When the Kaiser Family Foundation started tracking employer health benefits 20 years ago, employee deductibles weren't a concern. Over the years, though, the survey has adjusted to reflect not just the growing percentage of employees with a deductible (85 percent in 2018) but the growing amount of that deductible ($1,573 for an individual in 2018) . In fact, according to the 2018 KFF Employer Health Benefits Survey, the burden of deductibles has tripled in the past decade and increased eight times faster than wages. Among small employers, 42 percent of workers pay a deductible of $2,000 or more. "Rising health care costs absolutely remain a burden for employers, but they're a bigger problem for workers, as cost-sharing has been rising much faster than wages in recent years," KFF president and CEO Drew Altman said in a press briefing. Related: 10 states where employers spend the most, least per employee on health care This year's survey shows no dramatic shifts in the employer-sponsored health care space but continues to illuminate a number of trends, including increasing health care premiums, greater focus on employee wellness and alternatives to traditional health care providers. Premiums have increased five percent this year, costing a family for four an average of $19,616. Of that cost, employees contribute $5,547, and employers pay the rest. For single-coverage, premiums increased 3 percent to $6,896. "Premium growth is important, but it's only part of the story," noted Altman. "The bigger issue is rising cost-sharing. What happens with wages can be as important to closing that gap as what happens to cost-sharing itself." Almost half of employers continue to offer PPO plans, while three in 10 offer a high-deductible plan with a savings component. Some employers (13 percent) offer an incentive to encourage employees to opt for one plan over another. HDHP adoption is stagnating, comprising 29 percent of all plans. Part of this slowdown may be due to the uptick in the economy. "Given the economy is good and health care costs are relatively tame, I think employers don't have a strong incentive at the moment to push people into plans they may not be as comfortable with," said Gary Claxton, KFF vice president and director of the Health Care Marketplace Project. "I think we've stalled a bit on the growth of HDHPs. Things will get more interesting if we move into a recession." Wellness is getting more of employers' attention. Seventy percent of large firms now offer health-risk assessments, and 81 percent use data from those assessments to better understand health risks, target their wellness program promotions, design new programs and/or measure health care costs. "As employers have gotten more involved in trying to develop programs to encourage employees to be healthy, having the info is necessary to determine what kind of programs to sponsor and what employees need information about," Claxton said. More employers are looking at workers' activity data--21 percent now collect information from a wearable device as part of their wellness program, an increase from last year's 14 percent. Interest in telemedicine and retail clinics continues to grow. Among large employers, 74 percent offer telemedicine services, an increase of 63 percent since last year. In addition, 76 percent cover retail clinic services, and some offer employees a financial incentive to choose these services. A number of factors, including wages and the economy, will continue to impact the employer health care space in the coming years. Ten percent of employers expect that the elimination of the individual mandate will result in fewer workers purchasing employer-sponsored coverage. Another factor asked about during the briefing was the increase in prices by health care systems and providers. Consolidation among major health care systems continues to shift the balance of power when it comes to price negotiation. "We're in a competitive health care system," Claxton noted. "We rely on private insurers and employers to mediate prices. They haven't been very successful in recent years. It is hard because most workers work for fairly large employers with multiple locations. It's hard to develop narrow, efficient networks that would cover all of your employees, and the large health plans don't really have an incentive to create these options." Read more about the current state of employer-sponsored health care: |

• As costs rise, employers drive change in health care delivery
• Employers having second thoughts on HDHPs
• Is consolidation in health care good for employers?