2010 Health Care Cost Survey - Trustmark Voluntary Benefits

Transcription

2010 Health Care Cost Survey
Workforce Health 2010: New Deal, New Dividend
21st Annual U.S. Results Report
What’s Inside
2010 Survey Highlights
1
Exhibit A: The growing affordability gap
2
Exhibit B: Average actual 2010 employee cost increase
3
Exhibit C: Employers may be missing opportunities to optimize retiree health benefits
9
Exhibit D: Workforce well-being: Increasing importance among high-performing companies
19
Exhibit E: Proposed excise tax: A new benchmark for efficient plans
21
By the Numbers: A Detailed Look at the Survey Results
4
Exhibit 01: Average monthly medical costs and cost increases by covered group
4
Exhibit 02: Average cost increases — 1993-2010
4
Exhibit 03: Average cost increases — 2001-2010
5
Exhibit 04: Total employee/employer health care costs — 2005 vs. 2010
5
Exhibit 05: Average monthly employee/retiree share of 2010 medical coverage costs
6
Exhibit 06: Average employee/retiree share of monthly medical costs and cost increases by covered group
6
Exhibit 07: Retirees pay more than half of an ever-increasing cost burden
6
Exhibit 08: Far fewer future retirees will receive subsidized medical coverage
7
Exhibit 09: Are employees financially prepared to retire?
7
Exhibit 10: ABHPs offer significantly lower premiums than other plan types
10
Exhibit 11: Importance of ABHP objectives: High performers vs. low performers
10
Exhibit 12: Extent to which ABHPs meet objectives
11
High Performers: Staking Out Strong Positions in a Changing Environment
Exhibit 13: Cost variation across companies; High-performing vs. low-performing companies
12
12
Exhibit 14: High performers define their health care role: Employee empowerment, risk management, workforce productivity 14
Exhibit 15: Factors shaping health care strategy: High performers take a broad view
14
Exhibit 16: Combining the power of culture with management disciplines
15
Exhibit 17: Critical performance factors: Are they in place?
15
Best Practices Enter the Mainstream
16
Exhibit 18: Engaging consumers: Best practices enter the mainstream
16
Exhibit 19: Employee health management: Best practices on the rise
16
Exhibit 20: Measurement best practices expand
17
Exhibit 21: High performers have higher expectations for the measurable impact of their programs
17
Exhibit 22: The health dividend: High performers achieve positive business outcomes
20
Exhibit 23: High performance: Employees are on board
20
Exhibit 24: High performance: Communication drives desired behaviors
20
High Performers: Seizing Opportunities for Change
22
Exhibit 25: The evolving role of the employer: Today vs. 2012
22
Exhibit 26: Health care strategy: Trends for 2012
22
Exhibit 27: Personalizing the health management experience: High performers lead emerging trends
22
Exhibit 28: Trends in consumer engagement: High performers set new directions
23
Exhibit 29: High performers envision expanded use of incentives
23
Exhibit 30: Emerging trends in employee incentives
26
Exhibit 31: Influencing employee behavior: High performers make good decisions easy and comfortable
26
Exhibit 32: High performers lead measurement evolution
27
Exhibit 33: Emerging trends in incentives for providers: Tip of an iceberg?
27
New Frontiers
30
About the Survey
30
Participant List
31
2010 Survey Highlights
As this edition of our annual Health Care Cost Survey goes
to press, U.S. employers find themselves at a crossroads.
The effects of a severe economic downturn have yet to be
shaken off; sweeping reforms of the health care coverage
system are under discussion in Washington, and health care
costs continue to climb.
Despite these challenges, employers have never
been more interested in workforce health and wellbeing as a business value that can be measured,
managed and turned into a competitive advantage.
There have never been more creative opportunities
to use technology — to support new ways of
engaging the workforce in managing their physical
and financial health and increasing the efficiency
and quality of health care delivery. In fact, there has
never been a better time for “disruptive” innovation
— a time when achieving better results means
replacing old models and processes with new ones.
Our survey shows that employers are eager to
embrace change. Leading companies are looking
creatively at ways to redefine the deal with
employees, optimize their investments in building
and sustaining a culture of health, and capture a
health dividend for the business.
The 2010 Health Care Cost Survey takes the
measure of these powerful trends. This survey
has been providing the industry’s most in-depth,
prospective look at employer health care costs for
more than 20 years. The 2010 database includes
detailed information on the health benefit programs
provided by 552 of the nation’s largest employers.
This year’s respondent group, representing
approximately 10.3 million employees, retirees
and dependents, and over $57 billion in annual
spend on medical and dental benefits, stands as
a powerful chronicle of current best practices and
emerging trends in the rapidly evolving health care
marketplace.
“ Leading companies are
looking creatively at ways
to redefine the deal with
employees, optimize their
investments in building
Here’s a quick summary of the key findings:
and sustaining a culture
• Affordability remains a chronic problem. With
costs continuing to climb at rates well above the
general Consumer Price Index (CPI), employers,
employees and retirees face record-high costs in
2010. The dollar burden for employees has grown
exponentially over the past several years due
to the ever-increasing cost base and the added
impact of benefit design-related increases in outof-pocket costs. Low-wage workers and individuals
who retire before Medicare eligibility are most
vulnerable to the cost crunch.
of health, and capture a
health dividend for the
business.”
• The affordability gap continues to widen as
health care costs for active employees outpace
wage increases year after year and the economic
downturn takes its toll on reward programs
(Exhibit A on page 2).
• Gross health care expenditures will rise by an
average of $636 per employee in 2010, pushing
the average total cost above $10,000 for the
first time in history.
2010 Health Care Cost Survey 1
“ The competitive advantage
achieved by companies
with high-performing
health programs has never
been greater from a cost
perspective, but also drives
other significant business
outcomes.”
• Considering both premium increases and benefit
design changes, employees will pay nearly
$400 more on average in 2010 than they did in
2009 (Exhibit B).
• High performers in the 2010 survey pay 18%
less — roughly $2,000 per employee — for
their health benefit programs, which means
a high-performing organization with 10,000
enrolled employees would spend, on average,
$20 million less annually than a low-performing
competitor.
• Pre-65 retirees face the highest costs of all
groups — paying three times more than active
employees for similar levels of coverage. The
growing number of pre-65 retirees who still provide
coverage for their families must contribute more
than 50% of the total $20,000 annual cost —
an amount that is unaffordable for most.
• The affordability proposition for employees is
also better, with employees at high-performing
companies paying 20% less than their
counterparts at low-performing companies.
• High performance matters more than ever.
Our performance analysis,* now in its fifth year,
shows that the competitive advantage achieved by
companies with high-performing health programs
has never been greater from a cost perspective,
but also drives other significant business
outcomes.
• Higher efficiency and lower trend position high
performers well for health care reform, as
cost pressures could increase; for example,
proposed excise taxes on “high cost” health
plans would affect more than half of the
companies in the survey database on the 2013
effective date, but the high performers could
buy themselves considerable time (three years)
beyond 2013 before hitting the tax thresholds.
Exhibit A. The growing affordability gap
Cumulative active employee health care costs vs. wage increases
160%
149%
140%
120%
100%
Affordability
Gap
80%
60%
40%
37%
20%
0%
2000
2001
2002
2003
2004
Active employee health care costs
2005
2006
2007
2008
2009
Workers’ earnings
Source: Towers Watson Health Care Cost Survey 2010 (active employee data) and Bureau of Labor Statistics,
seasonally adjusted data from the Current Employment Statistics Survey August to August, 2000 – 2009
* Towers Watson divides respondents in its annual health care cost database into three categories: low-performing, average-performing and high-performing
companies. Performance designations are based on relative costs, as well as whether an organization is meeting its health benefit objectives in key areas that
include controlling employer and employee costs, enhancing efficient purchasing of health care services, enhancing employee satisfaction, understanding and
involvement in health benefit programs, supporting employees’ good health and addressing health risks/current health problems.
2 towerswatson.com
Exhibit B. Average actual 2010 employee
cost increase
Including benefit design cost shift (actives only)
$2,500
$2,000
Total = $2,487
$195
$204
$2,088
$1,500
$1,000
$500
$0
2009 premium cost
2010 premium cost increase
2010 benefit design cost shift
• Additional aspects of the health dividend for
high performers include supporting/building
the company reputation, attracting the needed
workforce, maintaining productivity and
supporting workforce well-being — all areas
where high performers are roughly twice as
likely as low performers to report positive
impacts delivered by their health programs.
• Necessity is the mother of invention. With health
care reform in the offing, ongoing affordability
concerns and, more broadly, a reset of the reward
proposition at many companies, the imperative
for change is stronger than ever. The survey
suggests that best practices will soon enter the
mainstream, as many employers, including the
low performers in our database, are compelled
to up their game and adopt key elements of the
“high-performance top 10” (see page 13). Survey
respondents also point to some new directions
for change — and to some areas where solutions
have yet to fully emerge.
• Investments in wellness programs, communication and measurement disciplines — hallmarks
of the high performers in past surveys — will
be increasingly prevalent across all companies
(including today’s low performers) just three
years from now.
• Top performers are disrupting the status quo
and leading the charge into new territories
— including the use of new technologies and
new engagement approaches, such as social
networking, behavioral economics and, in a few
cases at the margin, provider incentives.
“ Most employers cite
retirement readiness as
an important element of
workforce management,
but far fewer feel their
current employees are
financially prepared
to retire.”
