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Six-Year Study of CDH Plans Quantifies Employer Savings

By Stephen Miller  3/18/2009
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Health insurance firm Aetna released the results of a six-year study of health care claims and utilization for members in its Aetna HealthFund consumer-directed health (CDH) plans, showing that employers' costs were lowered when more employees enrolled in a CDH plan option and that employees who selected a CDH plan increased their use of preventive care services and reduced their use of hospital emergency rooms.

Released on March 10, 2009, the study looked at 2.6 million members across the spectrum of Aetna medical products, including 200 plan sponsors who offered a health reimbursement arrangement (HRA) and/or a health savings account (HSA), representing 410,000 Aetna members. Key findings include:

For full replacement HRA and HSA plans, employers saved $21 million per 10,000 members over the five-year period.

• Employers who offer Aetna's CDH plans as an option along with traditional health plans saved $7 million per 10,000 members over the five-year period.

• Employers who offer Aetna CDH plans as an option and implemented the strategies that Aetna identified as "best in class" saved $23 million per 10,000 members over the five-year period.

The "best in class" strategies that Aetna identified include:

• Fostering a culture where employees and senior executives are engaged health care consumers.

• Implementing a focused and continuing employee education campaign.

• Offering wellness programs and incentives for healthy behavior.

• Providing 100 percent coverage for preventive care and constructing a plan carefully with the appropriate mix of member responsibility.

Appropriate Encouragement

According to Aetna, employers are encouraging employees to enroll in a CDH plan by offering it as the lowest cost option, lowering the required premium and increasing employer-contributed funds to employees' health accounts.

One useful approach: providing employees with a tool to compare their total costs under a CDH plan vs. a traditional plan over past periods, factoring in their individual health care use and the premium and deductible levels of both types of plans.

"Consumerism in health care is about much more than a product; it is the idea that with the right mix of education, member responsibility and benefits design, you can engage members and help them make more informed health care decisions for themselves and their families," said a statement by Aetna President Mark Bertolini. The study results show that consumers in the insurer's CDH plans "sought online health information twice as often as the control population and were twice as likely to take a health risk assessment," he added.

Changed Behaviors

The results show that Aetna CDH plan members are seeking increased levels of chronic and preventive care, using generic drugs more often and accessing online tools and information at higher rates than preferred-provider organization (PPO) members, while experiencing lower annualized medical cost increases. Aetna CDH plan members had lower emergency room use than PPO members, suggesting that members are becoming better informed about where to access health care.

Specifically, Aetna CDH plan members:

• Seek preventive care more often than the control matched PPO population. Aetna CDH plan members had 10 percent lower primary care physician utilization for nonroutine services and 15 percent lower utilization of specialist care.

• Access the same or higher levels of screenings for diabetes and breast and cervical cancer, compared to members in traditional PPO products.

• Utilize the prescription drugs necessary to treat chronic conditions such as diabetes, congestive heart failure, coronary artery disease and high cholesterol at similar or higher rates than PPO members.

• Use consumer tools and information — including searching for health information and using the cost of care tools available through the insurer’s web site — at twice the rate compared to PPO members.

Commented Alexander Domaszewicz, a health care lead consultant with Mercer, "The study reinforces the evidence we've seen emerge throughout the decade, that strategies such as encouraging employee financial responsibility, offering robust coverage for preventive care and providing a full suite of online tools and information help employers achieve cost savings, promote a healthier workforce and still meet plan sponsor attraction, retention and employee satisfaction goals. We need to recognize, however, that many employees need high-touch outreach and face-to-face support when they face complex illnesses. The ideal strategy when implementing consumer-directed health plans combines all of these approaches in the right way."

Stephen Miller is an online editor/manager for SHRM.

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SHRM Online Benefits Discipline

Related Articles: 

Most Workers Underestimate Employer's Health Benefit Costs; Value 401(k) MatchesSHRM Online Benefits Discipline, March 2009

U.S. Employers Less Confident in Future of Health Benefits, SHRM Online Benefits Discipline, March 2009

Curtailing Health Spending, Promoting Wellness, Remain Priorities, SHRM Online Benefits Discipline, March 2009

HSAs and Preventive Care, SHRM Online Benefits Discipline, September 2007 

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