According to the Employee Benefit Research Institute, participation in account-based healthcare plans remains low, but continues to grow: 22 million Americans are currently enrolled in consumer-driven health plans (CDHPs) or high-deductible health plans (HDHPs), according to EBRI’s latest annual Consumer Engagement in Health Care Survey.
Enrollment in CDHPs rose to 5 percent of the privately insured population in 2010, up from 4 percent last year. Enrollment in HDHPs, meanwhile, rose to 14 percent of the privately insured population, up from 13 percent in 2009. (CDHPs are high-deductible plans paired with a tax-favored health-savings account; HDHPs are plans with deductibles of at least $1,000 that are either not paired with an HSA or in which enrollees have elected not to sign up for an HSA.)
Perhaps not surprisingly, given the higher deductibles that enrollees in CDHPs and HDHPs must pay, they tend to exhibit more cost-conscious behaviors than their counterparts enrolled in traditional healthcare plans: 51 percent of CDHP enrollees and 50 percent of HDHP enrollees ask for a generic drug instead of a brand name, compared to 44 percent of employees in traditional plans.
CDHP enrollees are also more likely to participate in health-risk assessment programs and are more likely to choose doctors based on whether they use health-information technology such as electronic health records, according to the survey, which queried 4,509 adults between the ages of 21-64 with private health insurance coverage. They also tend to exhibit healthier behaviors (not smoking, exercising) than their counterparts in traditional plans, the survey found.
The last part, about CDHP enrollees being healthier, struck me as hardly surprising: After all, the conventional wisdom has been that healthier employees are more likely to choose these types of plans because they’re less likely to need healthcare services—and therefore less likely to be put off by those high deductibles. But the EBRI’s Paul Fronstin says that’s not necessarily true.
“Many employers, especially small businesses, offer only one plan, so in many cases employees enroll in a CDHP because that’s the only option,” he says.
More importantly, despite those high deductibles, CDHPs can be structured in such a way that employees can actually save a bit of money compared to a traditional plan, he says.
“Plan design drives peoples’ behavior,” he says. “Employers can actually make it easier for employees to choose a CDHP over a traditional plan. For example, if you offer a CDHP with a $2,400 annual deductible for an employee and their spouse, with very low monthly premiums, and a traditional plan with a much lower deductible but monthly premiums of $200, the CDHP could be the better deal, especially if the employer ‘seeds’ the HSA with $1,000 or so.”
According to the EBRI, 61 percent of employers that offer CDHPs contribute $1,000 or more to each employee’s HSA for family coverage; for employee-only coverage, 28 percent of employers contribute $1,000 or more.