• Underscoring these powerful new trends, high
performers will, over the next few years, focus
their strategies and measurement disciplines
on key workforce management factors that
influence positive business results, such as
workforce productivity, well-being and retirement
readiness.
• Notable among reported gaps, most employers
cite retirement readiness as an important
element of workforce management, but far
fewer (28%) feel their current employees are
financially prepared to retire. Employers will need
to review their strategies and options in this
critical area by, for example, better positioning
their account-based health plans and exploring
new approaches to providing value to retirees
while keeping their commitments manageable
and valuable from the organization’s
perspective.
By the Numbers:
A Detailed Look at the Survey Results
Employers face an average 7% increase in health
care costs in 2010, according to our 2010 Health
Care Cost Survey. The 2010 rate increase for
retirees is slightly lower than for actives — total
overall costs for pre-65 retirees will increase 6% in
2010 and 4% for the post-65 group (Exhibit 1).
Looking at the dollar amounts for year-over-year
increases from 2009, the composite health care
cost for active employees (averaging all coverage
Exhibit 01. Average monthly medical costs and cost increases
by covered group
Employee/ Employee/
Retiree
Retiree
Only
Plus One
Family
Average
Increase
Composite* From 2009
Active employees
$432
$874
$1,249
$849
7%
Retirees under age 65
$633
$1,249
$1,633
$1,163
6%
Retirees age 65 and older
$320
$654
$517
4%
N/A
*Composite (i.e., employee/retiree only, employee/retiree plus one and family combined)
Exhibit 02. Average medical cost increases
1993-2010
25%
20%
15%
10%
5%
0%
-5%
93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Active employees
Consumer Price Index
Source: U.S. Department of Labor, Bureau of Labor Statistics
4 towerswatson.com
levels) will rise by $53 per month, to $849 in 2010.
The composite cost for retirees under age 65 will
increase by an average of $55 over 2009 levels, to
$1,163 per month.
At 7%, this year’s growth in medical benefit expenditures marks the sixth consecutive year of single-digit
increases, in contrast to the double-digit trends seen
in the first four years of the new millennium. As an
important reminder, however, average health care cost
increases have outpaced the CPI for over a decade
and will continue to do so in 2010 (Exhibits 2 and 3).
These trend data highlight the competitive
advantage achieved today by high-performing
companies — the top tier of survey respondents
who, among other achievements, are successfully
holding cost increases at or below the medical cost
component of CPI, a significant accomplishment
today and a rare event in years past (see the 2010
high-performer analysis, beginning on page 22).
The Cost Climb Continues
The affordability issues raised by this year’s cost
increases are far more acute than the growth rates
themselves might suggest. The cumulative effect of
year-after-year increases has once again produced
record-high costs for employers, employees and
retirees.
Exhibit 03. Average cost increases
2001-2010
Medical Plans
Active employees
Combined
Dental Plans
Active employees
2001
2002
2003
2004
2005
2006
2007
2008
12%
17%
18%
13%
13%
13%
19%
14%
15%
17%
19%
16%
12%
15%
13%
12%
8%
9%
9%
8%
7%
9%
8%
7%
6%
6%
7%
6%
2001
2002
2003
2004
2005
7%
6%
4%
6%
5%
4%
7%
6%
5%
5%
5%
6%
5%
4%
2007
2008
3%
3%
7%*
7%*
2%*
5%*
Inflation Measures
Consumer Price Index (CPI)
Medical care component of CPI
2001
2002
2003
2004
2005
2006
2007
1.6%
4.7%
2.4%
5.0%
1.9%
3.7%
3.3%
4.2%
3.4%
4.3%
2.5%
3.6%
4.1%
5.2%
7%
9%
6%
7%
2006
2008
2009
2010
6%
6%
4%
6%
7%
6%
4%
7%
2009
2010
3%
4%
3%*
N/A
2009
0.1% -1.5%**
3.3% 3.2%**
*Average cost increase for retirees under and over age 65
**Unadjusted 12 months ended August 2009; Source: U.S. Department of Labor, Bureau of Labor Statistics
Employers are now paying 28% more for health
care than they did just five years ago ($7,896
today versus $6,169), and employees are paying
40% more ($2,292, compared to $1,642). These
financial burdens would be significant in the
best of economic times. They are severe, and in
some cases crippling, in an environment of deep
economic recession when wages remain flat and
lag significantly behind health care cost increases
(Exhibit 4, and Exhibit A on page 2).
Underscoring the affordability issue, the cost spiral
hit a milestone this year with average annual peremployee spend crossing the $10,000 mark.
Looking at the coverage-level data in Exhibit 1, the
average reported cost of medical coverage in 2010
for active employee-only coverage is $432 per
month ($5,184 per year) and for family coverage,
$1,249 per month ($14,988 per year). Family
coverage for pre-65 retirees — the most expensive
by far — costs more than $1,600 per month, which
adds up to nearly $20,000 per year. In this survey,
almost half (47%) of respondents say their retirees
cover dependents, and for the expanding group of
early retirees who still have dependent children, the
cost for family coverage is over 30% more than the
premium active employees pay for a comparable plan.
Exhibit 04. Total employee/employer health care
costs
2005 vs. 2010 (composite — actives only)
2005 Total Cost = $7,811
Employee $1,642
Employer $6,169
2010 Total Cost = $10,188
Employee $2,292
Employer $7,896
The Affordability Gap Widens
Exhibit 05. Average monthly employee/retiree share of 2010 medical
coverage costs
Employee/
Retiree Only
(% of Total Cost)
Employee/Retiree
Plus One
(% of Total Cost)
Family
(% of Total Cost)
Active employees
20%
23%
23%
52%
51%
54%
52%
53%
N/A
Exhibit 06. Average employee/retiree share of monthly medical costs
and cost increases by covered group
Employee/ Employee/
Retiree
Retiree
Only
Plus One Family
Active employees
Average
Increase
Composite* From 2009
$87
$201
$290
$191
10%
$332
$639
$879
$621
8%
$167
$345
N/A
$270
5%
The employer share of active employees’ health
coverage costs continues to hold steady. In 2010,
employers will once again subsidize 80% of active
employee-only coverage costs and 77% of family
coverage (Exhibit 5), which is notable given the
economic pressures employers experienced
beginning in 2008 and throughout 2009. Nevertheless, the actual dollar burden for employees has
grown due to the ever-increasing cost base (Exhibit 4).
In addition, employee costs are increasing at an
accelerating pace. Employee premium contributions,
on average, will rise by 10%, or $191, during
2010 — a bigger jump than the 8% increase seen
in 2009 (Exhibit 6). In terms of specific coverage
levels, active employees will pay, on average, $87
per month ($1,044 per year) for single coverage
and $290 per month ($3,480 annually) for family
coverage.
*Composite (i.e., employee/retiree only, employee/retiree plus one and family combined)
Exhibit 07. Retirees pay more than half of an ever-increasing cost burden
Average annual employee/retiree share of 2010 medical coverage costs
$0
$2,000
$4,000
$6,000
$8,000
$10,000
Active employees
1,044
2,412
3,480
3,984
7,668
10,548
Retirees age 65 and over
2,004
4,140
Employee/retiree only
6 towerswatson.com
Employee/retiree plus one
Family
$12,000
The additional burden employees will bear in 2010
is exacerbated by indirect cost shifting through
benefit design changes such as increased copayments, which add significantly to the overall cost —
about $195 on average (see Exhibit B on page 3).
Notably, the level of cost shifting evident in the 2010
survey is consistent with years past — surprising in
an economy where bigger shifts might be expected.
However, employees are feeling the impact more
keenly because these actions come at a time when
wages at some organizations are flat or declining,
401(k) balances and employer matches are down,
and other aspects of total rewards such as bonuses
and profit sharing are being scaled back.
Retirees face significantly greater affordability
challenges as they continue to pay a considerably
larger share of coverage costs — between 51% and
54% depending on status and type of coverage (in
contrast to the 20% to 23% share active employees
pay). Not surprisingly then, the 6% and 4% increases
reported for the pre- and post-65 groups hardly
speak to the impact of the costs these individuals
must shoulder.
Retirees who are not yet eligible for Medicare
(i.e., pre-65 retirees) are paying $3,984 per year for
single coverage (Exhibit 7). For pre-65 retirees with
families to cover, the retiree share of the nearly
$20,000 annual cost ($10,548) has become
increasingly prohibitive and unsustainable for many
individuals — causing many of today’s older workers to
rethink their retirement plans and delay retirement.
For retirees age 65 and older, Medicare benefits
help cover some of the costs, but this group is not
fully protected from the health care cost spiral.
Medicare-eligible retirees are paying $2,004
annually for single coverage, and $4,140 annually
for a retiree plus one dependent (Exhibits 6 and 7).
The Retiree Medical Dilemma:
Obligations and Opportunities
Affordability is a weighty issue for employers that
offer retiree medical programs. A tough economy
has cut bottom lines at many organizations. And
coupled with serious business issues are concerns
about the impact of health care reform. As a result,
many organizations are compelled to look at their
overall retirement benefit proposition — including
retiree medical. In fact, many employers have
exited their retiree medical plan sponsorship role,
an ongoing trend seen over the past few years and
once again evident in our 2010 survey results.
