Employers are implementing bolder health care program changes in preparation for health care reform and cost challenges, a new survey says.

The most systemic changes in decades will hold employees and providers more accountable for managing costs and improving worker health, according to the 16th Annual Towers Watson/National Business Group on Health survey. These changes are designed to control the impact of rising costs on employers’ total rewards offerings and guard against reform penalties, the survey said.

“Health care benefit managers have historically been focused on making incremental plan design changes,” said Randall Abbott, a senior health care consultant with Towers Watson, in a statement. “When confronted with the post-reform health care landscape, employers are now considering sweeping changes to their health benefit and workforce health improvement strategies. Increasingly, this is a focus of the executive suite, which is accelerating the discussion.”

The survey indicated that to mitigate costs and minimize health care reform’s long-term impact, employers are redesigning health benefit programs to incorporate enhanced point-of-care consumerism; repositioning incentives to improve employee engagement; redefining their financial commitment to dependent and retiree coverage; and emphasizing use of high-value providers.

About 68% are moving to increase contributions for dependents, with 19% targeting per-dependent contributions, and 35% using or planning to implement spousal waivers or surcharges, the survey found.

Exactly 26% of employers plan to cease employer sponsorship; 25% plan to convert a current subsidy to a retiree health account; and 23% plan to eliminate employer-managed drug coverage for post-65 retirees and rely on Medicare Part D plans, the survey showed.

The survey said 28% of employers plan to differentiate cost sharing for high-performance networks or centers of excellence in 2012, and 21% plan to adopt value-based designs over the next year.

A third of employers plan to reward or penalize their employees based on biometric outcomes (for weight and cholesterol), compared to 6% in 2010, the survey reported.

The survey was completed by 588 employers between November 2010 and January 2011. Respondents collectively employ 9.2 million full-time employees and have 7.8 million employees enrolled in their health care programs, equating to a collective $81 billion in total health care expenditures.