With changes in healthcare laws presenting lots of questions and few answers, employers have to weigh every aspect of the cost of employee benefits.

Healthcare reforms will roll out incrementally over the next few years and businesses don't yet know how it will affect their cost structure and how care is delivered.

Tom Colvin, executive vice president of benefits at Schiff, Kreidler-Shell downtown says premiums will go up in the next year and lower costs won't be realized for three to five years, if at all.

As the cost of benefits soars, many businesses have made managing costs a shared responsibility, working more closely with employees on what benefits, such as disability or dental insurance, they want most and what they're willing to give up to get it.

Thinking longterm has never been more important.

Unemployment locally and across the country is hovering at 10 percent. But that doesn't mean smart managers aren't taking steps today to make sure that their workers are statisfied, creating benefits packages that may not necessarily include pay raises while business is slow but still demonstrate an appreciation for talent.

"As we start to come out of this recession, top workers are going to be a commodity that other employers will want to offer positions," Colvin says.

"In this economy, what employers have to do with their benefits programs is find out what employees want. I think that's critical to our employee base."

According to a Merrill Lynch survey in July of affluent workers, pay and promotions top the list of what they want out of an employer, followed closely by healthcare benefits and simply enjoying what they do.

Having a good boss, a convenient commute and flextime are also important.

Interviews with a variety of Greater Cincinnati businesses indicate a common theme of evolving benefits packages that try to address needs beyond a bigger paycheck, including more employee choice in healthcare plans and programs to encourage healthy lifestyles to ensure productive employees while possibly trimming costs related to unhealthy habits.

Balancing family, work

Flextime: Sheakley Group, the Fairfield-based human resources and employee services company, established flextime that allows parents to pick up children from school, spend time with an elderly parent or take care of any other obligations that may occur during business hours.

"One of the things that employees are concerned about is life balancing, making sure that they can take care of their families and also hold a job," says Eleni Liston, Sheakley vice president of human resources.

In most divisions of the 552-employee company, which also handles human resources for another 500 workers at other companies, workers have the option of working four 10-hour days.

Schiff Kreidler-Shell appreciates employees' ability to work outside of the office, taking advantage of mobile phones and laptop computers. "I think they are more tech-savvy and feel that they can be just as efficient wherever they may be," Colvin says. "I think a lot of employers are trying to be flexible to meet employees' needs. Whether that means flex hours or working from home, those are all very important to workers nowadays."

Kroger employs workers whose ages and circumstances run the gamut. The Cincinnati-based grocer makes it work to the advantage of the company and the employees.

"We have many associates who want to work part time to accommodate their personal needs," says Rachael Betzler, a Kroger spokeswoman. "We have a portion of our associate population who are attending school, and have other commitments in which part-time work schedules allow for the flexibility they require. Other associates, who are focused on working full-time, maintain 40-hour per week schedules."

That flexibility allows teenagers to pick up temporary work at Kroger or begin a long career there. "This works well for our associates, especially with the amount of under-18-year-olds we have on staff. In fact, 58 percent of our new hires are under the age of 18," Betzler says.

Managing costs

Health, Life and Disability Insurance: Skyrocketing healthcare costs are nothing new to businesses, but many are trying to manage costs by putting more spending power into the hands of their workers.

"At Sheakley, we are one of the companies that led the way in high-deductible plans," Liston says. "We've developed a consumer-driven program in which employees can help determine where and how they can spend their money. We're educating them, giving them sites where they can look up options so that they can take a major role in how that money is being spent."

Colvin, who advises clients on healthcare issues as well as managing Schiff Kreidler-Shell's in-house healthcare planning, says businesses are grappling with another year of steep healthcare cost increases despite the passage earlier this year of healthcare reform. Cost savings may materialize as more of the reforms are implemented within three to five years, he says, but in the meantime, it's up to companies and workers to shop for the best price.

Providing the tools

"We give them internet tools where they can research pricing of medicines and MRIs. Most employees are very internet-savvy and they like having the information," he says.

Colvin says employees actively participate through surveys and other feedback to fashion their healthcare packages. The goal is to create coverage that best suits workers' needs with the added benefit of helping them understand how much it costs and how difficult the choices are.

"There are only so many ways you can slice the pie, and we want to provide what you want. If you're willing to have higher out-of-pocket expenses when you use the health plan in exchange for life or disability insurance, that's what we'll provide," he says.

While many companies have apportioned a greater share of healthcare costs to employees, Procter & Gamble has consistently held the line on sharing the burden.

"As healthcare costs increase, both P&G and the employees see the same percentage increase in costs. P&G has not been shifting more of the increase to employees," says Robyn M. Schroeder, a P&G spokeswoman, noting that the company pays 75 percent of healthcare costs.

Kroger, which has unionized workers, uses top-notch healthcare benefits to its advantage. "In the Cincinnati Dayton marketing area, our associates have access to healthcare benefits that are competitive. Our associates' healthcare plan is more generous than many of our competitors," Betzler says.

Wellness: Healthy workers need more than insurance to stay that way, and companies are finding investing in fitness center plans and wellness programs to create a win-win scenario: healthier, happier and more productive workers.

"It's important for workers to cope well with personal life. We offer employee assistance programs for counseling and also quarterly seminars on issues like coping with teenagers, job loss, how to get through the holidays for those who have lost loved ones, and how to cope with divorce," Sheakley's Liston says.

Sheakley also offers discounted memberships to Mercy hospitals' fitness centers, free mammograms and even occasional visits from massage therapists.

Colvin says 50 to 75 percent of healthcare spending is related to controllable lifestyle choices including obesity and smoking.

"Stress wellness for employees and families because human resources is the most expensive cost for running a business. As long as you don't make it intrusive, wellness can be a very successful strategy because you really are concerned about their wellbeing," he says.

P&G shares that philosophy. "We have increased our focus on improving the overall health of our employees and their families through wellness initiatives with cash incentives. For example, Blueprint for Healthy Living is a voluntary program that helps to assess an employee's health and offer goals or programs on how to improve it," Schroeder says.

Recognition: It's also the little things that may boost morale and loyalty, like Sheakley's "I Did It" award, a play on the company's "It's Done" slogan, in which workers are very publicly recognized. "We literally walk up to that person's cubicle and make an announcement to let their peers know that that they've gone above and beyond," Liston says.

It all adds up to attracting and retaining the best employees, Colvin says, regardless of the economy.

"As an optimist, I believe we will come out of this (lackluster economy), and I think that employers who have prepared their employees all along will have the best opportunity to keep them," he says.