Multiple studies show that higher out of pockets result in delayed maintenance of chronic diseases, or even delay of initial diagnosis.

How can an employer maintain (or improve) benefits and cut costs?

One option is high performing networks. Don't confuse this with carriers' narrow networks that are almost exclusively based on discount alone, which doesn't translate into lower costs, and doesn't take quality into account.

A quickly emerging model is called direct primary care. DPC is a high-value way to ensure appropriate levels of care and direct patients to high performing specialists, when necessary. One such practice, Blue Skies Family Medicine in Mooresville, North Carolina has patients paying a small monthly fee for their care. There is no copay, no claims to file, and generally, no additional cost. Patients get 24/7 access to their doctor.

Many doctors in the DPC space once owned a more traditional practice, and sold it to one of the big local health care systems. The result was an increased demand on the business of medicine, requiring more patients per hour and referrals to more profitable specialists.

On the facility and hospital side, similar tactics can be utilized. Earlier this year, I wrote about Health City Cayman Island, a joint venture between Ascension Health and Narayana Health, that touts outcomes and accreditations equal or beyond any U.S. hospital, with up front, fixed cost often 75 percent below U.S. pricing. Employers could use a traditional network, but incentivize utilization of hospitals like this by waiving all deductibles and paying for travel for the patient and a family member. Pharmacologic tourism is an emerging trend — getting discounted specialty medication treatments overseas.

For the last few years, we have tried to deploy these techniques within our own practice. I know most employers are hesitant to make their employees uncomfortable, especially when it comes to personal health. It is this discomfort that breeds change, and if nothing changes, then nothing changes.