Another technique both payers and employers are using to help cut costs are "skinny" or "narrow" networks, sometimes referred to as EPOs or exclusive provider organizations. As the terminology suggests, these are networks that comprise a relatively small number of care providers, most of which have been selected because of high-quality performance; the theory is that restricting care to only high-quality providers will result in overall cost savings for payers and employers.

"We're seeing both skinny plans and skinny networks," says Karthik Ganesh, chief information officer for Qualcare. "But I don't think that the whole notion of skinny plans is going to fly; skinny plans only work, quite frankly, for the young-and-invincible population.

"Skinny plans are not a win for providers," adds Ganesh, "and they're definitely not a win for consumers who have a condition or who are likely to have a condition. They're great for twentysomethings who are healthy, but it could still come back to bite them, too."

However, Barlament also notes these plans might make sense for some employers in low-wage industries.

"We talked to a company with about 70 employees, big enough to have to worry about employer-shared responsibility, and most of their competitors in the market have 30 or 40 employees," he explains. "They're in a low-wage industry, and it's difficult for them to pass along the cost of health care because their competitors don't have those costs. So these are some solutions that we've seen employers offer.

"One strategy is for an employer that hasn't offered any health coverage in the past," he says. "and you come up with a non-minimum-value plan – maybe one that's free, that literally only provides for preventive care benefits – and you hand your employees the enrollment form and say, 'Look, we're so generous, we're going to give you these additional benefits,' then you don't mention that you're doing it in the hopes that the employee won't sign up for subsidized exchange coverage, which would then trigger the shared responsibility penalty against the employer. That's why they're doing it."

"Consumers aren't necessarily becoming more educated," Ganesh postulates. "So they're going to make decisions based on their pocketbooks and buy the skinny plans, which could be an incredibly dangerous trend as more folks with pre-existing conditions enter the health care system."

And although this might work as a short-term strategy, Barlament says, it could backfire on employers who attempt it.

"That might work for the first year," he allows, "but after the first year, if your employees start talking and understanding that by taking your plan, they're losing money in exchange subsidies, then they'll be annoyed with you because you more or less tricked them with your strategy. I'm convinced it's not a longer-term solution because of that issue."

"I don't see the skinny plans having a long tail to them, quite frankly," says Ganesh. "I think consumers are going to progressively become savvier about what they're buying, and employers are going to see that skinny plans will [disincentive] people from wanting to work for them. At the end of the day, a lot of consumers look to employers for effective health coverage. There's going to be so much kicking and screaming from employees if that 16 percent number in the National Business Group on Health survey holds true that I just don't see these plans lasting longer-term.

"Brokers would be smart to push skinny networks over skinny plans," he adds. "Skinny plans are not employee-friendly offerings at the end of the day, but a skinny network still has value for the employee."