Large employers say rougher ways to cut health benefits costs seem to work better, at least in the short run, than gentler ways.

Analysts at the National Business Group on Health, a Washington-based association for large benefit plan sponsors, give large employers’ views on what works in a summary of results from a recent survey of 133 member employers. The employers provide benefits for an average of about 113,000 people.

Related: Companies tap brakes on ‘Cadillac’ plan shift amid anti-tax push

The NGBH team asked the employers for general cost trend information. The participating employers said they have held cost increases to 6 percent per year for 2015 and 2016, and that they expect to use plan design changes to cut the increase to 5 percent in 2017.

The survey team also asked the employers to identify the top three drivers of successful efforts to hold down health benefits spending.  

Related: New NBGH CEO to reset focus beyond PPACA

A few praised tools such as health care price transparency tools and efforts to improve vendor management. But more said the most effective tools tend to involve narrowing care options and increasing what the employees pay for a care.

For a look at the large employers’ favorite strategies for cutting health care costs, read on:

Improving the management of care should lead to big savings. Someday. (Photo: Thinkstock)

Improving the management of care should lead to big savings. Someday. (Photo: Thinkstock)

6. Getting away from fee-for-service approach

Wellness, disease management and concierge programs, and efforts to get away from the model that pays doctors to do as much surgery as they can get away with sounds appealing.

In theory, these ideas should help employers control the cost of care while improving quality and enrollee satisfaction. At the large employers surveyed, these ideas all ranked neared the bottom in terms of their power to control costs. Each of these had about 5 percent of the large employers identifying it as the top driver of holding down health care costs.

Related: Aetna: Wellness program achieved big ROI

Knocking expensive doctors out of the provider directory may work a little faster than care management. (Photo: Thinkstock)

Knocking expensive doctors out of the provider directory may work a little faster than care management. (Photo: Thinkstock)

5. Narrow provider networks

A slightly larger share of the big employers — 6 percent — identified limiting the number of providers in the plan directory as a major cost-cutting drivers.

Related: Regulators tiptoe into provider network battle

Controlling access to expensive drugs is the top savings driver for some employers, and it ranks in the top three for many. (Image: Thinkstock)

Controlling access to expensive drugs is the top savings driver for some employers, and it ranks in the top three for many. (Image: Thinkstock)

4. Pharmacy management techniques

About 11 percent of the participants said efforts to persuade patients to try cheaper drugs before they try more expensive drugs can do a lot to hold down plan costs.

Related: View: PBMs often cut drug prices by cutting drug choices

Simply making employees pay more for their care is great for holding down costs, employers say. (Photo: Allison Bell)

Simply making employees pay more for their care is great for holding down costs, employers say. (Photo: Allison Bell)

3. Increasing employee cost-sharing

Fourteen percent of the survey participants identified this as the top cost savings techique, and another 20 percent identified it as the second or third most powerful costing savings tool.

Related: EBRI finds spike in care access problems

A chance to building up purchasing value, or cash, seems to turn some workers into more careful health care shoppers, employers say. (Image: Thinkstock)

A chance to building up purchasing value, or cash, seems to turn some workers into more careful health care shoppers, employers say. (Image: Thinkstock)

2. High-deductible plan plus health savings account as an option

Sixteen percent of the participating employers named this as the most powerful cost-control tool. The NBGH analysts expect 84 percent of large employers to offer some kind of high-deductible plan with an HSA or HRA in 2017, up from 83 percent this year. 

Related: EBRI: High deductibles make patients talk

Thirteen years since federal law created the modern HSA program, many large employers say giving workers skin in the game makes them better players. (Image: Thinkstock)

In the 13 years since federal law created the modern health savings account program, many large employers say giving workers skin in the game makes them better players. (Image: Thinkstock)

1. High-deductible plan plus health savings account as only plan

Twenty-seven percent of the employers cited this as the king of cost-control strategies.

The NBGH analysts predict, based on survey responses, that 35 percent of large employers will offer a health account health plan as the only option in 2017, up from 33 percent this year. 

Related: 

9 FAQs about HSAs, FSAs and HRAs

Employer HSA contributions may be dropping

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