Large self-insured employers spend hundreds of billions of dollars annually on health benefits struggle to manage trend and reduce employee health risk. Consultants and carriers provide uninspiring choices from cost shifting to adoption of private exchanges.

Despite the outlay of billions only two things are certain for employers—employee engagement declines and administrative expenses increase. With national health expenditures eclipsing 17 percent of the gross domestic product, new players or vendors are flooding the market with products, technologies, and services with a promise to employers to reverse the slide of employee engagement and the escalation of health care costs.  While some industry estimates project 30 percent of health care cost as waste, health care payers through evidence-based approaches must sort through these options.

Each patient and episode of care is supported by hundreds of individuals and thousands of transactions across the health care system. Although patients and their physicians continue to sit at the center of these interactions, the evolution of medicine and the emergence of new technologies confuse the traditional relationship. Patients and doctors are confronted with an array of new resources (e.g., patient advocates, disease managers, wellness coaches, retail clinicians, free-standing labs) to supplement traditional interactions with nurses, pharmacists, specialists, and hospitals that aim to improve health outcomes and potentially reduce costs.