Employers that replaced their traditional health benefits plans with a consumer-directed health plan (CDHP) saved $21.5 million over a five-year period for every 10,000 enrollees, based on a multi-year study by Aetna of health care claims and utilization in traditional vs. consumer-directed plans it administers.
The study showed that CDHP enrollees accessed more preventive care and screenings than those with traditional preferred provider organization (PPO) coverage. In addition, Aetna's CDHP enrollees were more engaged health care consumers and continued to get the care they needed.
The study, which Aetna said is the longest-running review of CDHPs in the industry, included more than 2 million Aetna members. It compared PPO enrollees and those with CDHP plans linked to either a health savings account (HSA) or a health reimbursement arrangement (HRA).
A look at how HSAs and HRAs differ is provided in this sidebar.
When compared to PPO members, HSA members used online tools to look up cost information nearly three times as often and took a health assessment twice as often.
“Aetna has been on the forefront of the CDHP movement since the beginning,” said Aetna CEO and president Mark Bertolini. “The rising cost of health care has been a concern for companies for many years now. We have shown that by working together to engage consumers in their own care and by giving them easy-to-understand tools and actionable information, we can help companies keep their employees healthy and save money.”
While companies that switched completely to CDHPs reaped the highest cost savings, those that offered HRA and HSA plans as one option experienced savings of $9 million over five years for every 10,000 members enrolled in all health plan options.
Use of Health Care
Among other study findings, those enrolled in a CDHP:
• Spent 12 percent more on preventive care and accessed higher levels of screenings for breast and cervical cancer compared to enrollees in PPO plans. In particular, diabetics in the CDHPs accessed screenings at higher rates than diabetic members in PPO plans.
• Visited the emergency room for non-urgent care 5 percent less than members in a PPO plan.
• Used the prescription drugs to treat chronic conditions, such as diabetes, heart failure, high blood pressure and high cholesterol, at rates similar to PPO members.
HSAs Had Greatest Savings
The results showed that HSAs continue to demonstrate more dramatic savings than HRAs. HSA members had 15 percent lower primary care physician utilization for non-routine visits, which may include a cold or sore throat, 11 percent lower specialist utilization and 9 percent lower overall medical costs in 2009 compared to those enrolled in a traditional PPO plan.
The study looked at nearly 2.3 million enrollees, which consisted of 1.8 million employees whose employer offered an Aetna CDHP product but who chose a traditional health plan instead, and 498,000 CDHP enrollees. The study period extended from Jan. 1, 2002 to Dec. 31, 2009.
In addition, the study analyzed the impact of plan design on cost savings. Employers that offered plans that required increased member responsibility exhibited the best 2009 total cost trends. Specifically, those who offered Aetna CDHP plans with deductibles of at least $1,500 for individuals experienced approximately 4 percent lower total cost trend than plans with deductibles that were less than $1,000.
Stephen Miller, CEBS, is an online editor/manager for SHRM.
Consumer-Driven Decision: Weighing HSAs vs. HRAs, SHRM Online Benefits Discipline, May 2011
RAND Study: CDHPs Don't Adversely Impact 'Medically Vulnerable', SHRM Online Benefits Discipline, April 2010
Sweeping Health Plan Design Changes on Tap, SHRM Online Benefits Discipline, March 2011
HSA Participants: Savers vs. Spenders, SHRM Online Benefits Discipline, March 2011
Unexpected Boost for Consumer-Directed Health Plans, HR Magazine, December 2010
Health Savings Accounts Can Build Retirement Wealth, SHRM Online Benefits Discipline, October 2010
Future Bright for Health Savings Accounts, Says Policy Analyst, SHRM Online Benefits Discipline, September 2010
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