As the healthcare landscape shifts, employers are taking the opportunity to reassess their role as a healthcare benefits provider and subsidizer, while redefining their role in the health, safety, and performance of their workforce.

According to a recent Aon Hewitt survey of nearly 2,000 U.S. employers representing over 20 million employees and their dependents, most employers plan to continue sponsoring a medical plan for their employees.

However, says an Aon Hewitt press release, they are migrating from a traditional "managed trend" approach to a "house money/house rules" approach that is more requiring of employees and integrates a pay-for-performance philosophy into their benefit programs.

This strategy includes elements of:

• Wellness and health programs that aim to improve the health of employees, reducing the amount and cost of care required, while minimizing work days missed due to illness. Aon Hewitt's survey shows a growing number of employers are offering incentives and are beginning tolink incentives to a result, as opposed to simply participating in a program. In other cases, employers may require a health risk questionnaire, biometric screening and/or ongoing health coaching in order to be eligible for the richest plan or the highest employer subsidy.
• Consumer-driven designs that expose employees to the direct cost of care up to a limit, encouraging more personal economic decisions about how to access care, how much care to use and what types of care to use. Aon Hewitt's survey found that consumer-driven health plans have become the second most common plan design offered by U.S. employers, with 58 percent of employers offering a CDHP in 2012.
• Plan design strategies that encourage employees to consume less health care. Examples are plans that replace copays with coinsurance, migrate employees to generic prescription drugs and mail order refills for maintenance drugs, and levy surcharges for working spouses or additional dependents with coverage available elsewhere.

Aon Hewitt's research finds that more than 40 percent of employers are considering moving to a corporate healthcare exchange model in the next 3 to 5 years. For example, more than 100,000 U.S. employees are enrolling in health benefits through Aon Hewitt's fully insured, multicarrier corporate healthcare exchange this fall.

"Most employers want to continue to offer benefits, but face financial pressure to achieve a meaningfully different cost outcome," noted Jim Winkler, chief innovation officer for Health & Benefits at Aon Hewitt. "Employers will either need to more aggressively manage traditional programs by finding ways to reduce demand for health care and reforming the provider system or move in the other direction—towards a defined contribution approach that places accountability on individual employees."