Employers play a significant role in the health insurance coverage of Americans – providing health benefits to more than three out of every five of the nonelderly¹⁴ – so their attitudes, knowledge, and experiences are important factors in health policy discussions.

This year’s survey asked employers a number of questions about their opinions on various issues and on possible future changes in health benefits, including whether they shopped for new coverage, how they view different approaches to containing cost increases, and how they plan to change their health benefit plans in the near future. A large share of firms shopped for a new plan or health insurance carrier in the past year and relatively few firms think that any of the currently available cost-containment strategies are “very effective.”

This year, for the first time in several years, we asked employers about the use of 3 utilization management provisions and 4 disease management programs. We find that a substantial percentage of workers are enrolled in a health plan with a utilization management provision and/or a disease management program.

• Overall, 60% of firms offering health benefits say that they shopped for a new plan or insurance carrier in the past year (Exhibit 12.1).
  
  
  • Among firms offering health benefits that shopped, 24% say that they switched carriers within the past year and 30% report that they changed the type of health plan they offer.¹⁵ Although less likely to have shopped for a new plan or insurance carrier, jumbo firms (5,000 or more workers) that shopped are more likely than all firms that shopped to report switching carriers (45% vs. 24%) (Exhibit 12.1)
    
    
  • Jumbo firms (5,000 or more workers) are less likely than all firms to report that they shopped for a new plan or insurance carrier in the past year (Exhibit 12.1).
  
  
  
• All firms, including both those that offer and do not offer health benefits, were asked to rate how effective several different strategies are in reducing the growth of health care costs. Few firms rated any one strategy as “very effective” at controlling costs.
  
  
  • Consumer-driven health plans are rated as “very effective” at reducing cost growth by 16% of firms, 14% of firms report that disease management is “very effective,” 12% say that higher employee cost sharing is “very effective,” and 7% report that tighter managed care networks are “very effective.” Around 45% of firms report that consumer-driven health plans and higher cost sharing are “somewhat effective” at controlling costs (Exhibit 12.5).
  
  
  
• Ninety-three percent of all covered workers are enrolled in a health plan with at least one of the following utilization management provisions: case management for large claims, pre-admission certification for hospital care, or pre-admission certification for outpatient surgery.
  
  
  • Among covered workers, 81% have case management for large claims, 75% have pre-admission certification for inpatient hospital care, and 55% have pre-admission certification for outpatient surgery (Exhibit 12.3).
  
  
  
• Over half of all covered workers (56%) are enrolled in a health plan with a disease management program (Exhibit 12.4).
  
  
  • Among covered workers in plans with a disease management program, 99% have a diabetes program, 86% have an asthma program, 82% have a hypertension program, and 66% have a high cholesterol program (Exhibit 12.4).
  
  
• Each year we ask employers whether they expect to change the contributions, cost sharing, or eligibility for health benefits in the next year. Generally, large firms (200 or more workers) are more likely than small firms (3-199 workers) to say that they intend to increase employee costs (Exhibit 12.6).
  
  
  • Almost half (43%) of large firms (200 or more workers) say that they are “very likely” to increase the amount employees pay for health insurance next year, compared to 15% of small firms (3-199 workers) (Exhibit 12.6).
    
    
  • Employer interest in tiered cost sharing for physician or hospital services remains limited: less than 0.5% of employers say that they are “very likely” to offer a tiered network, while 14% say that they are “somewhat likely” to offer tiered cost sharing.
    
    
  • As observed in previous years, relatively small percentages of employers report that they are likely to restrict eligibility or drop coverage altogether (Exhibit 12.6).