A recent Hewitt Associates report finds that when it comes to health care benefits, employers aretaking a more long-term view by focusing on programs with an eye on improving employee health and productivity.According to Hewitt's "2009 TRA Emerging Health Trends Survey Report," promoting employee accountability is the number one health and prevention component of organizations' health care strategies in 2009. Offering competitive benefits and managing health risk rounded out the top three strategies at 86% and 71%, respectively. In addition, beating out the current economic crisis as a top business issue in 2009 is managing health care cost. Keeping employees healthy has become the primary workforce issue in 2009 impacting an organization's approach to health care benefits up from the number two position in 2008.With employers equating employee behaviors and health risks with cost, there has been a shift in focus from managing cost to managing health risk as a cost driver. Some 57% of respondents offer incentives to engage employees to purchase and use health care in a bid to motivate employee actions that will result in net savings. To that end employers are using a variety of tools, resources and approaches to manage cost and promote employee accountability.Most employers are focusing on conventional and progressive approaches to address the costs related to their health care plans. The survey finds that 65% of companies plan to shift more costs to employees; 49% plan to reduce the number of benefit plans; 33% plan to increase their focus on wellness programs; and 40% plan to increase the prevalence of consumer-driven health care plans.According to Hewitt consultants, looking ahead employers must fundamentally change the demand for health care services while rewarding those who act now to take good care of themselves. Here is a look at the other survey findings.