Employers are concerned about waste and inappropriate care in the health care industry, with the total mounting to an estimated $750 billion, but 60 percent of bosses aren't actively managing the problem.

That's according to a survey on employers' perceptions and actions related to waste in the health care system released by the National Alliance of Healthcare Purchaser Coalitions and Benfield, a part of the Gallagher Human Resources & Compensation Consulting Practice.

The survey finds that while 57 percent of employers believe that up to 25 percent of treatments their employees and dependents receive are wasteful, most employers don't collect or analyze data to track waste (59 percent), and those that do leave it up to their vendors (34 percent).

They think that the biggest contributors to waste are medical imaging, such as X-rays, and medications, and they don't have a great deal of success in managing perceived waste; just 25 percent report being effective on medical imaging and 12 percent on physician referrals. And while most of them plan on more strategic/activated benefit design, they don't have actual plans in place, although they hope to within the next five years.

The ones who do collect and track waste-related data experience changes in attitude on the topic, and they tend to take a more active approach to managing health care, whether they do it internally or through a vendor. In addition, the survey finds that activated employers are less likely to rate treatments as contributing significantly to waste, but also more likely to manage treatments to reduce waste. They also report greater success in managing waste than employers that don't collect data.

Suggested ways for employers to approach the problem include asking vendors to share information on health care waste and report what they're doing to address overuse; considering value-based benefit design strategies that encourage less use of low-value services, such as increasing copays, prior authorization and provider steerage; and moving toward alternative payment mechanisms that do not reward waste or unnecessary services, such as bundled payments.

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When it comes to health care waste, employers are all talk, no action

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