Today, less than half (45%) of the companies in our
database offer subsidized retiree medical coverage
for all or some current employees and retired
workers, and an additional 14% provide access-only
benefits to these groups (Exhibit 8). Only 22% of
survey respondents offer some sort of subsidized
retiree coverage to future retirees coming into the
company as new hires. Another 23% offer new hires
access to a company-sponsored retiree medical plan
as a retirement benefit, but require participants to
pay the full cost.
Looking into the future, among responding companies
that currently sponsor programs, 10% are planning
to exit the role, and another 20% are seriously
considering this option for the future.
Clearly, the cost and administrative burdens associated with retiree medical programs raise tough
issues for companies today. But as an ongoing
human resource objective, most companies’
workforce management strategies aim to support
employees’ financial readiness to retire — roughly
two-thirds of our survey respondents cite retirement
readiness as a priority (Exhibit 9). However, only
about a quarter of respondents (28%) say that their
current employees are, in fact, financially prepared
to retire.
Exhibit 08. Far fewer future retirees will receive subsidized medical coverage
Percent respondents offering programs by covered group
0%
20%
40%
60%
80%
100%
Existing retirees/active employees
45
14
New hires
22
23
Subsidized coverage
Access only
Exhibit 09. Are employees financially prepared to retire?
Percent responding strongly agree/agree
0%
10%
20%
30%
40%
50%
60%
70%
80%
It is important to our workforce management strategy that current employees
are financially prepared to retire
64
We provide programs that help employees to be financially prepared to retire (e.g., ABHPs)
50
We provide resources to help employees and retirees manage the transition to retirement
49
Our current employees are financially prepared to retire
28
Optimizing Retiree Health Benefits
“ Accessing the vibrant
external marketplace
for individual insurance
products tailored to
Medicare beneficiaries
can actually increase
the total dollars available
to retirees.”
8 towerswatson.com
With health care reform destined to drive
changes in employer benefit plans and
potentially increase already high program costs
and administrative burdens, employers need to
ensure that every dollar invested in health
benefits is wisely spent. Not surprisingly, that
scrutiny applies equally to benefits for actives
and retirees.
Retiree medical programs can add an
important component to a company’s reward
portfolio, and provide valuable support for
retirement readiness and an organization’s
related workforce management goals. And for
employers that plan to continue to offer these
benefits in some form, there are ways to rein
in costs and better manage administrative
burdens. However, survey results suggest that
many employers are not yet fully capitalizing
on available solutions. Following are some
observations:
• Building a health and wealth strategy. Developing
a consistent health benefit strategy that links
active employee benefits to retiree programs is
one effective way for employers to achieve savings
while delivering value and empowering employees
to play an active role in preparing for retirement.
• Aligning tactics. Certain tactics lend themselves
to supporting a health and wealth strategy. For
example, HSAs represent a unique, tax-effective
way for active employees to save for retiree
medical costs and for pre-65 retirees to pay
medical expenses tax-effectively. However, only
31% of survey respondents that sponsor retiree
medical programs currently offer employees this
important savings opportunity (Exhibit C). Another
21% are, however, considering this approach for
2010 or later.
Another related solution is a retiree medical
savings account (RMSA), which allows employees
to accumulate unused health care dollars provided
in active employee plans through an HRA. Only 9%
of survey respondents sponsor such retirement
“spillover” accounts.
• A new take on employer sponsorship.
Employers should also recognize that their
traditional role as plan sponsor may not be
the best way to provide value to their retirees.
Accessing the vibrant external marketplace
for individual insurance products tailored to
Medicare beneficiaries can actually increase
the total dollars available to retirees by giving
them access to higher levels of government
funding and improved plan choice. Yet 65%
of employers have not yet taken advantage
of this option.
What’s more, employers can reduce administrative burdens and preserve the value of
their financial subsidy to retirees by converting
their current commitment into a reimbursement
account and letting retirees choose how to
spend it. Employers can also contract with
third parties to handle retiree enrollments —
including state-of-the-art retiree call centers
that provide counseling and decision support
to retirees.
Economic conditions, changes in the Medicare
market and health care reform provide some
strong incentives for employers to change their
current approaches to retiree medical. The
bottom line in today’s environment: Efficient use
of employer dollars and resources is paramount.
And missed opportunities to optimize investments
can be costly to a company in many ways.
Employers today should explore the full range
of things they can do, short of increasing their
financial obligations — such as providing creative
retirement savings opportunities, education and
modeling tools, along with support for ongoing
plan management and administration that
maximizes value for retirees and efficiency for
the company.
Exhibit C. Employers may be missing opportunities to optimize retiree
health benefits
Actions taken/will take for retiree medical program
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Implement HSA for actives/pre-65 retirees as a means to help employees/retirees
save for future expenses
31
21
48
Move from self-insured plans to fully insured plans for post-65 retirees
15
20
65
Offer Medigap options to post-65 retirees
13
19
67
Convert current subsidy to a retiree health account
8
23
70
RMSA that allows employees to accumulate unused health care dollars provided
in active plans through an HRA
5
4
91
In place in 2009/will implement in 2010
Will not implement or consider
Considering for 2010 or later
In response to these challenges, creative solutions
are beginning to emerge, offering alternatives to
abandoning retiree medical commitments altogether.
And, as part of an overall retirement benefit strategy,
some employers are working to preserve their
retiree medical programs using emerging markets
and service capabilities. For ideas and related
survey data, see the sidebar on page 8.
Exhibit 10. ABHPs offer significantly lower premiums than other plan types
Average 2010 monthly medical costs by coverage level
$1,500
$1,295
$1,171
$1,200
$1,042
$904
$900
$815
$737
ABHPs Continue to Gain Ground
$600
$446
$402
Employer adoption of account-based health plans
(ABHPs) has risen significantly over the last several
years — now at about 55% of companies in our
database — as employers recognize and embrace
the value of these plans.
$360
$300
$0
Employee plus one
Employee only
Family coverage
All other plans (combined, excludes ABHPs)
ABHP with HRA
ABHP with HSA
Exhibit 11. Importance of ABHP objectives: High performers vs. low performers
Percent responding extremely/very important
0%
10%
20%
30%
40%
50%
60%
70%
80%
Controlling employer costs
77
72
Building a sense of shared responsibility with employees
77
41
Achieving measurable change in employee behaviors that have an impact on company costs
71
54
Controlling employee costs
71
48
Providing a tax-effective savings option for postretirement medical expenses
65
39
High-performing companies
10 towerswatson.com
Low-performing companies
ABHPs provide both employers and employees with
a clear cost advantage. This year’s survey data
again show lower average premiums for ABHPs than
for any other plan type: $360 per month for single
coverage in an ABHP with a health savings account
(HSA) and $402 for single coverage in an ABHP with
a health reimbursement account (HRA), versus the
$446 per month average for actives in other plans
(Exhibit 10).
In addition, the employee contribution percentage
is lower for ABHPs. While employees in other plans
carry between 20% to 23% of the total cost, those in
ABHPs with HSAs contribute between 16% and 19%,
depending on the coverage level.
With employer commitments to retiree medical
benefits under increasing pressure, the growing
availability of ABHPs is a welcome development for
many employees because these plans, particularly
those featuring tax-favored savings opportunities,
offer an effective way to save for health care
expenses in retirement. Employers initially favored
HRA features over HSAs when ABHPs were first
gaining prevalence four and five years ago. Today,
however, growing numbers of employers offer the
HSA feature, signaling their increased interest
in providing savings vehicles for retiree medical
expenses.
However, the survey suggests that many employers
are still experiencing challenges in positioning
ABHPs for success. Among companies offering
HSAs, only 15% of the total eligible employee
population, on average, is enrolled in the plan. In
addition, many of these companies (roughly 45%)
report that half or fewer of the participating
employees actually contribute to the account — a
significant missed opportunity, given that the ability
to plan for future expenses is undoubtedly one of
the most important attributes of HSAs.
By contrast, the high-performing companies in our
survey database (see footnote, page 2, for the
definition of high performer) are significantly more
likely to offer ABHPs (63%) than low performers
(42%) and are more successful with these programs
in virtually all respects. For starters, high performers
craft their strategies with clear objectives, focused
on building a sense of shared responsibility,
encouraging behavior change and making the
connection to retirement needs (Exhibit 11). Not
surprisingly, they report better results (Exhibit 12)
— in terms of controlling costs, providing a taxeffective savings opportunity and changing employee
behaviors.
Exhibit 12. Extent to which ABHPs meet objectives
Percent responding fully/largely meeting objectives
0%
10%
20%
30%
40%
50%
60%
70%
80%
Controlling employer costs
51
27
Controlling employee costs
46
25
Providing a tax-effective savings option for postretirement medical expenses
35
21
Encouraging employees to spend health care dollars more wisely
35
16
Building a sense of shared responsibility with employees
33
4
Achieving measurable change in employee behaviors that have an impact on company costs
26
9
As just one yardstick for the value of this differential,
high performers with account-based plans in this
survey could extend out their “excise tax free zone”
under health care reform by as much as six years
beyond the proposed 2013 effective date (see
sidebar on page 21).
High Performers:
Staking Out Strong Positions in a Changing Environment
“ The cost differential
between high and low
performers — at more
than $2,000 per employee
per year — is the most
significant in the survey’s
history.”
As evident in prior years, performance variations like
the ones just noted tell an important story about
the characteristics of successful health benefit
programs and the specific factors that contribute to
superior results. Arguably, with economic challenges
persisting and health care reform legislation poised
to transform the health care landscape, there
has never been a more critical time for employers
to have their health benefit programs operating
efficiently and on solid ground. And the potential
for a clear competitive advantage has never been
greater.
