In a PPO, workers are encouraged to use an in-network doctor, but if they want to use someone else, they can. They just pay more.
"People like the concept of being able to go outside the network, even if their intention is not to," Billet said. "It's mental insurance" and it's "a big factor" in the preference for PPOs over HMOs, he said.
A variation on this, not widely seen in the Washington area, is the "tiered" network, in which workers pay at several levels even inside the network, with the lowest costs for doctors and hospitals that have been found cheapest and most effective.
POS plans have declined in popularity recently. These are hybrids between HMOs and PPOs in which participants get in-network prices if they go first to a primary-care physician for referral to specialists or other doctors, but they pay higher, out-of-network prices if they "self-refer."
• Preventive care. A growing number of employers are offering workers incentives to participate in health surveys and other kinds of health assessments. The idea is to catch unhealthy conditions and lifestyles, and nudge (or pressure) the worker to take preventive action before something serious and expensive happens.
Some plans have "health coaches" who try to work with employees to improve their health.
"The idea of a health coach and preventive care is, let's get a base line of where you are right now. If you're healthy, great. You probably won't hear from them. But if they pick up markers, like your blood pressure is really high, you really should do something about this, here's what we suggest," Patterson said.
A variation on this is what has come to be called disease management. Typically, this is employed to help workers with serious or ongoing health problems such as heart disease, diabetes or asthma.
The plan works specifically with such patients to, first, get them the best care, and make sure, in the case of a person with multiple ailments, that it is coordinated. Then the plan works with the person to make sure he or she takes any prescribed medicines and to try to make lifestyle changes that will improve health.
Employers have found preventive programs "are a great way to save money," Patterson said.
