Employers are starting to think outside the box when it comes tohealth care sticker shock.

While still pursuing traditional methods to controlling risinghealth care costs, such as cost sharing and plan design changes,large employers are increasingly looking to new cost-savingsmethods and ways to improve outcomes and increase satisfaction fortheir employees, according to the Large Employers’ 2018 Health CareStrategy and Plan Design Survey, by the National Business Group onHealth.

“As we approach 2020, employers will continue to do all thatthey can to control costs through demand-side initiatives —implementing consumer-directed health plans, modifying plandesign and cost-sharing strategies, and adding price transparencytools,” the authors write. “However, employers are increasinglyfocusing on areas that address how health care is delivered andpaid for — telehealth, on-site clinics, centers of excellence andaccountable care organizations.”

“Another strategy many employers are pursuing involves new waysto guide and navigate employees through the complexities of thesystem,” they write. “At the same time, employers also remainfocused on specialty pharmacy, which continues to be a primarydriver of health care costs.”

And rising costs are still a grave concern, according to thisyear’s survey of 148 large employers. For the fifth year in a row,employers expect costs will increase by an average of 5 percent in2018. And the average cost of insuring an employee is expected tobe $14,156 — almost 70 percent of which would be covered by theemployer. Employees, however, would be responsible for the rest —about $4,400.

“While this number is still well below what most people can findon the public exchanges, these cost increases outpaceworkers’ earnings … and are unsustainable over the long term,” theauthors write.

More survey respondents are offering consumer-directed healthplans, and by 2020, virtually all (97 percent) of large employerscould be offering such plans, according to the survey. In 2018, 90percent of employers will be offering at least one CDHP as anoption. In addition, 39 percent of large employers will offer onlyCDHPs in 2018, an increase of 11 percent from2017.

The most cited driver of increasing health care trend continuesto be skyrocketing specialty pharmaceutical costs, according to thesurvey. Respondents say they are trying to mitigate the costs bymanaging where certain high-cost medications are administered,building outcome-based or indication-based pricing into theirpurchasing agreements for select specialty medications, andimplementing programs to manage the impact of manufacturercoupons.

Employers are also focusing on improving the ways health care isdelivered to employees with the following initiatives:

• Virtually all employers (96 percent) will make telehealthservices available in states where it is allowed next year. Morethan half (56 percent) plan to offer telehealth for behavioralhealth services, more than double the percentage this year.Telehealth utilization is on the rise, with nearly 20 percent ofemployers experiencing employee utilization rates of 8 percent orhigher.

• Twenty-one percent of employers plan to promote accountable careorganizations in 2018, but that number could double by 2020, whenanother 26 percent are considering offering them.

• More than half of employers (54 percent) will offer onsite ornear site health centers in 2018, and that number could increase tonearly two-thirds by 2020.

• Nearly 9 in 10 employers (88 percent) expect to use centers of excellence in 2018 for certainprocedures, such as transplants or orthopedic surgery. Bundledpayments or other types of alternative payment arrangements will beused by 21 percent to 48 percent of COEs contracts, depending onthe medical procedure or condition.

• Nearly 40 percent of employers have incorporated some type ofvalue-based benefit design in which employees receive reduced costsharing or premium reductions when they take steps to managechronic conditions or obtain higher-quality or more efficient care.There has been some increase in the use of value-based benefitdesign to steer employees toward telehealth.

“Employers are continuing to manage costs through plan designefforts, but they are looking more to the supply-side,” the authorswrite.

“As a result, more employers are ramping up their efforts tohave a positive impact on both the supply and demand sides of thehealth care system. Employers are focusing on ways to supportchange in health care payment, as well as transformation of thedelivery system. In addition, employers hope that empoweringemployees and their families to become more knowledgeable consumersof health care will lead to employees choosing higher-quality,lower-cost providers and, ultimately, improved patientexperience.”

Survey respondents are also more focused on enhancing“the employee experience.” According to the survey, two-thirdsof companies will offer medical decision support and second opinionservices in 2018, an increase of 47 percent from this year.Additionally, the number of companies offering high-touch conciergeservices will increase from 28 percent this year to 36 percent in2018.