The 2010 survey results underscore the importance
of this performance edge. For starters, high
performers are way ahead on cost management.
In the 2010 survey, the cost differential between
high and low performers — at more than $2,000
per employee per year — is the most significant in
the survey’s history. For companies with thousands
of employees, this differential quickly adds up to
millions of dollars in savings — so, for example, a
high performer with 10,000 employees would have
a $20 million cost advantage over a low-performing
competitor (Exhibit 13).
As we’ve seen in previous years, the investments
high-performing companies make in workforce health
produce a powerful health dividend. The dividend
includes significant cost savings and productivity
gains, as well as support for a culture of health that
helps meet broader talent management objectives,
such as recruiting and retention, and stronger
employee engagement in the company mission.
What’s more, while 35% of low performers report
double-digit cost increases, high-performing
companies are keeping trends well below national
averages. Over 33% of these organizations have
held their cost increases to 4% or less.
The data also suggest that the cost advantage for
high performers significantly enhances the affordability
proposition for employees; employees at highperforming companies will pay nearly 20% less for
health coverage in 2010 than their counterparts at
low-performing companies.
Exhibit 13. Cost variation across companies (actives only)
High-performing vs. low-performing companies
High-Performing
Companies
Low-Performing
Companies
Difference
$9,240
$11,244
$2,004
Increase in overall cost
6%
8%
2%
Increase in employer cost
5%
7%
2%
Increase in employee cost
9%
10%
1%
Cost per employee per year
(composite for all plans)
12 towerswatson.com
Employee annual contribution
$2,028
$2,496
$468
Cost per employee for ABHP with HRA
$8,820
$10,932
$2,112
Cost per employee for ABHP with HSA
$7,812
$9,264
$1,452
As a final critical point, ongoing program performance
could have significant implications for employers
under health care reform. Regardless of how the
impact of reform unfolds, it’s clear that companies
with efficient programs and a clear, forward-looking
strategy for supporting workforce health will be
winners in the new environment (see sidebar on
page 21).
The High-Performance Top 10
To understand the many factors that contribute
to the dramatic variations in performance results
among companies in our survey, our analysis divides
respondents into three categories: low-performing,
average-performing and high-performing companies.
These performance designations, in place for the
past five years, are based on relative costs and cost
increases, but also take into account whether an
organization is meeting its health benefit objectives
in key areas that include:
• Managing employer and employee costs
• Enhancing efficient purchasing of health care
services
• Enhancing employee satisfaction, understanding
and involvement in health benefit programs
• Supporting employees’ good health and
addressing health risks/current health problems
in the employee population
The survey data highlight the range of benefit
strategies, program management disciplines and
investments that differentiate high performers from
other organizations. Summarizing the 2010 results,
following are the top 10 factors that distinguish the
high performers in our survey. These organizations
achieve superior results by:
1. Understanding, supporting and demonstrating
the business value of workforce health
2. Ensuring that key success factors, such as
leadership support and disciplined execution, are
firmly in place
3. Establishing business-focused goals to ensure
that health investments deliver a health dividend —
and rigorously measuring the program’s success in
producing targeted results
4. Building action plans to address gaps and
opportunities
5. Engaging employees and promoting a culture of
health
6. Creating a sense of shared responsibility
and employee accountability for health and cost
management
7. Designing programs that support transparency
and create meaningful incentives for healthy
behaviors and choices
8. Investing in a broad range of current and
emerging health management approaches and
technologies
9. Supporting employee needs for risk management
and planning appropriately for health expenses in
retirement
10. Building connectivity across health-related
programs and vendors
High Performers Get the
Fundamentals Right
Exhibit 14. High performers define their health care role: Employee
empowerment, risk management, workforce productivity
Percent responding primary/large role
0%
10%
20%
30%
40%
50%
60%
70%
80%
Motivating employees to own the management of their health
69
23
Supporting employees’ capability to make sound health care decisions
64
23
Identifying and managing health risk/conditions in employee population
59
26
Enhancing employee productivity through health care strategy/programs
51
19
Meeting employees’ future financial protection needs in retirement, including
retirement income and retiree health care
41
29
High performers see the connection between workforce health and positive business outcomes — and
that insight is clearly reflected in their strategies.
For example, key factors shaping strategies at highperforming organizations include measuring the
business impact of health programs (Exhibit 15).
Exhibit 15. Factors shaping health care strategy: High performers take
a broad view
Percent responding extremely/very important
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Providing affordable health plans to employees
87
73
Demonstrating the organization’s interest in employee well-being*
71
36
Demonstrating the business impact of health benefits and health-related programs
61
30
Supporting employees in managing their health and wealth
56
25
Building connectivity across all health-related programs and vendors
56
23
*Senior management interest in employee well-being is the top driver of employee engagement
in the Towers Watson 2007-2008 Global Workforce Study.
14 towerswatson.com
The difference begins with the most basic elements
of the approach — such as governance processes,
guiding principles and measurement. As a foundational proposition, high performers see the role of
health benefits in the employment relationship not
simply as a mechanism for delivering compensation
or a needed-to-play program with the primary
purpose of covering the cost of illness, but as a
partnership with employees in promoting workforce
health and productivity (Exhibit 14).
100%
Notably, high performers also focus on demonstrating
the organization’s interest in employee well-being —
a point that deserves emphasis. According to
employee research we’ve conducted over multiple
years in countries around the globe, senior management interest in employee well-being is consistently
the key driver of employee engagement. And engaged
employees are far more likely to devote discretionary
effort to their jobs, which in turn leads to performance
improvement for the organization overall.
Combining the Power of Culture
With Management Discipline
Underscoring these powerful differences, highperforming companies see workforce health as a
critical component of business performance. Picking
up on the employee engagement theme, they “walk
the talk” by communicating to employees through
senior management and other channels that the
company cares about employee well-being (Exhibit 16).
They make an explicit commitment to building a
culture of health, see good health as part of the
organization’s fabric and identity, and focus their
messages to employees on the value of health and
what it means to be a good health care consumer.
In implementing their health care strategies, high
performers recognize the importance of critical
factors for success and ensure that these performance
conditions are in place. They recognize, for example,
the importance of senior management involvement,
and support from managers and supervisors in
getting employees to take on expected financial
responsibilities and positive health behaviors
(Exhibit 17). The most successful companies also
measure performance and act on results — an
ongoing management discipline that pervades all
aspects of the program.
Notably, high performers know they have a responsibility to help employees understand and manage
new risks — a factor that correlates strongly
in other research with employee acceptance of
benefit program changes, trust in management
and perceptions of the organization overall. Not
surprisingly, managing risk is top of mind for many
employees in today’s environment, where job
security, day-to-day expenses and 401(k) balances
are real concerns.
Exhibit 16. Combining the power of culture with management disciplines
Percent responding strongly agree/agree
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Our company views employee health as a critical component of superior business performance
86
64
Our company promotes a culture of shared responsibility and accountability
84
52
Our senior leadership communicates clearly that the organization cares about
employee well-being*
80
58
Our organization is committed to building and maintaining a “culture of health”
for employees
78
57
Our organization focuses its health care communication on the benefits of improved
personal health
75
52
Our organization has clearly communicated to employees what it means to be
an effective health care consumer
60
24
in the Towers Watson 2007-2008 Global Workforce Study.
Exhibit 17. Critical performance factors: Are they in place?
Percent responding critical factor; in place now
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Senior management involvement
85
67
Disciplined execution
78
45
Support from managers and supervisors
77
53
Employee trust in senior management
74
51
Measuring performance and acting on results
67
36
Ability to demonstrate ROI
47
24
Employees’ ability to manage increased risk/responsibility
44
20
Best Practices Enter the Mainstream
Exhibit 18. Engaging consumers: Best practices enter the mainstream
Percent responding doing to a great/moderate degree
0%
10%
20%
30%
40%
50%
60%
70%
90%
80%
100%
Health resources website sponsored/hosted by the company
53
78
Year-round employee education and communication
52
82
Tools/information to help employees make better decisions about their health care
45
75
Total compensation or total benefit statement that includes the value of health benefits
44
73
Changes in the work environment to encourage healthier behavior and/or support
a culture of health
41
69
Today
Engaging Employees
For example, high performers historically have
committed to in-depth, ongoing employee communication programs that integrate messages and
employ a broad range of vehicles. Looking ahead
three years, significantly more companies anticipate
using communication tactics that are now “owned”
primarily by the high performers.
2012
Exhibit 19. Employee health management: Best practices on the rise
Percent responding doing to a great/moderate degree
0%
10%
20%
30%
40%
50%
60%
70%
90%
80%
Care disease management programs
66
88
Health promotion programs
59
85
Wellness programs
57
88
Health risk assessment
56
85
Health advocate to manage chronic condition/serious illness
47
75
Today
2012
16 towerswatson.com
Over the five years of our performance analysis,
we’ve seen highly distinct and consistent differences
between high- and low-performing companies. This
year, we also tested employers’ future plans for
certain key practices. Interestingly, this analysis
indicates that, across all companies in the database
(including low performers), practices in certain areas
will likely be more consistent three years from now
than they are today, as low-performing companies
begin to recognize gaps and take action in key areas
that need improvement — many of which are areas
where high-performing organizations excel today.
