Employers providing health insurance to employees continue to focus on workers’ health and productivity, despite economic decline and the need to cut costs. This is good news for 2009.

2010 may be a different story, depending on the length and depth of the recession.

Hewitt’s 10th Annual Health Care Report, Challenges for Health Care in Uncertain Times 2009, surveyed over 340 employers in January 2009. 75% of employers said they planned to focus on improving employee health and productivity in the next 3 to 5 years. 19% (1 in 5) said they would stop directly providing health care benefits. This percent of employers who say they’ll back away from providing health benefits has increased nearly five times since last year’s survey — when only 4% of employees said they’d back away from providing health benefits.

In 2010, 49% of employers will reduce their health benefit plan offerings. At the same time, 40% of employers will increase adoption on consumer-driven health plans. 1 in 3 employers will also increase the use of wellness programs, and 20% will use incentive programs to nudge employees to better health habits.

Two-thirds of employers will move more costs to employees. One-half will reduce the number of plans offered to employees. 40% will increase consumer-driven plans.

3 health conditions are in employers’ disease management radar in 2009: diabetes (75%), cardiovascular (69%) and asthma (56%). Employers will intensify efforts to manage these conditions in 2009-2010 through the use of incentives and “nudge” approaches in benefit design.

Health Populi’s Hot Points: Hewitt segmented employers’ approaches to health care benefits into four buckets: the segment that’s growing fastest is the “driving stop light-to-stop light,” in which employers are seeking short-term fixes aimed at reducing medical costs. In 2008, 15% of employers took this approach; this year, 31% of employers are moving to this short-term cost-management strategy.

This survey illustrates the employer’s delicate balance between cutting short-term health costs while trying to engage and motivate workers’ personal wellness behaviors. “Employee accountability” will be the watchword: workers fortunate enough to receive a health benefit will be called up to pay more for the benefit, as well and engage more with health programs to manage existing conditions, and approaches to fending off disease and improve personal health.

In the long run, beyond 2010, health costs in the U.S. can’t be managed simply through paying attention to the resulting “costs” themselves, but to the underlying drivers of un-wellness: areas that can be prevented, such as diabesity and cardiovascular disease, along with early diagnosis, intervention, and treatment with proven therapies.