Consumer-Driven Health Plans Showed Continued Growth in 2011

By Stephen Miller, CEBS Dec 15, 2011

Enrollment in consumer-driven health plans (CDHPs) continued to grow in 2011, according to the 11th annual EBRI/MGA Consumer Engagement in Health Care Survey. In 2011, 7 percent of the U.S. adult population was enrolled in a CDHP, through a group plan or individual policy, compared with 5 percent in 2010.

The survey of 4,703 privately insured U.S. adults ages 21–64 was sponsored by the not-for-profit Employee Benefit Research Institute (EBRI) and Mathew Greenwald & Associates (MGA). The survey report was published in the December 2011 EBRI Issue Brief, “Findings from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey.”

Adult Coverage by Type of Health Plan: 2006 vs. 2011

(private-sector group health plans and individual policies)

2006

2010

2011

Tradition health plan with individual deductible less than $1,000 (individual) or $2,000 (family).

92%

82%

78%

High-deductible health plan with deductible of at least $1,000 (individual) or $2,000 (family), but no account.

7%

14%

16%

Consumer-driven health plan with deductible of at least $1,000 (individual) or $2,000 (family), with account.

1%

5%

7%

Source: 11th annual EBRI/MGA Consumer Engagement in Health Care Survey, EBRI Issue Brief, December 2011.

During the last decade, in response to rising health costs, employers have turned their attention to CDHPs, which typically combine health plans with deductibles of at least $1,000 for employee-only coverage with a tax-preferred savings or spending account—such as a health savings account (HSA) or health reimbursement arrangement (HRA)—that workers and their families can use to pay out-of-pocket health care expenses.

Account-based health plans first appeared in 2001, when a small number of employers began to offer employer-funded HRAs. In 2004, employers were able to start offering health plans with HSAs, funded by employers, employees or both. (To learn about the differences in these approaches, see the SHRM Online article "Consumer-Driven Decision: Weighing HSAs vs. HRAs.")

Overall, 15.8 million U.S. adults ages 21–64 with private insurance were in a CDHP or a high-deductible health plan that was eligible for an HSA in 2011, according to the survey. When their children are included, about 21 million individuals with private insurance, representing about 12 percent of the market, were in a CDHP or an HSA-eligible plan.

Cost Conscious Behavior

As previous versions of the EBRI/MGA survey have found, the 2011 findings suggest that those enrolled in CDHPs tend to have different characteristics than those in traditional health plans. They were somewhat more cost conscious; were more likely to try to find information about their medical service provider's cost and quality from sources other than the health plan; and were more likely to take advantage of a health risk assessment.

Among key survey findings:

More focused on costs and quality.Individuals in CDHPs were more likely than those with traditional coverage to exhibit a number of cost-conscious behaviors. They were more likely to say that they had:

Checked whether their plan would cover care.

Asked for a generic drug instead of a brand name.

Talked to their doctor or other health care provider about treatment options and costs.

Talked to their doctor about prescription drug options and costs.

Developed a budget to manage health care expenses.

Checked the price of a service before getting care.

Used an online cost-tracking tool.

More engaged in wellness programs.CDHP enrollees were more likely than traditional plan enrollees to report that they had the opportunity to fill out a health risk assessment, and they were more likely to report that they had access to a health promotion ("wellness") program.

More responsive to financial incentives.When it comes to participating in wellness initiatives, CDHP enrollees were more likely than traditional plan enrollees to take advantage of a health risk assessment but not necessarily the health promotion program. However, when offered a cash incentive or reward to participate in a health promotion program, these financial incentives were more likely to be a factor for CDHP enrollees than for traditional plan enrollees.

Another View: CDHP Growth as Percentage of Employer Plans

In a survey, HR consultancy Mercer revealed that 2011 saw the biggest increase ever in the adoption of high-deductible, account-based CDHPs by large U.S. organizations:

A CDHP was offeredin 2011 by 32 percent of all employers with 500 or more employees, up sharply from 23 percent in 2010.

The largest employers were the most likely to offer a CDHP (47 percent of those with 10,000 or more employees did so).

Among small employers,CDHP use grew as well, from 16 percent to 20 percent of those with 10-499 employees.

Overall, 13 percent of all covered employees were enrolled in a CDHP. Enrollment growth has been rapid—five years earlier, CDHPs enrolled just 3 percent of covered employees, according to Mercer.

To learn more about this survey, see the SHRM Online article "Employers Accelerate Efforts to Control Health Costs."

Stephen Miller, CEBS, is an online editor/manager for SHRM.​

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