,900 employees have accessed $8.1 million in low interest loans, effectively averting long-term cycles of debt. FMOLHS estimates that this has resulted in the retention of more than $21 million of personal wealth when accounting for interest payments, penalties, and additional fees. In recognition of the disparities in the banking system and the barriers they pose to generational wealth-building, FMOLHS has also partnered with local credit unions and banks to expand access to banking services and financial counseling.75
Health systems can also provide support to employees to help them pay down student loan debt, an issue that prevents many individuals from achieving financial stability. Across disciplines, borrowers from the lowest income quintile face substantially higher default rates compared to those in higher income brackets.76 People of color are more likely to take on student debt, and are five times more likely to default on loans than white undergraduates. 76a , 76b Meanwhile, women hold nearly two-thirds of the outstanding student debt, and three-quarters of nursing students graduate with student loan debt. 76c , 76d In 2019, Children's Hospital of Philadelphia (CHOP) began partnering with PeopleJoy to provide public student-loan forgiveness repayment planning and loan forgiveness advice to employees with student loan debt. Additionally, in April 2022, CHOP introduced a new student loan repayment benefit through Bright Horizons (EdAssist), which is paid for by the health system. These benefits have helped the system attract talent and bolster the HR recruiting team’s efforts. Eric Breniman, senior benefits manager, stated: “It's truly a differentiator when [our HR recruiting team] is speaking to a candidate.” Since introducing these benefits, CHOP has documented exponential interest and employee engagement in public student-loan forgiveness. About 70% of employees who take steps to utilize these benefits are consistently receiving 4 or 5 out of 5 in their annual performance review ratings. 77
EMPLOYER-ASSISTED HOUSING PROGRAMS
Employer-assisted housing programs offer several employee and community benefits. For lower-wage employees, homeownership is a critical tool for building wealth and achieving economic well-being and security. There are many strategies for structuring such a program, including forgivable loans, down payment assistance, or a mortgage buy-down.78 With built-in support measures, such as connections to financial institutions with stable loan products and homeowner financial literacy trainings, these programs often provide sustainable paths to homeownership. This strategy can help to address the displacement pressure lower-wage employees can face in high-cost neighborhoods or neighborhoods experiencing gentrification.
Intentionally linking impact workforce programs to an employer-assisted housing program can ensure that a broader range of employees can take advantage of this type of benefit. Although many institutions already have employer-assisted housing programs, special measures can be employed to consider how such a program can complement an impact workforce strategy so that entry-level workers also have realistic access to such employee benefits.
The MetroHealth System is collaborating with community development partners in Cleveland on an integrated approach to housing development that fosters a mixed-income neighborhood and expands access to safe, healthy, and affordable housing. Through a two-year community engagement process, the health system found that housing was a major health issue and as a result, initiated the development of a neighborhood master plan and began making direct investments in expanding housing stock. In 2024, MetroHealth partnered with The NRP Group to open Via Sana, a 72-unit, affordable housing complex located in the Clark-Fulton community, adjacent to MetroHealth’s main campus. The Via Sana building also offers community space, workforce training, computer access and training, and financial coaching at no cost to community members and residents.79
In the Upper Valley of New Hampshire and Vermont, limited access to affordable housing poses a significant recruitment challenge for Dartmouth Health. To address this, the health system launched the Relocation and Community Resource program in March 2021, offering workforce housing units, income-based subsidies, and relocation support for new hires moving to the area. Since then, the program has expanded to master lease 189 apartments near its hospitals, currently subleased to 227 new employees who provide or support direct patient care and relocate from over 50 miles away. Additionally, a rental network and website enable local landlords to list available units, increasing housing options. The program is managed by a dedicated director and coordinator who assist new hires throughout their relocation process. In the first three quarters of 2025, over 1,025 individuals received housing and relocation support, with more than 3,800 assisted since the program’s inception. Complementing these efforts, the Dartmouth Health system collaborates with local employers and a regional housing finance partner through the Upper Valley Loan Fund, contributing $9 million to expand affordable housing supply in the region.80
MATCHED RETIREMENT SAVINGS PROGRAM
Another way to help magnify the impact of higher wages is to help facilitate employee savings. Employer contributions to a retirement plan—a common employer strategy—help do this. Rush University System for Health has an auto-enrollment and auto-escalation program for employees’ 403(b) retirement savings plans. All new employees are automatically enrolled with Rush matching 6% of employees’ contributions. For employees who were already employed when the auto-enrollment program began, Rush increases that percentage from an initial 3 to 4% by 1% each year until it reaches 6%. With this example, Rush monitors internally whether employees opt out of this program on a monthly basis, and have found that employees typically remain auto-enrolled.81
Further Reading: Financial Benefits for Employees
The following resources from Commonwealth, a national nonprofit building financial security and opportunity for people earning low-to-moderate income through innovation and partnerships, offer employers practical guidance and research on implementing intentional workplace benefits to strengthen employee financial well-being.
