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Consumers, meanwhile, who are paying a greater share of the cost, are making spending adjustments.  Many are delaying care, using fewer services and choosing less expensive options such as retail clinics, urgent care centers and mobile health devices.

“Healthcare cost increases continue to exceed overall growth in wages, but the gap appears to be shrinking.  The long-term trends suggest that as the economy improves, the cycle of runaway cost increases will be broken,” said Michael Thompson, principal with PwC’s human resource services practice.  “This is critical as employers strategically reevaluate the role of healthcare benefits to their organizations and step up efforts to engage employees more directly in value-based healthcare decision making.”

Companies are increasingly offering employees health plans that allow them more freedom to choose doctors and hospitals and that generally do not require referrals from primary care doctors for specialty care.

insurers generally still pay a fee for every visit and procedure, a payment system that has been blamed for driving up spending.

this movement back toward’’ fee-for-service medicine “is really going to hurt us.’’

Most in the Pioneer group achieved quality improvements, but only 18 produced cost savings.

It remains to be seen whether it functions profitably or not," said Alan Miller, chief executive of Universal Health Services, which operates more than 200 hospitals, behavioral health facilities and outpatient centers."There has been a lot of discussion of moving away from fee- for-service to something like this, but we are a long way from there," Miller said.

The big opportunity for cost savings lies in getting preventive care for people before they land in the hospital with illnesses such as heart disease, diabetes and asthma,