High-deductible and consumer-driven health plans appear to effectively change consumers’ cost consciousness

January 13, 2016

By Danielle Andrus Executive Managing Editor Investment Advisor Magazine

Consumer-driven health plans appear to be effective ways to encourage cost-conscious behavior among participants, according to EBRI. The 2015 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, released in December, found consumers in high-deductible or consumer-driven plans were more thoughtful about the cost of health care than those in traditional plans.

“The theory behind CDHPs and HDHPs is that the cost-sharing structure is a tool that will be more likely to engage individuals in their health care, compared with people enrolled in more traditional coverage,” authors Paul Fronstin on EBRI and Anne Elmlinger of Greenwald & Associates wrote.

The survey found just 13% of privately insured people were in consumer-driven plans, meaning they were enrolled in a plan with a deductible of at least $1,300 for individual coverage or $2,600 for family, and were also enrolled in a health reimbursement account. Individuals eligible for health savings accounts, whether or not they were actually enrolled in one, were also counted in the CDHP group.

Among the 13% of CDHP participants, almost a quarter were eligible for an HSA but hadn’t opened one.

Anyone else enrolled in plans with those deductibles were in the high-deductible health plan group: 11% of participants.

Participants in CDHPs and HDHPs were more likely than counterparts in traditional plans to check whether care would be covered by their plan; to ask for a generic instead of a brand name drug; to talk with their doctors about other options for prescriptions and treatments, including asking about less expensive options; and to develop a budget to manage their health care expenses.

The report pointed out that CDHPs and HDHPs are specifically designed with incentives that encourage this kind of cost-conscious behavior, but added, “the ability to make informed decisions is highly dependent on the extent to which people have access to useful information.”

CDHP and HDHP participants were almost twice as likely to seek out information before getting care. However, participants who researched cost information, regardless of plan, relied on similar sources. Most found information on their health plan’s website or through printed material. HDHP participants were more likely than other groups to call the customer service department for information. The health care provider’s office or website were other sources of information.

Wellness programs were not as common in HDHPs as in CDHPs, the survey found. The report identified three different types of wellness programs offered by health plans: health risk assessments, health promotion and biometric screening.

Health promotion programs were the most popular type, offered in 51% of CDHP plans. Interestingly, they were more common in traditional plans (42%) than HDHPs (38%).

CDHPs were more likely than other plans to offer a wellness program of any kind. A little over a third of HDHPs and traditional plans offered biometric screening, compared with 47% of CDHPs, with almost identical percentages offering risk assessments.

Participants in CDHPs and HDHPs were also more likely to participate in those programs. Among participants who didn’t, 68% said they felt they could make changes on their own. Over 60% said they were already healthy and didn’t need a wellness program, while about half said they just didn’t have time.

The study found incentives were effective ways to increase participation in wellness programs, with some distinctions based on the type of plan a participant was enrolled in. CDHP participants were more likely to participate in a wellness program if it got them a lower premium, or if participation in the wellness program was a prerequisite to enrolling in their preferred plan type.

Regardless of plan type, between 57% and 79% of health plan participants said they would participate in a wellness program if there were cost sharing incentives on prescriptions or office visits