The tight job market has employers large and small rethinking their health benefits for 2019.

According to researchers at PwC, the big goal next year is to try to insulate workers from rising health costs.

For Atlantic Health System in New Jersey, that means a bold plan to join with five other New Jersey hospitals on a health insurance venture, which will leverage the size of their combined 50,000-person workforce to get better deals from insurers and pharmacy benefit plans.

"How do you drive out unnecessary utilization, while maintaining very high quality?" explained Brian Gragnolati, Atlantic's CEO. "We've got a lot of experiences with that so what we're trying to do here is take those best practices and apply them to our own workforce."

Gragnalti believes the combined plan could help Atlantic cut health benefit costs by 10 percent — that's cash they can put toward retaining workers in a competitive market.

"If you're spending more money on benefits, it's less money that you can spend on wages. The opportunity for savings here allows us to put more in our employees' pockets," he said.

Researchers at PwC's Health Research Institute are projecting that large employers will see health costs increase 6 percent in 2019, according to their latest medical cost trend report.

The growth rate has hovered between 5.5 to 7 percent for the last five years. But for 2019, large employers surveyed for the report are rethinking some of the benefit designs they've used to keep expenses in check over the last few years.



"When we asked 'what are you doing in terms of strategy'… last year, a lot of them were going to go full replacement, high-deductible plan. This year they really backed off," from plans to do that, said Barbara Gniewek, a principal with PwC who focuses on employer health benefits consulting.

Employers continue to be focused on bringing overall costs down by designing medical plans with tighter provider networks, and drug plans with restrictive brand name formularies. But most large employers are trying to avoid raising deductibles and shifting more costs to employees, and planning to absorb the higher costs.

"We really think that's because they're worried about the labor market being so tight," Gniewek said, adding, "so they're kind of staying exactly where they are … not shifting costs to employees."

They are also investing more in services and digital tools to help employees optimize their benefits. Researchers found employers with a workforce under 35 place a higher priority on hiring health-care vendors focused on a better consumer experience.

Like Amazon, Berkshire Hathaway and J.P. Morgan, Atlantic and its partners in New Jersey are hoping to leverage data and digital tools to help make health benefits easier to navigate for their workers.

"This gives us an opportunity to really prove to ourselves and prove to our local employer markets that we can develop something that's different," said Gragnolati.

While it's not clear when the Amazon-led initiative will get off the ground, the hospital alliance expects to finalize its plan this month and expects to roll out the health plan for 2019 open enrollment in the fall.