Aon Hewitt surveyed about 2000 employers and a number of employees for their 2012 Health Care Survey. (AH Survey) At a macro level, the firm believes that health costs will continue to rise rapidly, that reform does little to address this issue and that the population engages in a substantial number of unhealthy behaviors which contribute to the cost increases. In this environment, employers can continue pretty much as they have in the past, get out of the health care coverage business and pay the reform penalties or seek new ways of encouraging health and reducing costs. The top challenges reported by respondents are motivating plan members to change behavior, 65%; dealing with government regulation, 35%; and other issues related to the employee population, around 30%. The top desired outcomes for companies all relate to increasing employee awareness of health issues and behaviors and increasing use of wellness and disease management programs and the primary tactics to achieve these goals include use of incentives for behavior change, 61% of respondents, promoting a better health culture, 48%, and rewarding actual health outcomes, 44%.
According to the survey, 76% of employers offer condition management programs and 70% want to increase member use of wellness and other programs. Employers recognize that engaging employees and dependents is key, but are unsure what the best way to do this is. Many are turning to behavioral economics, consumer marketing and social media techniques. Employers are increasingly willing to put significant incentives or penalties in place and to tie those to actual biometric or other health outcomes, not just to program participation. About 80% offer tools for employees to become more aware of their health status and risks and 64% reward use of these tools. As other surveys have suggested, however, employers don’t always gather a lot of feedback from employees on program design and what might actually motivate them to change. Employers generally say they will continue to pick up the bulk of health care coverage costs, but also are looking at ways to control that cost, with greater reliance on data gathering and analysis to spot problems; exploration of new delivery and payment mechanisms, like ACOs, medical homes and bundled payments, and are willing to use more innovative benefit design, including value-based plans and defined contribution.