It's another open enrollment season for health insurance, which means another uptick in prices for 2019. But there are signs of progress in the fight to contain health care costs.
The rate of increase has leveled off at about 5 percent a year — still ahead of general inflation yet lower than a decade ago. And many efforts to rein in spending and improve outcomes are taking root and growing.
Most large companies now offer coverage in retail clinics and through telemedicine. In the next few years, about half may adopt high-performance networks that could benefit patients, employers and providers.
There's also a big push to add navigators or patient advocates to guide people through the health care maze, from where to get an MRI to finding a new doctor.
All these features offer the hope of lower costs and more healthy habits even as the medical spending keeps climbing.
"None of our employers are sitting on their hands, saying 'Oh, poor me,'" said Marianne Fazen, executive director of the Dallas-Fort Worth Business Group on Health, a coalition of companies working together on health care issues.
The coalition includes major employers, such as American Airlines, Texas Instruments and Southwest Airlines. Together, members provide coverage for over 700,000 employees and family members.
The Dallas area has some of the highest health costs in the country. And industry consolidation, both among hospitals and physician groups, has not lowered prices here, Fazen said.
That's one reason many employers embraced high-deductible plans, which typically require workers to cover the first several thousand dollars in annual medical spending. Those plans often lead to fewer doctor visits, lab tests and prescriptions, but there's a growing backlash.
"The challenge, especially in the Dallas market, is how to keep employees' share of out-of-pocket costs low enough so they won't stop using health care," Fazen said. "They resent all the cost-shifting, and the fear is they'll get upset and go elsewhere to work.
"That's the biggest balancing act [employers] are struggling with now," she said.
High-deductible plans grew rapidly for a decade. In 2006, 4 percent of covered workers nationwide were in the plans, and by 2016, that number had grown to 29 percent, according to the Kaiser Family Foundation Employer Health Benefits Survey.
For the last three years, the share has remained the same while the size of deductibles keeps growing. This year, the average deductible for all plans was $1,573 for single coverage, up slightly from last year but two-and-a-half times greater than a decade ago.
In addition to higher deductibles and premiums, workers often pay more in co-payments. Taken together, employees' share of health costs rose 5.9 percent this year, compared with a 3.5 percent increase for employers, according to the Milliman Medical Index.
Milliman estimated the annual price of health care for a family of four at $28,166 — $10,000 more than in 2010. That expense is steadily taking a bigger bite out of the family budget even as employers continue to pay more than half the costs.
"For more than 10 years now," Milliman said, the index "has been increasing at an average of just over $100 per month."
Those trends have led to new approaches. In 2015, about 1-in-4 large companies offered a telemedicine benefit; this year, three out of four offered the service, Kaiser said.
Most added coverage in retail clinics, where prices are often lower, and some employers offer incentives for these options.
There's growing interest in high-performance provider networks, which include accountable care organizations. They typically direct employees into smaller groups of providers with the promise of better outcomes and cost savings.
In North Texas, two of the largest health systems are building major ACOs. Baylor Scott & White's Quality Alliance projects that it will cover almost 700,000 lives next year, up from 300,000 in 2016.
The Southwestern Health Resources Accountable Care Network, which includes doctors from Texas Health Resources and UT Southwestern, covers about 550,000 lives. It expects to top 600,000 lives next year, said Marinan Williams, who oversees contracts with insurers and employers.
The ACO model can share the upside from health savings if total costs are lower than expected. On its first two commercial contracts, she said, Southwestern Health saved $33 million, which was divided among employers and providers.
"The idea is to get everyone engaged to make these programs successful," Williams said.
Employers can sign contracts directly with an ACO or add the network through an insurance company. The state's top health insurer, Blue Cross Blue Shield, had 118,000 members in an ACO in 2015, the company said. This year, 1 million members are enrolled in ACOs — roughly 20 percent of its customers.
"Blue Cross and Blue Shield of Texas is committed to a coordinated, efficient care model, demanding high-quality care at reasonable prices," said Dr. Paul Hain, president of the North Texas market.
Its HMO also has grown rapidly, from 400,000 in 2015 to about 800,000 members today, he said. Such managed care products were popular in the 1990s and then fell out of favor. They're coming back, along with other improvements: ACOs, centers of excellence for specialized treatment, bulk buying for prescriptions and direct contracting with providers.
"All of this is promising, and employers are glad to watch it happening," said Fazen of the D-FW health coalition. "But we haven't solved health care costs yet."
