They think that the biggest contributors to waste are medical imaging, such as X-rays, and medications, and they don't have a great deal of success in managing perceived waste; just 25 percent report being effective on medical imaging and 12 percent on physician referrals. And while most of them plan on more strategic/activated benefit design, they don't have actual plans in place, although they hope to within the next five years.

The ones who do collect and track waste-related data experience changes in attitude on the topic, and they tend to take a more active approach to managing health care, whether they do it internally or through a vendor. In addition, the survey finds that activated employers are less likely to rate treatments as contributing significantly to waste, but also more likely to manage treatments to reduce waste. They also report greater success in managing waste than employers that don't collect data.

Suggested ways for employers to approach the problem include asking vendors to share information on health care waste and report what they're doing to address overuse; considering value-based benefit design strategies that encourage less use of low-value services, such as increasing copays, prior authorization and provider steerage; and moving toward alternative payment mechanisms that do not reward waste or unnecessary services, such as bundled payments.

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