For the past several years, employers have wrestled with how to control health care costs while also ensuring employee satisfaction with their benefits in an increasingly competitive market. While previous strategies have included shifting health care expenses onto employees via higher premiums and deductibles, employers in 2019 applied a new approach: diversifying benefits options to provide employees with the personalized care they need.

DirectPath's 2019 Medical Trends and Observations Report, based on an analysis of more than 1,000 employee benefits plans from nearly 200 companies and created in collaboration with Gartner, shows a clear effort by employers to diversify health plan options, offer more voluntary benefits and encourage and reward employee participation in a broader host of wellness programs.

Here's a look back at the top benefits strategies employers used to reduce costs and increase employee satisfaction in 2019.

Diversified health plans 

The showed that employers offered more — and more creative — plans in 2019 in response to employees' demand for choice. Employers in general offered a selection of health plans, enabling employees to choose the best option for their personal circumstances. This trend underscores how important benefits are for talent attraction and retention. Particularly with today's workforce, comprised of so many different generations and priorities, "choice" has become the operative word for employer-sponsored benefits plans.

In addition to offering more plans, a number of employers explored some new approaches. For example, some offered a cafeteria-style plan in which employees had a specific dollar amount to spend on the coverage of their choice, or the ability to combine a core medical plan with "add-on" coverage for specific treatments on an as-needed basis.

By offering tailored health care plans, employers in 2019 seemingly aimed for enhanced employee satisfaction with benefits, and consequently, their jobs. This, in theory, helps overall productivity. In this way, diversified strategies can go beyond controlling just health care spend; they can positively impact businesses' bottom lines, too.

Growing voluntary benefits

Employers expanded voluntary benefits offerings in 2019, perhaps because Millennials and Gen Z employees — who now represent a large portion of today's workforce — appear to be more focused on work-life balance. For example, the report revealed an increase in family-friendly benefits, with 19 percent of organizations offering adoption assistance and 7 percent offering back up childcare, as well as financial wellness checks (7 percent), legal services (46 percent) and identity theft protection (25 percent).

Still, "standard" voluntary benefits remained popular, with most employers offering dental and vison (75 percent), supplemental life insurance (75 percent) and accidental death and dismemberment insurance (60 percent).

Voluntary benefits are valuable because they enable employers to fill perceived coverage gaps without incurring additional costs, allowing employees to tailor a benefits package that meets their individual needs.

HDHPs holding steady

In 2019, high deductible health plans (HDHPs) represented 41 percent of plans offered, up from 30 percent in previous years. That said, because employers offered more plan options in 2019 overall, this does not imply that they are relying more on HDHPs; rather it is one of many plan types available to employees.

Of the employers offering an HDHP option, 51 percent offered one or more tax-advantaged accounts to offset those high deductibles. Health savings accounts (HSAs) were by far the more popular offering. Seventy-nine percent of employers offering HDHPs also offered HSAs, up from 51 percent last year. This growth may be in recognition that employees need assistance with managing their health care costs, and such assistance has become "table stakes" in the current competitive market. Alternatively, 21 percent of those employers offered health reimbursement accounts (HRAs).

Related: HDHP enrollees are better-informed, but they're still skipping care

While employers' base contributions to tax-advantaged accounts decreased in 2019, many employers are balancing this decline with more opportunities for employees to "earn" additional contributions by becoming more engaged in their health and in corporate wellness initiatives.

Higher focus on wellness

In 2019, 40 percent of the employers in DirectPath's database sponsored wellness programs. Traditional wellness activities remained the most popular, including biometric screenings, health risk assessments and tracking tobacco usage. That said, a number of employers also rewarded employees for activities reflecting a broader interpretation of "wellness," including:

• getting dental check-ups
• obtaining a second opinion on health procedures
• using a center of excellence
• donating blood
• volunteering in the community

In addition, the 2019 report found that the most popular "reward" for participation in wellness initiatives was additional contributions to employee HSAs or HRAs. This strategy could help drive enrollment in HDHPs and/or offset lower base contributions to those tax-advantaged accounts. Other employers included "points" that employees could accumulate over the course of the year and redeem for prizes — or even provided limited access to certain health plan offerings to the employees who complete wellness tasks.

With the end of the calendar year approaching, employers are evaluating the outcomes of their 2019 plan design changes while simultaneously rolling out their offerings for 2020. Organizations should include an assessment of how successful their communications strategy for the year has been. The success of that strategy in achieving desired metrics (e.g. improved or increased appropriate plan usage, enrollment in more cost-effective plans, engagement in wellness programs and interest in voluntary programs) can inform next year's decisions about plan design and determine communications efforts for the year ahead.

Kim Buckey is VP of Client Services at DirectPath.