U.S.-based employers say they are more committed to providing some form of a health care benefit to employees over the next 10 years than they have been in recent years now that the Affordable Care Act (ACA) is settled law. Employers' confidence that they will still be offering health care a decade from now nearly doubled — rising from 25% in 2014 to 44% this year, according to the 487 respondents to the 2015 Willis Towers Watson/National Business Group on Health (NBGH) Best Practices in Health Care Survey.

Standing out from the crowd is a small group of best performers that are gaining significant competitive advantage by creating and leveraging best practices, especially superior network and provider contracting strategies, to control costs and improve workforce health. Throughout this report, we identify specific tactics that best-performing companies are doing much more than the national average or other organizations — best practices focused on our seven core areas:

  • Participation
  • Subsidization
  • Vendor partner strategies
  • Health care delivery
  • Pharmacy
  • Workforce health
  • Engagement and consumerism

Clearly, the ACA's excise tax is increasingly a priority. Last year, only 31% of employers said they were making changes to avoid the tax, up from just 20% the year before. This year, 83% said they are giving it at least moderate attention, with the vast majority (58%) giving it great attention. Now that the ACA's implications and future are better understood, employers are becoming more aggressive about controlling costs and improving plan effectiveness.

Over the next three years, most employers (95%) will be focused on evaluating their health and pharmacy plan design, with 80% giving it high priority.

Top priorities of employers' health care activities over the next three years

Top priorities of employers' health care activities over the next three years

Currently, most companies (70%) focus primarily on direct financial incentives (rewards and/or penalties) to influence desired behaviors, but they are discouraged by low employee enrollment in these programs, which affects all industries. Realizing now that wellness has more to do with behavior change than lowering health care costs, 96% expect to increase their focus on employee well-being, and 94% expect to develop or enhance a culture where employees are responsible for their health. Companies are willing to make investments that take a few years to pay off, provided there is evidence of effectiveness.

Industry advantage

The median of employees participating in any wellness activities or health management programs in the last year is less than 55% (except for Financial Services).

Industry advantage

Tax-advantaged account-based health plans (ABHPs), an upstart idea at the millennium, are now omnipresent across every industry. Eighty-six percent of employers plan to offer them in 2016, up from 54% five years ago. The long-term effectiveness of ABHP design in helping to control health care costs — a subject of much debate and further research — will become increasingly clear over time as employers move to encourage employee enrollment in their ABHPs. Enrollment has more than doubled, from 20% to 43%, over the last five years.

Take-up in ABHPs approaching universal

Take-up in ABHPs approaching universal
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