Open enrollment is upon us and for the majority of employers,that means offering employees a high deductible health plan. It isalso the time of year when benefits professionals are most likelyto remind employees to shop around when using their health care andinvite them to engage with a price transparency tool. And yet ifyou focus solely on these strategies, you may be missing amonumental opportunity to curb your health care spending while alsoimproving your employees’ health.

The bulk of employer health care spending on an annual basis isdriven by the care provided to a handful of very high costemployees, like the employee with multiple chronic conditions orthe employee with recurrent cancer. A new report out from the American HealthPolicy Institute and Leavitt Partners documents that among 26 largeemployers, 1.2 percent of employees are high cost claimants whocomprise 31 percent of total health care spending. Highdeductible health plans do nothing to contain costs for theseemployees who quickly meet their deductible. Benefits professionalsneed a multi-pronged strategy to improve care and contain costs forthis special population.

Many employers have already deployed one common strategydesigned especially for employees with multiple chronic conditions:wellness. But the jury is still out on the ROI of engaging the sick to exercise and eatbetter. To understand how we can save dollars while improvingcare, we need to take a closer look at the five critical points inan employee’s health care journey where costs can jump suddenly anddramatically. Then we can better understand the strategies andtools benefits professionals have at their disposal to interveneduring these critical moments.

First off, we need to make sure patients have the rightdiagnosis. If we treat a patient who has the wrong diagnosis, weare throwing money down the drain, at best. At worst, the wrongdiagnosis can be fatal. The problem of misdiagnosis is a lot morecommon than you may realize. One in 20 patients, almost 12 millionAmericans, is misdiagnosed each year. No wonder the IOM tellsus that $750 billion —or 33 percent of annual health carespending — is wasted on unnecessary services annually. One obviousbenefits strategy to address this is the use of second opinionservices, which are growing in popularity among large employers.According to Willis Towers Watson, onequarter of employers plan to tie reimbursement to second opinionservices by 2018.

Once we have a correct diagnosis for the employee, we need tomake sure they are getting the right care at the right time at theright place. This has huge potential for savings. Getting the rightcare isn’t as easy as it sounds in a health care world where almosthalf of patients fail to get recommended care, according toa landmark RANDstudy.

The second step is making sure the employee is seeing a highquality physician, one who practices evidence-based medicine. Highquality providers cost less in the long term because they are lesslikely to prescribe unneeded services, such as imaging, and morelikely to follow evidence based guidelines. In itsreport BetterCare at Lower Costs: The Path to Continuously Learning Health Carein America, the IOM noted that more than 30 percent ofhealth care costs could be avoided as a result of improving qualityand efficiency. Benefits professionals can help employees get tohigh quality physicians using a variety of strategies, includingnarrow networks, steerage, and centersof excellence.

Sometimes, the right care is actually a less invasive and lessexpensive procedure. For example, consider the case of an employeewith lower back pain contemplating spinal fusion surgery. Thelong-term outcomes from such a surgery may not be worthwhile whenphysical therapy and other interventions may work better. Decisionsupport tools and services can help employees understand the risksand rewards of various types of procedures and choose the care paththat is right for their health condition and lifestyle. These canbe a very valuable tool in the benefit professional’stoolbox.

If the patient wants to move forward with a more invasiveprocedure or surgery, getting them to the right place is the nextstep. Surgical volume remains one of the best proxies we haveto measure care quality. So when that employee is considering atotal hip replacement, we want to get him to the physician andhospital that has performed thousands of the same procedures.Again, relying on a strategy like using a center of excellencegives employers a leg up here. Some employers, likeKroger and Walmart, will even pay for employees to travel tocenters of excellence, because their return on investment is sopowerful.

And after the surgery or intervention, when recovery begins, weneed to make sure the patient and his or her family/caregiver aregetting the longitudinal support they need. This is the piece ofthe care journey that is frequently overlooked and in some ways isthe most important. For example, arecent Carnegie Mellon/Blue Shield study found thatproviding intensive case management — including home visits —reduces costs by more than $18,000 per patient for very sickpatients dealing with cancer.

Telehealth can be another useful strategy to help recoveringemployees check in frequently with their care providers. And manyorganizations offer medical ally services to provide ongoingtelephonic support.

On a final note, benefits professionals shouldn’t ignore therole that benefit design can play in helping contain costs andimprove quality for the highest cost employees. Several of theemployers my organization works with have seen phenomenalengagement using incentives and even penalties. For example, anemployee considering back surgery receives a $400 incentive fortalking through her condition and treatment options with an expert.Sometimes that means the employee, once fully informed, will electnot to have back surgery, which may indeed not be the best courseof treatment given her medical issues and lifestyle. One largeemployer saved $5.6 million after switching to a penalty; employeeshad to engage in surgical decision support or pay $1,000. Not onlydid the program cause employees to make smarter decisions, it alsogained very high employee satisfaction scores.

High deductible health plans have their place in a benefitsprofessional’s toolbox, but they can’t be our only tool if wereally want to reduce spending and improve care quality, especiallyfor our sickest employees. Fortunately, there are anumber of other strategies and tools available to help containcosts and improve care for the sickest and most expensiveemployees.