| Focus: Benefit Overview | ||
| Resource | Description | Relevance for Employers |
| Intentional Employee Benefits That Support Retirement Savings for Workers Living on Low to Moderate Incomes | Brief that explores six promising benefit areas that support short- and mid-term financial needs while strengthening long-term retirement security:
| Resource for employers exploring intentional benefit options to strengthen employee financial well being. Content can be used all together—or one or more sections used separately. |
| Focus: Student Loans | ||
| The Hidden Burdens of Student Debt & The Potential of Employer- Provided Solutions | Summary of Commonwealth research on the impact of student loans and employer options to support employees—including direct support for student loans and retirement matching for student loan payments. | Resource for employers considering benefit options to support employees with student loans. May be especially relevant for healthcare organizations. |
| Focus: Education Savings (529s) | ||
| How Employers Can Help Workers Save for Their Child’s Education Through 529 College Savings Plans | Report that summarizes insights from Commonwealth’s research on the cost of post-secondary education as a significant barrier to wealth building and the role employers can play as partners in providing 529 college savings plans support to workers earning low to moderate incomes. | Resource for employers considering offering education savings options as a benefit, such as 529 education savings plans, with payroll deduction. |
| Promoting Financial Wellness Through 529 Workplace Benefits | Blog post highlighting the benefits of 529s education savings and the opportunity for employees to offer 529s as an optional workplace benefit. | Practical tips for employers considering offering 529 education and payroll deduction as a benefit |
| Focus: Emergency Savings | ||
| Catalyzing Financial Resilience | Case study of a healthcare company’s emergency savings rollout, achieving nearly 70% opt-in enrollment in two months—driven by targeted incentives, integrated payroll deposits, and strong uptake among low to moderate income and diverse employee groups. | Practical summary resource for healthcare employers considering offering emergency savings. |
| The Power of Payroll: Driving ‘Sticky’ Savings Behaviors with GXO’s New Emergency Savings Benefit | Case study of GXO’s effort to launch and promote an emergency savings tool for employees integrated with payroll to save directly from their paycheck. GXO leveraged creative communication channels, going beyond email—for instance posters and in-person engagement— to reach their workers without regular access to a computer and email as part of their jobs. | Practical resources and examples for employers considering emergency savings benefits for employees. |
| How AutoNation Brought a Multi- Solution Emergency Savings Benefit Program Access to 24,000 Employees | Case study of AutoNation’s effort to identify, launch, and drive engagement with an emergency savings benefit for AutoNation’s 24,000 employees. | |
| How UPS and Voya Designed a Solution Resulting in $10 Million in Savings | Case study of UPS’ effort to boost employee emergency savings participation through targeted outreach and an in-plan solution, revealing that employees who increased after-tax emergency contributions were twice as likely to also increase their retirement savings. | |
| Focus: Financial Education | ||
| Tax Time Is The Perfect Time To Increase The Financial Well- Being of Your Employees | Practical tips on how employers can help employees maximize tax season to improve financial security. | Resource for employers looking for high-impact but low-lift opportunities to provide employee financial education. |
72b.
Debbi Perkul and Danielle Price, interview by David Zuckerman and Katie Parker, Cleveland, OH, January 11, 2016, transcript.
73.
Anne Kandilis, Josephine Hauer, and Donald Jonas “Helping Families Climb the Economic Ladder by Addressing Benefit Cliffs,” (HAN Impact Workforce Call, Springfield WORKS and Atrium Health, Webinar, September 08, 2022).
74.
“Employee Resource Center (ERC),” (presentation to Healthcare Anchor Network Impact Workforce group, The Ohio State University, December 2022).
75.
Coletta Barrett and Karen Estela, “We Listen, We Heal: Promoting Health Equity and Improving Patient Outcomes, Nurse Leader 21 (2003): 619-622, accessed November 4, 2025, https://www.nurseleader.com/article/S1541-4612(23)00237-9/fulltext.
76.
“Who Experiences Default?,” Pew, data visualization by Pew, accessed November 10, 2025, https://www.pew.org/en/research-and-analysis/data-visualizations/2024/who-experiences-default.
76a.
“Who Experiences Default?,” Pew, data visualization by Pew, accessed November 10, 2025, https://www.pew.org/en/research-and-analysis/data-visualizations/2024/who-experiences-default.
76b.
“The Student Loan Default Divide: Racial Inequities Play a Role,” Pew, accessed November 10, 2025, https://www.pew.org/en/research-and-analysis/reports/2024/12/the-student-loan-default-divide-racial-inequities-play-a-role
76c.
American Association of University Women, “Analysis: Women Hold Two-Thrids of Country’s $1.4-Trillion Student Debt,” Press Release, May 21, 2018, https://www.aauw.org/resources/news/media/press-releases/analysis-women-hold-two-thirds-of-countrys-1-4-trillion-student-debt/.
76d.
Pete Pappas, “Nursing degrees lose professional status under new federal loan rules: New borrowing caps could leave future nurses with fewer financing options as hospitals brace for persistent workforce shortages,” Digital Health Insights, December 12, 2025, https://dhinsights.org/news/nursing-degrees-lose-professional-status-under-new-federal-loan-rules.
77.
PeopleJoy and Children’s Hospital of Philadelphia, “Premier Student Loan Employee Benefits,” (presentation for the Healthcare Anchor Network IW group, May 9, 2024).
78.
A full list of strategies can be found in Anna Afshar, New Arguments for Employer-Assisted Housing (New England Community Developments: Federal Reserve Bank of Boston, 2006), page #3, https://share.google/getfqdQiIwvvsWB4Z.
79.
“MetroHealth announces $60 million investment in Clark-Fulton neighborhood apartments,” Cleveland, July 02, 2019, https://www.cleveland.com/business/2019/06/metrohealth-announces-60-million-investment-in-clark-fulton-neighborhood-apartments.html.
80.
Dartmouth Health Workforce Development (Healthcare Anchor Network, 2023), page #5, https://healthcareanchor.network/2023/12/dartmouth-health-workforce-development/.
81.
Shweta Ubhayakar, interviewed by Lauren Worth, Healthcare Anchor Network, 2022, phone interview.