Room for Improvement in Employers’ Health Care and Wellness Efforts

In light of the changes to the United States health care landscape as a result of the Affordable Care Act (ACA), the National Opinion Research Center (NORC) and the Associated Press conducted a survey on employers’ perspectives on the health insurance marketplace, the plans that they offer employees, and employer wellness programs. This survey employed a nationally representative sample in order to get an accurate representation of practices and attitudes nationwide.

As part of the ACA’s goal of providing improved health care quality while lowering costs, the US government is funding efforts to collect and provide data and ratings of health care plan quality. Six in 10 employers consider such ratings important, but this survey found that nine in 10 employers were unfamiliar with objective sources of quality information provided by the National Committee for Quality Assurance (NCQA), such as the Assessment of Healthcare Providers and Systems data and Health Effectiveness and Information Set scores. However, 36 percent of employers reported using data on quality provided directly from their current health care plan.

The survey also reveals that most employers are not comparing their health insurance offerings to the design of plans found on the ACA’s health insurance exchanges. Only one in five reported examining the exchanges’ plans as they worked on updating or changing the employer plans they offer. Yet many employers reported either choosing a new plan or carrier in the past year (27 percent) or shopping around and considering other options (46 percent).

The low usage of comparative resources may be related to the small number of individuals who are responsible for making health care plan decisions. For 45 percent of the employers surveyed, one individual is making the company’s health care plan decisions, with 38 percent of decisions made by a small group of individuals, 11 percent being made by a committee, and 6 percent by a combination of individuals and a committee. However, 63 percent of the businesses surveyed report always using a consultant or broker to receive additional professional guidance on their health care plan decisions.

Cost of health insurance to employers was reported by employers as their top concern, with 86 percent rating this as extremely (49 percent) or very important. Seventy-eight percent reported that cost to employees was also extremely or very important, and 72 percent reported deductibles and out of pocket expenses as very or extremely important. As for the impact of health plan quality ratings, only 11 percent reported that they were very or extremely likely to pay more to offer a plan with higher ratings. Forty-four percent said that they are somewhat likely to pay more for a plan with higher quality ratings, and 45 percent said that they are unlikely to pay more for such a plan. When asked about accepting a plan with lower quality ratings in order to save money, 37 percent of employers reported being somewhat, very, or extremely likely to do so. So most employers appear unwilling to sacrifice quality to save on costs. Taken together, it appears that most employers are comfortable with their current level of health care expenditures, being unlikely to either sacrifice quality for savings, or to spend more for higher quality plans.

The survey found that few employers (16 percent) were offering employees funds to purchase insurance on an exchange. Of those that did, six out of 10 offered less than $500 per month. Of those employers that do not offer insurance to employees, only 19 percent offered funds to employees to purchase insurance on an exchange. Sixty-four percent of employers reported that in the near future it is not too likely or not at all likely that they will join a private exchange.

As for wellness programs, 50 percent of employers reported offering wellness programs to their employees. Of those employers that offer health insurance, 76 percent offer wellness programs, compared to 14 percent of businesses that do not offer health insurance. Of those that offer wellness programs, 59 percent also provide wellness offerings to employees’ dependents. The most offered wellness programs are web-based resources for healthy living (35 percent), wellness newsletters (27 percent), and programs for managing chronic diseases (24 percent). Of the other wellness program strategies asked about (for example, competitions, biometric screenings, or incentives) none was offered by more than 15 percent of employers that offered a wellness program. Although many employers provided wellness programs, only 24 percent of employers offering them have any promotion strategy for their wellness programs, and few employers offered financial incentives to participate in wellness programs. For example, while 24 percent of employers with wellness programs offer disease management programs for chronic diseases, only 5 percent offer any financial incentive to participate. Of those employers that offer health risk appraisals or biometric screenings, only between 11 and 13 percent offer financial incentives for participation in these initiatives.

Overall, this survey presents a picture of many employers not taking full advantage of the objective resources available to them from the NCQA for assessing health plan quality, despite many of them exploring or choosing new health care options for their companies. The survey also suggests that most employers are content at their current levels for health care, being neither willing to sacrifice a quality rating in order to spend less, nor pay more for a higher quality rating. The survey also revealed that while many employers provide wellness programs, in many cases these programs appear to lack substantial support in terms of promotion or financial incentives. This could potentially be limiting the effectiveness of wellness programs on impacting employee health and health care costs.


AP-NORC Center for Public Affairs Research. Employer Perspectives on the Health Insurance Market: A Survey of Businesses in the United States. Accessed December 4, 2014.

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