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Several hospital chains are driving the boom – including HCA Inc., which will open its seventh ER later this year in Florida, and Wake Med Health and Hospitals, which will add its fourth next month in the Raleigh, N.C., metro area. They regard the facilities as a way to expand into new markets, generate admissions to their hospital and reduce crowding at their hospital-based ERs.

reater Houston has 150 emergency rooms — twice the number as greater Miami -- even though its population is only slightly bigger, according to a KHN analysis.

While the ERs charge insurers double or triple the amount per patient as an urgent care center or doctor's office, patients use them for routine care that could be provided in less costly settings, Ho says. That is the case with standard ERs as well. Yet, insured patients have little incentive to drive past the more expensive, freestanding ERs because their co-payment is only $50 or $100, just modestly more than what it might cost for a visit to an urgent care center or doctor’s office. Their insurers pay the balance generally.

Thirty percent of companies that provide coverage to Medicare-eligible retirees (age 65 and over) already have moved to exchanges, according to an Aon Hewitt survey of more than 1,230 employers released last month.

For Medicare-eligible retirees, employer benefits are supplemental. Retirees who use traditional fee-for-service Medicare might be offered a Part D (prescription drug) benefit, and a subsidized Medigap plan, which plugs coverage gaps in fee-for-service Medicare. Retirees using Medicare Advantage (all-in-one managed care plans) receive a subsidy toward buying those plans.

oving to exchanges also can help employers avoid the looming risk of the so-called Cadillac tax on rich-benefit insurance plans.

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.’’

Mr. Mead cited a report by the Institute of Medicine that tallied more than $760 billion in health care “waste” created annually as a result of consumer fraud, unnecessary procedures and excessive administrative costs.

r. Mead said the campaign also stressed the need for health care providers to shift to a model known as “accountable care,” which shifts their reimbursement models for health care professionals from being paid for the volume of services they perform to being paid based on the outcomes of patient care. Accountable care systems are usually linked to technologies that help health care providers measure performance and manage patient data. Aetna has 27 accountable health care agreements with hospitals and other health care providers around the country.

Bertolini said in the video. “If we fix just 20 percent of it, we could pay for the Affordable Care Act. We could insure everyone without increasing taxes.”

A national survey by Aon Hewitt consultants suggests that the Affordable Care Act's taxes and fees add 1% to 2% in direct costs to employers.

The Aon Hewitt survey found that 44% of companies are considering offering workers just one health-insurance plan — a high-deductible plan — rather than offer a high-deductible plan plus a more traditional plan that covers 70% to 80% of medical costs.

But those people will not get government subsidies if their company offers affordable health insurance, defined as costing less than 9.5% of income.And such employees would lose their employer's contribution to their plan unless the company agreed to provide such a payment in lieu of coverage.

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,