100%
Today, only about half of all respondents have healthfocused communication programs that span the
entire year (a key characteristic of high-performing
organizations) but, in three years, the number
with year-round employee health education and
communication programs could soar to over 80%
(Exhibit 18). Similarly, the data suggest a significant
increase in the prevalence of company-sponsored
health websites, as well as growing availability of
tools and information to help employees make
better decisions about health — areas where high
performers have historically taken the lead.
Along these same lines, the survey respondents
as a group (including the low performers) expect to
increase their investments over the next three years
in managing and improving workforce health — by
promoting wellness, encouraging employees to
assess their personal health risks and helping those
with chronic diseases manage their conditions.
Prevalence rates in many of these best practice
areas are expected to increase by 25% or more
(Exhibit 19).
Evolving Measurement Disciplines
Of equal importance in the high-performance arsenal
are measurement disciplines, which traditionally
have been key differentiators between high and
low performers, and now show signs of coming
into mainstream practice in a variety of areas. A
sampling of the survey results (Exhibit 20) indicates
an increasing interest in assessing:
• Employee health risks
• Gaps in care that could be costly to employers
and employees
• The cost of absence and disability
• Levels of employee involvement as evidenced by
use of support resources and tools
By 2012, fully two-thirds of survey respondents
expect to be using these disciplines.
The Proof Is in the Results
While the survey findings suggest that certain key
best practices will become more prevalent among all
companies in the near future, it remains to be seen
whether positive results will be more universally
achieved. Going back to our perennial observations
about high performers over the past five years,
the superior results these companies consistently
deliver seem to require deep and far-reaching
commitments to workforce health.
Exhibit 20. Measurement best practices expand
Percent responding doing/will do extensive/some measurement
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Employee use of disease management resources and tools
54
71
Employee health status/risk across the population compared to benchmarks
51
70
Gaps in care through ongoing review of medical claims
47
66
Employee use of information resources and tools to support health promotion
42
65
Employee attitudes, understanding, satisfaction with health benefits
42
64
Today
2012
Exhibit 21. High performers have higher expectations for the measurable
impact of their programs
How important is it that your health programs have a measurable impact on…
Percent responding extremely important/very important
0%
10%
20%
30%
40%
50%
60%
70%
80%
Managing labor costs
76
58
Maintaining a productive workforce
73
52
Supporting/building company reputation
68
Overall, high performers have higher expectations
for their health strategies and programs — in terms
of labor cost management, productivity, company
brand/reputation, talent management, employee
engagement and workforce well-being — in ways
that give evidence of those deeper commitments
(Exhibit 21). What’s more, they are much more likely
to report positive impacts in these areas — i.e., a
health dividend that truly goes well beyond reduced
health care claim costs and other basic program
efficiencies (Exhibit 22 on page 20).
47
Engaging employees to help the company succeed
61
34
Supporting workforce well-being
59
29
Workforce Well-Being:
Good Health Is Good Business
“ For the employer,
the benefits can be
significant: higher
levels of sustained
employee engagement,
lower turnover and
improved productivity.”
High-performing companies understand the
connection between workforce health and positive
business outcomes — and that insight is clearly
reflected in the importance they place on employee
well-being today, as well as their expectation that
health and well-being will be an even higher priority
in 2012 (Exhibit D).
What’s noteworthy is high performers’ increasing
emphasis on measuring the impact of well-being
on critical organizational performance indicators
such as employee turnover and productivity. Fully
41% report that these metrics are important today,
and 59% expect these measures to be important
three years from now. What’s more, all companies
in the survey (including low performers) expect that
demonstrating the organization’s interest in employee
well-being will be a factor shaping benefit strategies
in the years ahead (Exhibit 26 on page 22).
In contrast to other workforce metrics that focus
solely on physical health or a single aspect of
employee attitudes or behavior, “well-being”
encompasses three interconnected aspects of an
individual’s work life:
• Physical health — overall wellness, energy/
stamina and health risks
• Psychological health — stress/anxiety, intrinsic
satisfaction, accomplishment, optimism,
confidence, control, empowerment and safety
• Social health — work relationships, balance in
work and personal life, equity, fairness, respect
and social connectedness
18 towerswatson.com
For employees, well-being in the workplace
translates into such positive outcomes as a
sense of balance between work and home life,
meaningful work that is appreciated by the
employer, overall good health and a feeling of
control. For the employer, the benefits can also be
significant: higher levels of sustained employee
engagement, lower turnover and improved
productivity. In fact, according to the results of
the Towers Watson Global Workforce Study, senior
leadership’s demonstrated interest in employee
well-being is the number one driver of employee
engagement at many organizations and in most
countries.
Although the recession is slowly beginning to thaw,
organizations will need to work hard over the
coming year to get the best results from their
employees as they continue to manage costs and
the bottom line. While there’s no one-size-fits-all
strategy, following are some initial actions to
consider:
• Understand and measure both engagement
and well-being. Companies that examine and
measure their own cultures, and how those
cultures in turn affect engagement and wellbeing, will understand their critical issues in rich
detail, paving the way for targeted, cost-effective
solutions.
• Focus on effective leadership. The role of
leadership in employee engagement is always
critical, but never more so than in times of
change and uncertainty. First and foremost,
organizations must have effective and energized
leadership at the top who treat employees with
fairness and respect, and demonstrate genuine
interest in their well-being — through both words
and actions.
• Reevaluate the value proposition. What
does your organization expect from its
employees, and what do employees expect
in return? How has the economic downturn
affected various aspects of the deal? Have
you reduced or eliminated certain benefits,
or revised incentive criteria? How have
employees reacted? What steps can you
take to rebalance the deal in ways that meet
both company and employee needs?
• Focus on key talent. In the current environment, the best talent is in high demand.
These employees are the most mobile and
will find it easiest to change jobs if changing
workplace conditions aren’t meeting their
needs — especially as the economy picks up
steam. To avoid losing key talent, organizations should consider revisiting and, if
needed, resetting their retention strategies,
particularly for the pivotal roles that drive
business results.
Exhibit D. Workforce well-being:* Increasing importance among
high-performing companies
Percent high-performing companies responding extremely important/very important
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Communicating with employees about well-being
53
66
Supporting psychological well-being, e.g., empowerment, stress management, safety
50
66
Having a clear definition of employee well-being
48
62
Supporting social/relational well-being, e.g., work/life balance, fairness, connectedness
48
59
Measuring the impact of employee well-being on key outcomes, such as turnover, productivity
41
59
Today
2012
*”Well-being” includes social, relational and psychological health, in addition to physical health.
• Develop frontline managers. While senior
leadership can drive home key messages,
managers and supervisors are in the
best position to understand employees’
workloads, personal issues and day-to-day
activities, and can give employees flexibility
in scheduling when and where they work.
Effective managers are also best suited
to recognize and address employees’
challenges and problems, give effective
performance reviews, create a collaborative
team spirit and, overall, support a culture
of health and well-being.
Exhibit 22. The health dividend: High performers achieve positive business outcomes
To what extent are your health programs achieving positive outcomes today?
Percent responding extremely positive/very positive
0%
10%
20%
30%
40%
50%
60%
70%
80%
Managing labor costs
48
24
Supporting/building company reputation
At the program level, high performers are, not
surprisingly, more confident that employees “get
it,” are equipped to use their benefits effectively,
and accept their personal health and financial
management responsibilities under the program
(Exhibit 23). These companies also report that
employees are comfortable with the level of financial
risk they bear in their health plans — as noted
earlier, an important condition for employee trust
and buy-in.
48
14
Attracting the workforce we need
46
28
Keeping the people we need
45
31
Maintaining a productive workforce
39
20
Supporting workforce well-being
Finally, high performers are more confident that
their investments in employee communication have
a measurable impact in three key areas: the plan
options employees select, the way employees use
medical services and the extent to which they adopt
healthy behaviors (Exhibit 24).
33
11
Engaging employees to help the company succeed
32
12
Exhibit 23. High performance: Employees are on board
Extent to which the following are true about the company’s employees
Percent responding to a great/moderate degree
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Employees are comfortable with the level of financial risk the plan exposes them to
83
66
Employees accept their roles and responsibilities under the plan
81
61
Employees understand and use the decision support tools and other resources
available to them
63
35
Exhibit 24. High performance: Communication drives desired behaviors
To what extent have your communication activities influenced…
Percent responding to a great/moderate degree
0%
10%
20%
30%
40%
50%
60%
70%
80%
Plan options employees select
77
51
How employees use medical services
73
38
Employee adoption of healthy behaviors
59
30
20 towerswatson.com
90%
100%
Again, the data suggest that these successes would
not be possible without the deeper commitments
high performers make to workforce well-being and
the many disciplines required to build a culture of
health. So while certain best practices seem headed
for the mainstream, it’s not yet clear whether
performance will be consistently better across all
companies in our future surveys.
Health Care Reform:
High Performers Have the Edge
As this report goes to press, Congress is still
debating health care reform, and the outcome is
uncertain. If reform does pass, employers should
expect to see a new health care environment
developing in 2010 and beyond. They should also
expect to see higher company costs and increased
administrative burdens, regardless of the specifics
of the final law. Companies with clear strategies
and efficient programs will undoubtedly come out
ahead.
As an example, the proposed legislation as it
stood on January 1, 2010 included an excise
tax that would apply, beginning in 2013, to
health programs with combined health coverages
(medical, dental, vision, flexible spending
accounts, etc.) valued at more than $8,300 per
year for individuals and $23,000 for families.
