I've written recently about the lack of consumerism among patients, and the health industry's strong resistance to furnishing even a moderate amount of transparency that could boost consumer's shopping effectiveness. This article, however, speaks to a cultural shift that could provide tremendous employer impact. 

Most employers I work with want to provide their employees access to the "best" health care possible. And for ethical and regulatory reasons (think HIPAA), many executives steer clear of involvement in health care decisions, other than selecting the broadest network access possible. But from a financial perspective, few expenses impact the P&L that executives know so little about as much as health care. Managers are more likely to limit rental cars to $30 per day than limit an open heart surgery to $100,000.  And remember, under the coverage provisions of the Patient Protection and Affordable Care Act (PPACA), both fully-insured and self-insured are required to provide an unlimited benefit. The open credit card analogy really applies. 

The responsibility business owners feel to their employees' health care spending has shifted, empowering both cost-lowering and outcomes enhancement opportunities. Until now, employers' limited involvement has used two main strategies. They first offloaded costs to employees, hoping that more skin in the game would change behavior (and increase payroll deductions, out-of-pocket spending, or both). They also invested in wellness programs.   

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