Reshaping Health Care and DeliveryOver the next five years, the vast majority (92%) of employers anticipate at least modest change in health care, while nearly half of employers expect a significant or transformative change. More specifically, 49% expect more health care price transparency, and 45% expect to see new access points for health care delivery such as telemedicine, e-visits and data-enabled kiosks. And 39% are expecting providers to be reimbursed based on improvements in quality, efficiency and health outcomes. Employers are also looking at new options such as exchanges for active employee and retiree populations. Nearly 30% of employers are already facilitating access to an exchange-based solution for retirees in 2013, with another 36% planning to do so over the next three years. The outlook for active employees is a bit different. Eighty-two percent said it is not at all likely that their organization will direct active employees to an exchange without a subsidy in the next five years, and 60% said the same, even with a subsidy. “Now that the Supreme Court decision and 2012 elections are behind us, employers are moving forward with new supply-side strategies for the post-reform world,” said Helen Darling, president of the National Business Group on Health. “While employers look to integrate the development of exchanges, new networks and vendor performance into their strategies, they must also keep their focus on employee accountability, engagement and health.” Accountability and Engagement Currently, 66% of respondents offer an account-based health plan (ABHP), and that number is expected to increase to 79% in 2014. Nearly 15% of respondents with an ABHP now use a total-replacement ABHP, up from 7.6% in 2010. Over the same period, median enrollment in ABHPs nearly doubled, surging from 15% in 2010 to nearly 30% in 2013. These enrollment patterns underlie a fundamental evolution in ABHPs as employers increasingly use them to embed incentives and align with postretirement strategies.