Although these caps sound high, more than 50%
of the companies in our 2010 database will hit
Well-managed plans have an advantage
over time
$40,000
$30,000
Health care reform could bring complications
for retiree medical programs as well. For
example, with costs rising and federal
subsidies likely to change, the future value of
Medicare Advantage for post-65 retirees could
diminish. On the other hand, reforms in the
individual insurance market could guarantee
pre-65 retirees access to more affordable
coverage with no preexisting condition
exclusions or health underwriting. Enhanced
access could solve an important problem
employers worry about today — and potentially
give companies more flexibility in managing
their commitments to retirement benefits.
In fact, expanding access is the primary thrust
of current health care reform proposals, which
leaves critical employer concerns — cost and
quality — largely unaddressed. So for the
present, employers need to understand the
potential impact of reform, but also need to
move forward to set their strategies for cost
management, total rewards, health benefit
design and employee involvement.
Exhibit E. Proposed excise tax: A new benchmark for efficient plans
Family rates for combined coverages (e.g., medical, dental, vision, FSA)
$50,000
the caps within the next three years if current
cost trends continue. Of equal concern, the
adverse impact of the legislated caps would
likely increase over time, even with indexing on
the tax thresholds after 2013 (Exhibit E).
Tax Cap*
$20,000
$10,000
$0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Companies with combined coverages costs at the 50th percentile
Companies with combined coverages costs at the 90th percentile
*Tax cap assumes future index of 4%, medical trend 8%, dental 5%, HRA/FSA/HSA 3%.
High Performers:
Seizing Opportunities for Change
Exhibit 25. The evolving role of the employer: Today vs. 2012
Percent responding primary/large role
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Motivating employees to own the management of their health
42
72
Supporting employees’ capability to make sound health care decisions
42
65
Identifying and managing health risk/conditions in employee population
41
68
Primary/large role 2012
Primary/large role today
Exhibit 26. Health care strategy: Trends for 2012
Percent of companies responding extremely/very important
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Demonstrating the organization’s interest in employee well-being*
52
71
Demonstrating the business impact of health benefits and health-related programs
45
67
Supporting employees in managing health and wealth
38
54
Today
2012
Exhibit 27. Personalizing the health management experience: High performers
lead emerging trends
Percent of high performers responding doing/will do to a great/moderate degree
10%
20%
30%
40%
50%
60%
70%
80%
Health advocate to manage a chronic condition/serious illness
59
81
Personal health record
35
64
Lifestyle coaching
35
62
Integration of disability with medical care management
19
58
Remote biometric monitoring for chronic conditions (e.g., at home)
10
30
Today
2012
22 towerswatson.com
90%
In one of the most interesting 2010 survey
findings, the data suggest that high-performing
companies are taking current conditions —
including, for example, significant shifts in the
economy and the likelihood that health care
reform will transform the system — as an
opportunity to pursue new directions.
Recognizing the limitations of the status quo,
these companies have begun to adopt —
and plan to expand — strategy and program
changes aimed at influencing employee
behavior and decision making, coupled with
leading-edge technologies and other innovative
steps that could potentially disrupt, for the
better, current delivery models.
in the Towers Watson 2007-2008 Global Workforce Study
0%
Our surveys over the past several years have
shown a consistent and growing employer focus
on understanding employees’ health needs
and engaging them in managing their health
(Exhibit 25). Emerging trends also include a
strategic focus on demonstrating the organization’s interest in employee well-being and the
business impact of health programs (Exhibit 26).
While historically characteristic of top-tier
companies only, the consensus is that most
companies will embrace these priorities over
the next few years.
100%
Customized Health Management
Among important new directions are employer
efforts to understand and address the specific
health needs of different employee segments.
High performers are also exploring ways to
customize and personalize health decisions.
Here’s a sampling from our data on key trends:
• Personalizing care delivery for better
outcomes, including return to work. Among
important examples are the use of health
advocates to manage chronic conditions
or serious illnesses, lifestyle coaching
and integration of disability with medical
care management (Exhibit 27). While some of
these approaches are not new, the associated
disciplines and technologies — such as
experience analysis to identify gaps in individual
patient care — are pushing new frontiers in
customized health management.
• Leveraging new technologies to improve health
and engage consumers. Building on the concept
of personalized delivery, growing applications
include development of personal health records
(and related population data management tools),
with use among high performers expected to
double over the next few years. High performers in
increasing numbers also expect to adopt remote
biometric monitoring capabilities as a way to
involve employees in managing their health risks
and to improve the quality of care they receive
(Exhibit 27).
• Using social networking to increase employee
involvement. This personalized form of communication and influence is used by 11% of high
performers today, a group expected to more than
quadruple in size by 2012 (Exhibit 28). High
performers are also using blogs as a communication and connection tool today, with anticipated
application expected to grow substantially over
the next several years. E-learning is yet another
frontier that high performers are exploring today
with plans for future investments.
Exhibit 28. Trends in consumer engagement: High performers set new directions
Percent high performers responding doing/will do to a great/moderate degree
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
E-learning programs
25
55
Using social networks to impact employee health and well-being
11
42
Using blogs as a communication/connection tool
4
24
Today
2012
Exhibit 29. High performers envision expanded use of incentives
Percent high performers using/will use incentives for these activities/programs
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Health risk assessment
62
81
Health promotion programs (e.g., weight control, smoking cessation)
45
69
Wellness programs (e.g., fitness, prevention)
40
69
Biometric screenings
32
61
Care/disease management programs
25
50
Today
2012
Cisco Systems Links High-Touch
With High-Tech to Engage Employees
in Their Health
“ Since 2007, Cisco has
garnered an estimated
$37 million in annual
savings from reduced
medical claims and
increased productivity.”
Imagine attracting nearly 5,000 employees to
a health screening in a heated competition to
get their biometric screening results, hosting a
secure messaging program where employees can
conveniently communicate with their doctors via
e-mail or unveiling an on-site health center on
YouTube. These are just a few of the many ways
Cisco Systems, a leading provider of Internet
technology solutions, is engaging its employees
in managing and safeguarding their health for the
long term.
But it wasn’t always this way.
Back in 2005, Cisco Systems’ health care costs
were on the rise. And lost productivity due to a
myriad of employee health issues was hitting
the company even harder than direct medical
expenses.
Rather than pushing costs onto employees, Cisco
married high-touch with high-tech in a series of
initiatives to get employees involved. The result?
Since 2007, Cisco has garnered an estimated
$37 million in annual savings from reduced
medical claims and increased productivity.
Pressing the reset button. Cisco’s path toward
creating a healthier workplace started with a fairly
traditional approach, including an updated benefit
design, health risk assessments, brown-bag lunch
discussions, phone-based case management and
so on. The employee response? Lackluster.
“We quickly realized, if we were going to ask
employees to change their ways, we first needed
to understand their perceptions about their
health and what they would be open to,” says
Pamela Hymel, Corporate Medical Director and
Senior Director, Integrated Health, Cisco Systems.
To gauge people’s needs and preferences, Cisco
conducted online surveys, focus groups and oneon-one interviews.
24 towerswatson.com
After listening to employees’ points of view,
Cisco developed a host of programs to respond
to their needs. Take the case of health coaching,
a popular item on most employees’ wish lists.
Introduced in 2007, coaching is the most soughtafter health resource Cisco offers and serves as
an entry point for the company’s extensive disease
and condition management programs.
Leveraging existing technology. As a next step
in responding to busy employees who would
sooner pop into the ER on their way home from
work — even for minor ailments — than schedule
an appointment with their doctor, the company
partnered with Palo Alto Medical Foundation to
establish a secure messaging pilot program. Using
Internet technology, the program gives employees
a convenient, confidential way to communicate
with their doctors — and get a response within
24 hours. What’s more, the program yields an
impressive 10-to-1 return on Cisco’s investment.
Cisco also worked with its health vendors to roll
out a calendar of monthly events focused on
employees’ top medical issues. To spread the
word about these activities, the company used
cost-effective technology that employees regularly
tap into — such as podcasts, webinars, online
training courses and video-on-demand broadcasts
that ran on Cisco’s internal TV network.
By far the most popular employee campaign,
Know Your Numbers, attracted as many as 5,000
employees. Why was it so successful? Once again,
Cisco appealed to employees’ preferences — and
their highly competitive nature. Employees not
only wanted to know their own biometric screening
results, they wanted to get better numbers than
their coworkers.
Bringing the doctor to work. In its boldest move
yet, Cisco opened an on-site LifeConnections
Health Center on its main campus, in San Jose,
California, in November 2008. One of the center’s
key goals is to bring employees’ doctors to them
and use technology to make it convenient and
efficient. The center is also a petri dish of sorts
that Cisco can use to test and leverage new
technologies as part of its global business strategy
to change the way health care is delivered around
the world.
Noted for its convenience, privacy, quality care
and green design, the LifeConnections center
is unlike the world of medicine as most people
know it. Employees check in online, then swipe a
card containing all of their insurance and relevant
medical information. The entire check-in process
takes an estimated two and a half minutes. The
rest of the patient’s visit, up to 60 minutes, is
spent with a doctor in one of the center’s care
suites, which looks more like a cozy living room
than a physician’s office.
Vitals are taken and fed to an electronic medical
record. Then the patient is examined and treated
in an adjoining room while lab work is processed
in-house. If prescriptions are needed, the doctor
orders them online, and the patient picks them up
at the on-site pharmacy at the end of the visit.
