This month, I want to cast doubt on another “tried-and-true”method of reducing costs — reducing benefits.

Often referred to as consumer-driven health care,this strategy has been in place for decades, generally as a lastresort due to rising costs. Our industry has spun this as“engaging” the employee to be better stewards who have skin in thegame. Let's examine the challenges.

First, it assumes a patient wants to be a consumer. Most simply do notor cannot. Often, they are faced with an emergency, or are insultedat being told to “challenge” the advice their trusted doctorprovides.

Second, it assumes a patient can be a consumer in this space.Consumerism is the answer to problems in our health system, butit's impossible under current rules. I recently had a medicalsituation and I called four outpatient facilities. Two weeks, 16calls, and I was able to get a price from two. One quoted $184.20;the other $2,840. I went with the cheaper option, but was actuallybilled $10,939. How can we be consumers when there is norequirement to provide a price, let alone an accurate one?

Multiple studies show that higher out of pockets result indelayed maintenance of chronic diseases, or even delay of initialdiagnosis.

How can an employer maintain (or improve) benefits and cut costs?

One option is high performing networks. Don't confuse this withcarriers' narrow networks that are almost exclusively based ondiscount alone, which doesn't translate into lower costs, anddoesn't take quality into account.

A quickly emerging model is called direct primary care. DPC is ahigh-value way to ensure appropriate levels of care and directpatients to high performing specialists, when necessary. One suchpractice, Blue Skies Family Medicine in Mooresville, North Carolinahas patients paying a small monthly fee for their care. There is nocopay, no claims to file, and generally, no additional cost.Patients get 24/7 access to their doctor.

Many doctors in the DPC space once owned a more traditionalpractice, and sold it to one of the big local health care systems.The result was an increased demand on the business of medicine,requiring more patients per hour and referrals to more profitablespecialists.

On the facility and hospital side, similar tactics can beutilized. Earlier this year, I wrote about Health City CaymanIsland, a joint venture between Ascension Health and NarayanaHealth, that touts outcomes and accreditations equal or beyond anyU.S. hospital, with up front, fixed cost often 75 percent belowU.S. pricing. Employers could use a traditional network, butincentivize utilization of hospitals like this by waiving alldeductibles and paying for travel for the patient and a familymember. Pharmacologic tourism is an emerging trend — gettingdiscounted specialty medication treatments overseas.

For the last few years, we have tried to deploy these techniqueswithin our own practice. I know most employers are hesitant to maketheir employees uncomfortable, especially when it comes to personalhealth. It is this discomfort that breeds change, and if nothingchanges, then nothing changes.