Small and large employers are becoming more aligned in what they consider important from a health insurer, but there are still gaps, according to the study. Nearly 80 percent of large employers indicate that wellness programs are important to them, compared with 57 percent of small employers. However, among small employers, wellness programs and personal health records are the two service areas that experienced the largest increase in importance among small employers since 2008.

Performance guarantees continue to be rated the least important financial service offering among large employers, dropping almost 20 percentage points in importance and satisfaction since 2008. This could indicate that employers are not getting clear value from existing performance guarantees. According to PricewaterhouseCoopers, employers need better information on their employee population to determine how to structure performance guarantees to meet their expectations for health and financial outcomes.

"Employers recognize that it's better to manage the health of their workforce than to manage the cost of illness, and they want their health plan to help manage the entire health continuum," said Paul Veronneau, principal and U.S. healthcare payer leader, PricewaterhouseCoopers, in a statement. "There is only so much insurers can do to manage health and cost through provider discounts or on the back end of a claim. This is an opportunity for health insurers to look beyond traditional strategies and get more aggressive about healthcare quality and value."

Other findings:

Administration -

• Claims processing, administrative fees and provider discounts remain among the most important basic service offerings for large and small employers, though among large employers, wellness programs surpassed provider discounts as the more important offering.

Wellness and Disease Management Programs -

• Companies that offer them are frustrated with the low level of employee participation. Seventy-one percent of companies surveyed now offer wellness programs and 67 percent offer disease management programs.
• Employee participation in wellness programs continues to hover at around 50 percent. Many employers are finding that simple financial incentives such as cash, gift cards and annual premium savings are no longer working as a way to engage employees.
• Interest in personal technology tools such as personal health records and online comparison tools is surging. Nearly half of all employers say it is important for insurers to offer these tools, but less than half are satisfied with what they are getting.

What Employers Want from Health Insurers -

• Be a consultative partner with employers to help improve workers' health and advocate for employer health strategies.
• Take a more active role in waste reduction.
• Offer better strategies for engaging employees in wellness and disease management programs.
• Provide more meaningful, actionable and higher-quality data to build workforce profiles that will help employers better understand the health of their workforce, find intervention points for better outcomes and create targeted outreach and engagement campaigns.
• Deliver consistent and transparent health benefit plan reporting.
• Provide personal technology tools for employees.
• Assist in the continuity and coordination of care among patients and physicians.
• Provide education that will simplify health plans and benefits, engage workers in real behavior change and translate benefit information into actions that promote wellness.