Cisco’s payback. So what’s the payback for
Cisco’s ambitious efforts to engage employees
in managing their care — and their costs?
Apart from Cisco’s dollar savings in reduced
medical claims and increased productivity (the
LifeConnections Health Center is expected to
pay for itself in just two years) is the human
dividend. Forty-three percent of employees who
participate in the company’s smoking cessation
program are successful, and roughly 35% of
employees participate in health coaching. What’s
more, fully 97% of employees consider Cisco’s
online programs valuable in helping them make
significant lifestyle changes, such as improving
their diet and reducing stress.
“ The LifeConnections
Health Center is a petri
dish of sorts that Cisco
can use to test and leverage new technologies as
part of its global business
strategy to change the way
health care is delivered
around the world.”
The secret sauce for engaging employees at
Cisco? A blend of personalized, customized
solutions and high-tech delivery that’s accessible
anywhere, anytime.
Exhibit 30. Emerging trends in employee incentives
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Use of centers of excellence
24
44
Use of high-performance providers
12
32
Adherence to medication/treatment protocols
11
35
Use of evidence-based treatments
9
27
Today
2012
Exhibit 31. Influencing employee behavior: High performers make good
decisions easy and comfortable
Percent high performers responding doing/will do to a great/moderate degree
0%
10%
20%
30%
40%
50%
60%
70%
Offering on-site biometric screening
47
72
Promoting healthy foods
32
59
Applying principles of behavioral economics
24
58
Offering on-site health services
20
33
Providing access to retail clinic
17
34
Today
2012
26 towerswatson.com
80%
90%
100%
Employee Incentives
According to the survey data, high-performing
employers will, over the next few years, expand
their use of incentives to engage employees more
fully in managing their health and financial needs
(Exhibit 29, on page 23). Incentives to participate
in health risk assessments, which are already fairly
well established among high performers, will
become significantly more prevalent by 2012, with
the large majority of employers across the board
expecting to offer encouragement for participation.
Similarly, incentives to participate in health
promotion programs, biometric screenings and
wellness activities will also expand, with most
employers (led by the high performers) offering
them by 2012. High performers are also showing
an appetite for exploring how incentives can be
used to support value-based health management
approaches, such as centers of excellence, highperformance provider networks and evidence-based
treatments (Exhibit 30).
Behavioral Economics
Employers are beginning to leverage the potential
of behavioral economics to improve consumer
decisions about health and health care, with 24%
of high performers using this innovative decision
design model today and 58% expecting to do so
by 2012 (Exhibit 31). Also expected to grow are
related programs that promote good decisions and
offer convenience as an incentive, such as on-site
biometric screening, promotion of healthy foods
and access to on-site clinical services.
New Metrics for a New Vision
What employers measure offers insight into what
they value, and the survey shows that high performers
increasingly define the success of their health benefit
programs in terms of the impact these activities
have on workforce well-being, productivity and the
connections employees make between their financial
and physical health. For example, high-performing
companies expect to focus measurement efforts
increasingly on the cost of health-related absence
and disability, employee perceptions of well-being
and employee retirement readiness — all key areas
of human capital management where strategic
interventions can achieve important business results
(Exhibit 32).
Provider Incentives
One of the more surprising — and potentially transformational — survey findings is that employers
are beginning to show interest in using provider
incentives and/or penalties as a means of
encouraging new health care practices that could
improve outcomes and reduce costs. And while use
of provider incentives is evident only at the margins
today, the data suggest that employers will be
increasingly receptive to this approach, with current
use expected to triple over the next few years
(Exhibit 33).
Exhibit 32. High performers lead measurement evolution
Percent high performers responding doing/will do extensive/some measurement
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Cost of health-related absence and disability
38
65
Employee perceptions of well-being
34
60
Employee retirement readiness
31
57
Today
2012
Exhibit 33. Emerging trends in incentives for providers: Tip of an iceberg?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Positive health outcomes
6
25
Use of current or emerging technologies
6
23
Use of evidence-based treatments
6
20
Today
2012
Engaging Employees in Health Care:
Seven Simple Insights From Behavioral
Economics
“ Founded on the
premise that context
and a host of other
factors influence our
judgment, preferences and decisions,
this relatively new
but widely recognized field integrates
psychology and
economic science.”
Despite companies’ best efforts to engage
employees in managing their health and their
health care, results have been uneven. Looking
for creative ways to address the problem, a
number of organizations are designing programs
and engagement incentives based on insights
drawn from behavioral economics. Founded on
the premise that context and a host of other
factors influence our judgment, preferences and
decisions, this relatively new but widely recognized
field integrates psychology and economic science.
The following seven insights, gleaned from Towers
Watson’s research and client experience, illustrate
how behavioral economics can be applied in ways
that motivate employees to make healthier, more
cost-effective choices.
1. Prospect Theory: We hate losses more than
we love gains.
People are more motivated by the threat of loss
than by the promise of reward: We’re happy to win
$20, but much more dismayed if we lose $20. In
addition, a series of small gains (or losses) pack a
larger psychological punch than the same amount
gained or lost at once.
For example, a $100 incentive for completing
an HRA is perceived as more valuable when
presented as a gift card than when simply added
to a paycheck. Conversely, to lessen the sense of
loss, an employer making benefit cutbacks should
bundle them rather than drag them out in several
smaller takeaways.
2. Discounting: We like certainty more than
uncertainty.
In clinical experiments, subjects preferred a certain
$5 to a raffle ticket with a 33% chance of a $20
payoff. Similarly, a well-designed ABHP, coupled
with an HSA, can be economically beneficial to a
large portion of employees, yet most will select
the predictability of higher premiums and lower
deductibles and copayments, even if they end up
paying more.
28 towerswatson.com
Seen from this perspective, a variety of strategies
could reduce employees’ anxiety and resistance
(e.g., employers can “seed” HSAs, provide
periodic statements showing account balances
and offer easy-to-use tools to predict out-ofpocket costs).
3. Framing: We view economic losses or
gains in context.
People’s reactions to information differ dramatically based on how the information is presented.
For example, patients are more likely to undergo
an elective medical procedure if outcomes are
framed as “95% successful” rather than having
“a 5% failure rate.”
Because the copay system masks actual
costs and renders patients unable to make
comparisons, framing can easily sway them
toward costlier, more invasive procedures.
Employers can counter this emotional impact
by setting lower copays for high-performance
networks, providing higher coverage for
evidence-based medicine, creating structured
second-opinion programs and providing access
to objective advisors.
4. Endowment Effect: We like what’s
already ours.
People tend to overvalue what they own. For
example, employees often remain in a low-value
health plan simply because they’re used to it.
Even direct evidence such as poor quality ratings
rarely motivates people to change plans, doctors
or hospitals.
By using “choice architecture” to eliminate lowvalue options and the automatic default to the
previous year’s plan selection, employers can
encourage employees to rethink their choices.
5. Optimism: We overestimate our chance
of success.
People gamble because they deeply believe luck
is on their side. This is why most Americans don’t
purchase enough life insurance, and millions
continue to smoke and overeat.
Taking advantage of this insight, employers can
engage more employees by raffling off a
$15,000 car in a sweepstakes than by offering
a $15 incentive to 1,000 individuals. For
example, American Financial Group’s Great
Health Challenge program “motivated 73% of
eligible employees to take ownership of their
health by participating in biometric screenings,”
reports Scott H. Beeken, Vice President –
Corporate Services, Great American Insurance
Company. “We provided vivid and specific goals
and incentives — including a new Saturn Sky
convertible, shopping sprees and free health
coverage. The healthy competition and
collaboration on group goals led to people
connecting better in the workplace — and the
program’s cost was only about $10 per
employee.”
6. Fairness: We abhor anything that
appears unfair.
People will reject an offer to split $20 if their
cut is substantially less than half, even though
the net result is gaining nothing rather than
something. Why? We demand some degree of
equity with others. When employers penalize
employees for not completing an HRA or following
its recommendations, it can seem unfair and
draw negative rather than positive responses from
employees.
Fairness is a major motivator, so it can be very
effective, for example, to emphasize the (usually
higher) percentage employers pay toward patients’
more expensive prescriptions.
7. Availability: We are more motivated
by stories than statistics.
People remember powerful stories, positive or
negative. Although only about 100 people die yearly
in commercial airline disasters in the U.S. compared
to roughly 40,000 in automobile accidents, an
airline crash on national TV is far more vivid than
local newspaper coverage of automobile fatalities.
As a result, most people are more afraid of flying
than of using cell phones while driving.
Employers can use the power of narrative to
encourage positive lifestyle decisions. A “true life”
story about a CEO who commits to an exercise
program or quits smoking — communicated
through cost-effective technologies such as
YouTube, podcasts and social media — can drive
home important messages.
“ Understanding what
drives behavior can help
employers find ways to
encourage employees
to act in their own best
interests to protect and
improve their health.”
— Scott H. Beeken,
Vice President – Corporate
Services, Great American
Insurance Company
As employers have experienced in many contexts
and with health care in particular, people can be
suspicious of change and stubbornly hold onto
unhealthy and costly behaviors. Understanding
employee psychology is therefore critical. As
Scott Beeken points out, “Understanding what
drives behavior can help employers find ways to
encourage employees to act in their own best
interests to protect and improve their health. A
healthy employee is a happier, more engaged
employee — a health dividend for individuals and
the organization.”
