Dr. Martha Perez examines Maria Lebron in a room at the Community Health of South Florida, Doris Ison Health Center in Miami, Florida. Getty Images

At its Silicon Valley headquarters, network gear maker Cisco Systems is going to unusual lengths to take control of the relentless increase in its U.S. health-care costs. The company is among a handful of large American employers who are getting more deeply involved in managing their workers' health instead of looking to insurers to do it. Cisco last year began offering its employees a plan it negotiated directly with nearby Stanford Health medical system. Under the plan, physicians are supposed to keep costs down by closely tracking about a dozen health indicators to prevent expensive emergencies, and keep Cisco workers happy with their care. If they meet these goals, Stanford gets a bonus. If they fail, Stanford pays Cisco a penalty. At the center of it all is a spacious clinic inside Cisco's San Jose campus, the first point of contact for many employees and their families. They often see Dr. Larry Kwan, a Stanford Health general physician who rubs shoulders with workers in the cafeteria and company gym. "I'm in their space. I'm actually where they work," Dr. Kwan said. "I'm a bit of a village doc." Cisco said costs for Stanford plan patients are 10 percent lower than conventional coverage still used by most of its employees. Chipmaker Intel told Reuters it is saving 17 percent on its workers enrolled in a similar plan, known as Connected Care. Aircraft manufacturer Boeing and Walmart, the world's largest retailer, have likewise hammered out health plans directly with providers. The movement is small, just a few very large U.S. corporations that have signed up tens of thousands of workers so far. Their early efforts show the challenges of changing behaviors among patients and doctors. But they speak volumes about corporate America's frustration with inexorably rising medical costs and the traditional insurers that sell them coverage. "Before they were simply saying 'Okay, our vendor is going to help us with this,"' said John Jackson, who handles corporate programs like Cisco's for Stanford Health. "Many are no longer willing to do that." Corporations help pay for health care for more than 170 million Americans, in most cases working with an insurer to handle everything from the price of treatments to medical claims. These employers will spend an estimated $738 billion on health benefits in 2018, a figure that has been rising about 5 percent annually in recent years, according to federal data.

Cue Amazon

Other big firms are watching closely. Amazon.com, JPMorgan Chase, and Berkshire Hathaway said in January they will form an independent company to improve health care for their roughly 750,000 U.S. employees, prompting speculation that they would displace health insurers and other industry "middlemen." Amazon and partners say they will use big-data analysis and other high-tech tools to improve care and cut wasteful spending. The trio will study the new plans coming from Intel and other pioneers, a source close to the venture told Reuters. If they do, they will find plenty of hurdles. Reuters interviews with executives at Cisco, Intel, and Boeing and their health partners revealed similar challenges. Chief among them is habit. Many workers will not stray from conventional plans because they like their doctors or worry about access to the best specialists. To boost enrollment, all three companies have dangled sweeteners such as extra money for health savings accounts or lower monthly premiums and co-pays. The approach also requires employers to take a more hands-on role. "It's not something that you just turn the switch and not manage," said Katelyn Johnson, Cisco's senior integrated health manager for global benefits. Cisco's experiment began in 2008 when it opened the campus clinic for all of its employees there. Designed like a spa, the facility offered primary care in new-age sounding treatment areas: body, mind, heart, and spirit. The savings were notable: about 30 percent compared to an offsite doctor's office. Cisco later brought in Stanford to develop a full-blown medical plan, which took effect in 2017. Stanford operates the clinic and provides more specialized services through Stanford University's medical system. Like a health maintenance organization, the plan requires enrollees to stick to a closed network of doctors. There is an emphasis on primary care and fewer referrals to specialists. Treatment for back pain, for example, often begins with physical therapy at the clinic. Cisco also mandates that Stanford track a dozen health measures, including glycemic levels for diabetics and blood pressure for those with hypertension. Johnson said fewer than 1,000 people are enrolled, below Cisco's goal of 1,300 for 2018. The plan has yet to make a dent in Cisco's $500 million annual health-care tab, which has been rising by 3 percent to 4 percent in recent years. Still, Cisco is encouraged enough by the savings that it may expand the program to the company's second-largest U.S. center, in North Carolina's Research Triangle Park. "What we were doing in the past wasn't really working," Johnson said. "So this model ... is worth it."

Chipping away at challenges