The 18th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care tracks employers' strategies and practices to provide and manage health benefits — and the results of their efforts. This comprehensive report, Reshaping Health Care: Best Performers Leading the Way, identifies the actions of best-performing companies as well as current trends in the health care benefit programs of U.S. employers with at least 1,000 employees. Respondents were also asked about the specific implications of the Patient Protection and Affordable Care Act (PPACA) on their health care benefit programs.

Last year's report showed that significant changes in the U.S. health care system and continually rising costs drove some employers to consider recalibrating their total rewards program (that is, the combination of basic rewards such as salary and benefits, performance-based pay, and nonfinancial rewards) to balance cost concerns with their employees' needs for competitive salary, access to affordable health care and a secure retirement. The potential effect of the PPACA excise tax in 2018 on high-cost health care plans threatens that balance, and this year's survey results show that many more employers will seek strategies to lower costs, improve worker health and avoid the tax. The actions of our best performers may well provide a playbook that others can follow to achieve their goals.