Against this backdrop, three notable trends are developing.

1. Insurers (employees, too) look to reward quality over quantity.

Insurers are moving away from paying health care providers on a volume basis to focus more sharply on quality outcomes instead. Consumers are demanding higher quality care, in part because they are paying more out of pocket.

Alignment between carrier and employee interests will shift the industry away from "fee-for-service" to bring quality and cost incentives together. It's reshaping the delivery system, with high performance networks an evolving strategy. The focus on value-based care and quality (and more cost-effective) outcomes reflects a growing trend to emphasize the whole patient, rather than one-off payments for individual services.

2. Back to the future with capitation (and other incentives).

Pay for performance is not so common in health care, but payers are pushing the concept in the quest to align quality and costs. It takes incentives for this to fully evolve, and to that end, insurers are starting to move into bundled payments and bonuses to push the transition forward. It's also reviving the practice of capitation, which lost favor in the late 1990s as a strategy to effectively ration care. Today's version of this incentive, however, is geared to better manage care under a broader health management infrastructure where providers are paid a set per-employee fee to manage the overall health of the employee population.

3. Countering employee inertia in benefits decision-making.

The quality of employees' decision-making when it comes time to renew their benefits packages is an ongoing concern. A recent AFLAC study found that that 83 percent of employees spend less than an hour reviewing their options and 92 percent simply re-up for the previous year's package. It's leading a drive for the creation of better decision support tools that give employees a more compelling picture of their benefits choices and tradeoffs (including the financial implications).

Inertia is a powerful force that can keep people from investigating the nuances of their benefits and how different products may combine most effectively to meet their particular circumstances.  Any tool that counters that inertia will help employees make more informed decisions about benefits.

As 2018 progresses, employers will be challenged to create benefits strategies that engage employees and meet their needs as cost effectively as possible. The drive for improved quality over quantity and the value of incentives should help make a difference. So will smarter decisions by employees on their benefits options.

Mike Barone is president of Employee Benefits for Hub International. He leads strategic benefits planning, population health management, employee engagement and communication, healthcare reform guidance and compliance.