A survey of 1,230 large employers brings mixed news to healthcare providers struggling to maximize revenue as patients continue to absorb more of their treatment costs.

In the short run, surveyed companies covering more than 10 million employees expect to continue to shift costs to employees in a variety of ways. For instance, 42 percent are considering offering high-deductible health plans as a full replacement for the health benefit program, compared with 15 percent doing so today, according to Aon Hewitt, which offers risk management, insurance, outsourced human resources and business process services, and a health insurance exchange to large companies.

Nearly three-quarters of responding employers are or will be reducing subsidies for dependents, and 52 percent expect to shift to “unitized” pricing where employees pay for family health care on a per-person basis instead of a family rate. Only 5 percent of surveyed employers use unitized pricing today.

Twenty-four percent of employers plan to give employees tools to guide them in benefit plan selection and utilization, up from 19 percent today. Ninety-two percent expect to offer cost transparency tools, compared with 49 percent now.

Despite the cost-shifting move, many employers plan to offer carrots that can significantly lower health costs. Today, 20 percent of the companies use “gating” strategies that require employees to complete certain tasks, such as fill out a health risk questionnaire or get a biometric screening, to get a richer set of benefits. Jim Winkler, chief innovation officer of health and benefits at Aon, says employers for example might offer a high-deductible plan to all employees, but then make a PPO option available to those completing “gated” tasks. While more than half of surveyed employers today rely on cost-shifting strategies, only one-fifth of them expect to have the same strategies in three-to five years.

The Aon survey also finds nearly 68 percent of respondents plan to adopt reference-based pricing under which they set a pricing cap on certain medical services where prices vary widely without meaningful differences in quality.

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