The cost of employee health benefits in 2012 grew just 4.1 percent nationally, the smallest increase in 15 years.

The National Survey of Employer-Sponsored Health Plans, conducted annually by Mercer, said Wednesday that cost growth slowed this year from 6.1 percent in 2011.

A subset survey of 50 Kansas City area employers found a 4.3 percent increase this year, but the average per-employee cost of health benefits locally was $10,180, or 3.6 percent below the national average cost of $10,558.

Employers have “taken bold steps to soften the impact” of the Affordable Care Act in 2014, said Julio Portalatin, Mercer chief executive.

“Employers are very aware that in 2014, when the health reform law’s provisions kick in, they will be asked to cover more employees and face added cost pressure,” Portalatin said.

The cost controls came by moving employees into consumer-directed health plans or employee wellness plans or by changing benefit plans. Switching plans was more common among smaller employers.

Consumer-directed health plans — including Health Savings Accounts and Health Reimbursement Arrangements — are high-deductible benefit plans in which employers contribute a defined amount into employees’ individual spending accounts for the employees to buy routine health care services.

“If we’re not already at the tipping point for consumer-directed health plans — and we may well be — at this rate of growth it’s coming soon,” said Mark Whiting, a principal in Mercer’s Kansas City office.

Twenty-two percent of all employers offer consumer-directed plans, and the percentage leaps to 59 percent among the largest employers.

An employer’s cost of coverage in a typical consumer-directed plan is about 20 percent lower than the cost of providing employee access to a more traditional Preferred Provider Organization plan, the Mercer report said.

Nearly half of employers, 45 percent, said they now had or were considering using a defined contribution plan that would require their employees to pay anything above the employer’s set contribution.

Whiting said he was most struck by a counterintuitive finding by the survey: Health care cost increases for employers with fewer than 500 employees were lower this year than for larger employers.

The survey found employers expecting an average cost increase of 5 percent in 2013, largely because they are continuing to make plan changes. Area employers expect a 4.2 percent rise and more plan changes.

Looking ahead to 2014 and beyond, relatively few employers who offer employee health benefits said they were likely to terminate coverage.

The health care reform law is designed to assess a $2,000-per-employee penalty against employers who have 50 or more employees and don’t offer qualifying plans to eligible employees. Some employers already have said paying the penalty will be far cheaper than paying for health benefits.

“Just 7 percent of large employers and 22 percent of small employers (those with 10-499 employees) believe it is likely or very likely that they will do so,” the report said.

What’s also expected is a continued move toward employee wellness plans. Even though proving a return on investment has been difficult, most employers said that initiatives to improve their employees’ “health-conscious behavior” were valuable.

“For the third year in a row, there was a sharp increase in the use of incentives or penalties to encourage higher participation” in wellness plans, the report said.

The most common incentive for employees to participate in health assessment, exercise and diet programs was a reduction in the employee’s premium contribution. That median annual reduction for employee-only coverage was $260.

Also looking ahead, the survey found more than half of employers were looking for another cost-management strategy — banding together in private-sector health insurance exchanges, an alternative to Obamacare’s federal or state exchanges.

These private exchanges “give employers a way to offer employees a broader choice of benefits while allowing carriers to compete for their business and manage their risk,” Mercer said.