CDHP Enrollees Are Cost-Conscious, Use Wellness Programs

By Stephen Miller Dec 4, 2009

Americans in account-based consumer-driven health plans (CDHPs)—a health savings account (HSA) or a health reimbursement arrangement (HRA)—are more likely than those with traditional coverage to exhibit a number of cost-conscious behaviors, to be engaged in wellness programs, and to think that financial incentives matter in holding down costs, according to an analysis by the not-for-profit Employee Benefit Research Institute (EBRI).

But while CDHP enrollees were more likley to take cost into consideration when selecting health services and to avoid unecessary over-utilization, EBRI found that satisfaction levels for individuals in traditional health plans remained higher in 2009 than for those in consumer-driven plans. (For tips on crafting effective communications that address employee concerns regarding CDHPs, see Consumer-Driven Health: Communicating CDH Plan Designs.)

The findings are from the 2009 EBRI/MGA Consumer Engagement in Health Care Survey. Conducted annually over the past five years, the survey looks at the growth of CDHPs and high-deductible health plans (HDHPs) and the impact of these plans on participants' behavior and attitudes. Findings from the 2009 survey are compared with earlier surveys and appear in the December 2009 EBRI Issue Brief.

As before, the survey found that the health, income and education profiles of consumer-driven plan participants were different from those of traditional plan enrollees: People who are younger, healthier, higher-income, and better educated than others are more likely to be in consumer-driven health plans.

In theory, CDHP incentives are designed to promote heightened sensitivity to cost and quality in individuals’ decisions about their health care, the reportsays. Thus, account-based plans, and plans with higher deductibles, feature cost-sharing as a tool that will be more likely to engage individuals in their health care than persons enrolled in more traditional health insurance coverage.

Cost-Conscious Behavior

The survey found noticeable differences in behavior among participants in CDHPs vs. those with traditional coverage, as shown below.

Consumer-Driven Health Decisions

Individuals in consumer-driven health plans (CDHPs) in 2009 were more likely than those with traditional coverage to say that they had:

Among those enrolled in CDHPs

Among those with traditional coverage

Checked whether the plan would cover care.



Asked for a generic drug instead of a brand name.



Talked to their doctor about prescription drug options and costs.



Talked to their doctor about other treatment options and costs.



Asked their doctor to recommend a less costly prescription drug.



Developed a budget to manage health care expenses.



Checked the price of service before getting care.



Source: EBRI

Wellness Program Engagement

CDHP enrollees were more likely than traditional plan enrollees to take advantage of a health risk assessment and to participate in a health/wellness promotion program:

Slightly more than 70 percent of CDHP enrollees participated in a health risk assessment, vs. 56 percent of traditional plan enrollees.

53 percent of CDHP enrollees participated in a health or wellness promotion program, vs. 42 percent among traditional plan enrollees.

In addition, 41 percent of CDHP enrollees reported that their employer offered a health risk assessment, vs. 31 percent of traditional plan enrollees and 22 percent of enrollees in a high-deductible insurance plan without an HSA or HRA.

Cost-Sharing Incentives

CDHP enrollees were more likely than traditional plan enrollees to consider the impact of cost-sharing incentives when selecting health service providers, EBRI found. For example, to acheive lower cost sharing, 31 percent of CDHP enrollees would change to doctors who used health information technology vs. one-quarter of traditional plan enrollees. CDHP enrollees also would be more likely than traditional plan enrollees to switch to a doctor who used e-mail to deliver lab tests, allowed the individual to schedule appointments online and answered patient questions via e-mail.

Overall, about 60 percent of CDHP enrollees, and 50 percent of traditional plan enrollees, would change to doctors using health information technology.

Other Findings

Traditional plan enrollees were more likely than CDHP and HDHP enrollees to be extremely or very satisfied with the overall plan in all years of the survey. Differences in satisfaction with out-of-pocket costs might explain a significant portion of the difference in overall satisfaction rates among traditional plan, HDHP and CDHP enrollees.

Adults in CDHPs were significantly less likely to have a health problem than were adults in HDHPs or traditional plans. They were significantly less likely to smoke than were adults in traditional plans and were significantly more likely than those with traditional health coverage to have a high household income and to be highly educated.

The 2009 EBRI/MGA Consumer Engagement in Health Care Survey is based on a survey of 4,226 privately insured adults ages 21–64. The survey was conducted within the U.S., Aug. 8-20, 2009.

Stephen Miller is an online editor/manager for SHRM.

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