Consumer-Driven Plans Are Now Second Most Common Design

Plans that motivate employees to actively manage their health care spending gain traction

By Stephen Miller, CEBS Sep 20, 2012

Consumer-driven health plans (CDHPs) have surpassed health maintenance organizations (HMOs) to become the second most common plan design offered by U.S. employers, according to survey findings released in September 2012 by HR consultancy Aon Hewitt.

The late 2011 survey of nearly 2,000 U.S. employers representing over 20 million U.S. employees and their dependents found that 58 percent of employers offered a CDHP, 38 percent offered HMOs, 15 percent offered POS plans and 5 percent offered indemnity plans. Preferred provider organization (PPO) plans continued to be the most widely offered plans, with 79 percent of employers offering them.

Prevalence of Plan Types

PPO plans

79% of employers





POS plans


Indemnity plans


Source: Aon Hewitt.

Among employers that offer CDHPs, the survey showed that health savings accounts (HSAs) now outpaced health reimbursement arrangements (HRAs) by nearly two to one, with 34 percent of employers offering an HSA and 18 percent offering an HRA, while 6 percent offered high-deductible plans without a company-sponsored account.

CDHP Plans by Type

High-deductible CDHPs with health savings accounts (HSAs)

34% of employers

High-deductible CDHPs with health reimbursement arrangements (HRAs)


High-deductible CDHPs without a company-sponsored savings account


Source: Aon Hewitt.

Large employers, however, were more likely to offer HRAs—which are employer-funded and nonportable (to learn more, see the SHRM Online article "Consumer-Driven Decision: Weighing HSAs vs. HRAs").

Employers reported that the year over year cost increase for CDHPs was 6 percent—which was 2 percent lower than the cost increase trend for HMOs and 1 percent lower than for PPO plans—helping to fuel the shift.

Cost Increase Year Over Year

HMO plans


POS plans


PPO plans


Indemnity plans


High-deductible CDHPs without a company-sponsored savings account


High-deductible CDHPs with health savings accounts (HSAs)


High-deductible CDHPs with health reimbursement arrangements (HRAs)


Source: Aon Hewitt.

"Consumer-driven health plan designs are becoming increasingly popular among employers because they provide [employers] with a vehicle for promoting consumerism and a framework for educating and motivating employees to actively engage in understanding and managing their health," said Maureen Fay, vice president and head of Aon Hewitt's CDHP working group.

Employees Satisfaction with CDHPs Is Up

Concerning Americans' overall satisfaction with employer-provided health coverage, traditional-plan enrollees were more likely than consumer-directed health plan enrollees to be extremely or very satisfied with the overall plan. However, satisfaction levels have been trending up among CDHP enrollees, and trending down among traditional-plan enrollees, according to a new report by the nonprofit Employee Benefit Research Institute (see the SHRM Online article "Satisfaction Levels Up for CDHPs, Down for Traditional Plans").

Communication Is Critical for Successful Rollouts

"Employees want to choose the most cost-effective plan with the least hassle, but they often have very full lives and are not all that interested in digging into the details of CDHPs, HSAs and HRAs," said Joann Hall Swenson, partner and health engagement best practice leader at Aon Hewitt. "Our research and experience tells us that simply giving employees lots of educational information about these plans and accounts is only helpful to the small minority of people who like all the details."

To address this, Swenson advises employers to:

Get the right people into the right plan. Identify segments of the workforce most likely to value and take advantage of CDHP features and tailor the marketing campaign to them.

Reinforce the plan's advantages. Articulate what's in it for employers, specifically, how they can benefit from the plan's key features, such as building up spending account dollars, and compare the combined out-of-pocket and out-of-paycheck costs of a CDHP vs. traditional plans.

Make it easy for employees and their families to use the plan. For instance, fully fund employer contributions to the HSA or HRA at the beginning of the year.

In addition, employers should provide support throughout the year, so more employees and their families can learn how to do the following:

Use available tools to help make smart choicesin selecting appropriate treatments and providers based on available cost and quality information.

Assess their health opportunities and risks by participating in biometric screenings and health-risk assessments.

Access health coaches and disease management nursesto help make progress towards health improvement and maintenance goals.

Actively manage chronic conditions by working closely with their physician and adhering to evidence-based treatment protocols.

Employees Want Clear, Simple Benefits Info

Results from Aetna’s 2012 Empowered Health Index Survey show that employees who found health care benefits decisions difficult cited the following reasons:

The available information is confusing and complicated (88 percent).

There is conflicting information (84 percent).

It is difficult to know which plan is right for them (83 percent).

In addition, the survey showed that 43 percent of consumers rarely or never track how much they spend on out-of-pocket health care costs. Forty-one percent admit to having skipped a dose of prescription medication, stopped taking their medication or delayed a needed medical procedure, often due to cost concerns.

Consumers in fair or poor health (76 percent) and with chronic conditions (57 percent) were the most likely to skip, stop or delay prescription medication or a recommended medical procedure.

The survey was conducted during July 2012 among a demographically representative U.S. sample of 1,500 adults 18 years and older.


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

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