New Frontiers
The next three to five years will be telling for many
companies. Those with high-performing health
programs will have a distinct competitive advantage
from a number of perspectives. But even the high
performers have work to do in closing the affordability gap, harnessing new health management
techniques and technologies, and influencing the
key behaviors that drive risks and costs.
Retirement readiness still looms as a formidable
challenge as access and affordability concerns
remain, and most employers (even the high
performers) lack confidence that their employees
are financially prepared. HSAs (again, even at
high-performing companies) remain undersubscribed
in terms of both enrollment and employee contributions, and other promising solutions are still largely
untried.
The time has come for creative thinking — encompassing both income and health needs along
the continuum of active employment through to
retirement. And with health care reform coming
and baby boomers on deck to retire in the next few
years, the stage is set for employers and employees
to drive the market toward better solutions that
deliver more value for individuals and businesses.
30 towerswatson.com
About the Survey
The Towers Watson 2010 Health Care Cost Survey, conducted between
August and October 2009, marks 21 consecutive years that Towers
Watson has surveyed, analyzed and reported on major trends in U.S.
employee and retiree health care costs. Participants were asked to report
their 2010 per capita premium costs for insured health and dental plans,
or premium equivalents for self-insured plans.
A total of 552 employers, with operations in numerous locations
nationwide, responded.
Respondents are primarily Fortune 1000 companies. Collectively, they
provide medical and dental benefits costing $57 billion annually to
approximately 10.3 million U.S. employees, retirees and dependents.
We are grateful to all participants in this year’s research. We believe the
findings reveal interesting marketplace trends and provide a useful guide
for organizations seeking to better manage their health care investments
and costs. For additional information on the survey results, please contact
your local Towers Watson consultant or office, or visit our website at
towerswatson.com.
Participant List*
Actuant Corporation
Aetna
Ahlstrom
Bull HN Information
Systems Inc.
Burger King Corporation
Akamai Technologies Inc.
Allina Hospitals
and Clinics
Amdocs
American Academy
of Pediatrics
Cadbury
Cameron International
Corporation
Canon USA
Career Education Corporation
American Family Insurance
Group
Central DuPage Hospital
American National
Red Cross
Amerisure Mutual Insurance
Company
AmTrust Bank
ARCADIS
Ascension Health
ASQ
Atmos Energy
Baker Hughes Incorporated
Bank of America Corporation
Central Vermont Public Service
CF Industries Holdings, Inc.
Chevron Corporation
DICK’S Sporting Goods Inc.
Fujitsu U.S.
Discovery Communications
Dow Corning Corporation
Dresser Inc.
DTE Energy
Duane Morris LLP
Gilead Sciences Inc.
Educational Testing Services
Edward W Sparrow Hospital
Einstein Noah Restaurant Group
E&J Gallo Winery
Google Inc.
Graybar Electric Company Inc.
Gulfstream Aerospace
Helix Energy Solutions
EMCOR Group Inc.
Helmerich & Payne Inc.
Henry Ford Health System
City of Austin
Emergency Medical Services
Corporation (EMSC)
City of Charlotte
Emory Healthcare
Clear Channel Communications
Emory University
Coborn’s Incorporated
ESCO Corporation
Coca-Cola Enterprises Inc.
Evangelical Lutheran Church in
America Board of Pensions
Cincinnati Children’s Hospital
Medical Center
Columbia St. Mary’s
Exxon Mobil Corporation
H&R Block Inc.
HSBC North America (U.S.)
HSN Inc.
Humana Inc.
ICMA-RC
IM Flash Technologies LLC
Corning Incorporated
Fannie Mae
Covidien
FANUC Robotics
Cracker Barrel Old Country
Store Inc.
Fifth Third Bancorp
BMC Software, Inc.
The Boeing Company
Crown Castle
Boston Scientific Corporation
CVR Energy Inc.
First American Information
Solutions Company
Botsford Hospital
Cystic Fibrosis Foundation
First National of Nebraska
Financial Times
Fluor Corporation
Broadcast Music Inc.
H.J. Heinz Company
Exel
Fairview Health Services
Broadridge Financial Solutions
Danbury Health Systems, Inc.
Forest City Enterprises
Brocade Communications
Dayton Power and Light
Company
Frankenmuth Insurance
DCP Midstream LP
Frisch’s Restaurants Inc.
Brush Engineered Materials Inc.
Golden Living
Ellwood Group Inc.
Con-way Inc.
Brown Brothers Harriman
Giant Eagle Inc.
H-E-B Grocery Company LP
Children’s Hospital of Orange
County
BASF Corporation
Blue Shield of California
Georgia Gulf Corporation
Harvard University
Connecticut Children’s
Medical Center
Belk Inc.
Genentech Inc.
Electronic Arts
Compass Group USA Inc.
Bechtel Corporation
GCI (General
Communications Inc.)
Electric Reliability Council
of Texas Inc.
Children’s Hospital and
Health System Inc.
Barrick Gold of North
America Inc.
bebe stores inc.
Frontier Airlines Inc.
Dover Corporation
CACI
American Airlines
American Management
Association
Devon Energy Corporation
Freescale Semiconductor
InSinkErator
Interactive Data Corporation
International Automotive
Components Group N.A.
Janus Capital Group Inc.
JELD-WEN inc.
Jo-Ann Fabric and Craft Stores
John Deere
Jones Lang LaSalle
Journal Communications
Joy Global Inc.
J.R. Simplot Company
*Of the more than 550 employers participanting in this year’s survey, these companies have agreed to be listed by name in our report.
Kennametal Inc.
MoneyGram International Inc.
Prometric
T-Mobile USA Inc.
KeyCorp
Motorola
Public Service Enterprise Group
Tower Automotive
Koppers Inc.
M&T Bank
The Kroger Co.
Munich Reinsurance America
TransCanada
Questar
Murphy Oil Corporation
Land O’ Lakes Inc.
Lear Corporation
Legacy Health
Mutual of Omaha Insurance
Company
MWH Global Inc.
Lifetouch Inc.
The Lubrizol Corporation
The Lutheran Church —
Missouri Synod
Rochester Institute of
Technology
Nabors Corporate Services
UNC Health Care
Sabre Holdings
Unilever
Saint Agnes Medical Center
Unisys
National Presto Industries Inc.
Sanmina-SCI
United Parcel Service
Navistar
Savannah River Nuclear
Solutions and Savannah
River Site
Universal Technical
Institute Inc.
Lydall
The New School
Noble Energy Inc.
Madison Gas & Electric
Norfolk Southern
Manpower Inc.
Northside Hospital
Marathon Oil Company
Northwestern Mutual
Marriott International Inc.
NYU Langone Medical Center
Marshall & Ilsley Corporation
Schaeffler Group USA Inc.
S.C. Johnson & Son, Inc.
Seagate
Securian Financial Group
Seton Family of Hospitals
Shands HealthCare
Shaw Industries Group Inc.
Marvell Semiconductor Inc.
OneBeacon Insurance Company
MassMutual Financial Group
OSRAM SYLVANIA
MasterCard Worldwide
Shopko Stores
Operating Co. LLC
Solo Cup Company
MDU Resources Group Inc.
PACCAR Inc
Sony Electronics Inc.
Memorial Health System
Pacific Gas and Electric
Company
Southwest Airlines Co.
Metaldyne
The Methodist Hospital
MFA Incorporated
MGIC Investment Corporation
Micron Technology Inc.
M/I Homes Inc.
Millennium Pharmaceuticals Inc.
The Ministers Missionaries
Benefit Board
Ministry Health Care
Mitsubishi Pharma America
MMG Insurance Company
32 towerswatson.com
Tyson Foods Inc.
National Gypsum
The Neiman Marcus Group
Meredith Corporation
Tyco International
National Futures Association
Luxottica
Mercedes Benz USA LLC
Twin Rivers Technologies
Manufacturing Corp.
Rotary International
Lehigh Hanson Inc.
Lennox International
RML Specialty Hospital
Trinity Health
Pearson
The Pepsi Bottling Group
PerkinElmer Inc.
Phillips-Van Heusen Corporation
Plains All American GP LLC
Stanford University
Staples Inc.
Stepan Company
PRCLLC
Preformed Line Products
Company
Presbyterian Healthcare
Services
University of Minnesota
Physicians
University of Missouri
University of Rochester
University of Texas System
Unum
UPMC
U.S. Foodservice Inc.
UT M.D. Anderson Cancer
Center
Valero Energy Corporation
Visteon Corporation
Volunteers of America —
Greater New York Inc.
STERIS Corporation
Stryker Corporation
Sutter Health
PolyOne Corporation
Praxair Inc.
The University of Chicago
Medical Center
Watson Pharmaceuticals Inc.
Westar Energy
Telcordia Technologies
West Virginia University
Hospitals
Tennessee Valley Authority
The Williams Companies Inc.
Terex Corporation
Winn-Dixie Stores Inc.
Texas A & M University System
Worthington Industries
Texas Health Resources
Principal Financial Group
Textron Inc.
Zale Corporation
ProHealth Care Inc.
TIAA-CREF
Zebra Technologies Corporation
About Towers Watson
Towers Watson is a leading global professional services
company that helps organizations improve performance through
effective people, risk and financial management. With 14,000
associates around the world, we offer solutions in the areas
of employee benefits, talent management, rewards, and risk and
capital management.
Copyright © 2010. All rights reserved.
HC011-10
towerswatson.com

2010 Health Care Cost Survey - Trustmark Voluntary Benefits

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