Enrollment in so-called “consumer-driven” health plans continued to grow in 2011, according to the 11th annual EBRI/MGA Consumer Engagement in Health Care Survey (CEHCS). In 2011, 7 percent of the population was enrolled in a consumer-driven health plan, or CDHP, compared with 5 percent a year ago. When children are included, about 21 million individuals with private insurance, representing about 12 percent of the market, were either in a CDHP or an HSA-eligible plan, the survey found. <A href="http://www.ebri.org/pdf/PR951.13Dec11.CEHCS.pdf">Press release</A>
SEVENTH ANNUAL SURVEY: This Issue Brief presents findings from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey. This study is based on an online survey of 4,703 privately insured adults ages 21-64 to provide nationally representative data regarding the growth of consumer-driven health plans (CDHPs) and high-deductible health plans (HDHPs), and the impact of these plans and consumer engagement more generally on the behavior and attitudes of adults with private health insurance coverage. Findings from this survey are compared with EBRI’s findings from earlier surveys.
ENROLLMENT CONTINUES TO GROW: The survey finds continued growth in consumer-driven health plans: In 2011, 7 percent of the population was enrolled in a CDHP, up from 5 percent in 2010. Enrollment in HDHPs increased from 14 percent in 2010 to 16 percent in 2011. The 7 percent of the population with a CDHP represents 8.4 million adults ages 21-64 with private insurance, while the 16 percent with a HDHP represents 19.3 million people. Among the 19.3 million individuals with an HDHP, 38 percent (or 7.3 million) reported that they were eligible for a health savings account (HSA) but did not have such an account. Overall, 15.8 million adults ages 21-64 with private insurance, representing 13.1 percent of that market, were either in a CDHP or were in an HDHP that was eligible for an HSA but had not opened the account. When their children are counted, about 21 million individuals with private insurance, representing about 12 percent of the market, were either in a CDHP or an HSA-eligible plan.
MORE COST-CONSCIOUS BEHAVIOR: 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 about treatment options and costs; talked to their doctor about prescription drug options and costs; developed a budget to manage health care expenses; checked a price of service before getting care; and used an online cost-tracking tool.
CDHP ENROLLEES 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 also more likely to report that they had access to a health promotion program. CDHP enrollees were also more likely to report that they had been offered a cash incentive or reward to participate in a wellness program when a program was offered. HDHP enrollees were less likely to report having the opportunity to fill out a health risk assessment and to have access to a health promotion program.
FINANCIAL INCENTIVES MATTER: When it comes to participating in a wellness program, CDHP enrollees were more likely than traditional plan enrollees to take advantage of the health risk assessment but not the health promotion program. Among those participating, the reasons they gave were that they were offered incentive prizes and reduced premiums. Among those not participating, the reasons they gave were that they could make changes on their own; they lacked time; and they were already healthy. Financial incentives were more a factor for CDHP enrollees than for traditional plan enrollees when it came to participating in wellness programs.
CONSUMER USE OF TECHNOLOGY: A significant portion of the population reported using a smartphone, and 1 in 5 reported using a tablet. Among them, about one-quarter reported using an app for health-related purposes. Among those not using an app, nearly one-half were interested in using one.
incentives Distributio Appendix—Methodology [ALL THRE HDHP that The Among those remain to n wa der s fparticipate who o E QUESTIO s eligibl of t r non have his re qe uali for still nev port fie ad e n N mattered to al me examin r used a HSA S TO BE dical but es the e n had not o a xpenses are pASKED OF p for l in findings dividuals, r health-related pen subj from ed t Fig THOSE AGE 21 ec h t ee acco h ga t to r u e rr201 pur d eless of pl 8 eunt. gu 1 EB pose lar When t RI/MGA Consum sincome ta , nearly o an type. - h64 eir chil x as Nearl ] ne-half dren ar well y 70 percent er Enga is eit as a e cou h 20 geme er v n percent te e o nt ry or some d, a f participants in H bout pe ealth nalty 21 w Car m hat said illion e Paul Fronstin is director of the Health Research and Education Program at the Employee Benefit Research Institute. Findings From the 2011 EBRI/M Figure 3, Number of Years Covered by Current Health Plan, by GA Consumer Engagement in Type of Health Plan, 2011 .............................. 7 8 In theory, a random sample of 2,000 yields a statistical precision of plus or minus 2.2 percentage points (with 95 Figure 3 they wo Survey as t indivi (incr intereste ed ased fro uals uld pa d iwit h ney relate to um h rticipate s pr ing on 10 percent ivate i e in for th n differences a sur i welln n aings lik 2 nce, r 010 ess pro as a e and si e n prese u g re trit ra n milarities amo sult of m if ion in ting abo ther formatio PPACA u e Definit t 1 wa Figure 17 Figure 21 Figure 19 Figure 13 Figure 15 2 Figure 1 Figure 9 Figure 5 n ), whic s some type n, ex g i perc Figure 1 ndivi ent o i ercise on h is dua s waiv f t pr 1 l o s hf e market, enrolle ograms, w fi ed nancia if td he o in tra l i wer e nw ight mana ce n e d ntive to e eit itional r of t her h he geme e H in a do so. alth S C A dies, becom nt or D pla HP or ndiets, s, CDHPs an HS eA- s , and This Issue Brief was written with assistance from the Institute’s research and editorial staffs. Any views expressed in Availability and Use of Quality and Cost Information Provided by References Health Care Survey The findings presented in this Issue Brief Number of were Years derive Cov d f erred om the by 20 Current 11 EBRI/M Health Plan, GA Consumer Engagement in Health Care percent confidence) of what the results would be if the entire population ages 21–64 with private health insurance Figure 4, Length of Tim Likelihood Employ Interest in eReasons Percentage of With Premium Percentage of Familiarity HRA or er of Offers W for Not Participating Changing Enrolling in HSA, Employ Increases Indiv With Consumer-Dri 20 ellness Program, Indiv 05 er Offers iDoctor duals ? Plan 2011 ............................................................................... A iduals mReporting Using Select o If ng Employ Cash Cost Sharing in Reporting Employ Incentiv v by ethat They n T ers With Health Plans, 201 y Netw er's pe that They e W or of W as orks ellness Health Used Rew Low 10 Composed or W a er rd an ould Plan, 201 More Program or for A 1 pp Higher of 1, 7 HDHPs. Th 1. eligi disable presb cript Which led plan. , or ion e r of th is dr eug eligi port a e followin prices ble lso ex for , m Me a em dical dicare. g ines consum best claims describes your his er en tory, and gageme gen curr ne t more ral ent health health in gen in era fo lly. It e rmation surance sta xamin (Figure es health tus: 22). Amon care g in decision dividuals makiwith ng, cost a this report are those of the author, and should not be ascribed to the officers, trustees, or other sponsors of EBRI, Health Plan and Effort to Find Information From Other Sources, 2011 Chernew, Michael E., Allison B. Rosen, and A. Mark Fendrick. “Value-Based Insurance Design.” Health Affairs. Web 60% by Type of Health Plan, 2011 Survey, an Consumer-Driven Heal online survey thath Plans t examines issues surrounding consumer-directed health care, including the cost of coverage was surveyed with W Only More Than Once hen A Medical m Using Doctors complete o Probably Employ ng Participating Those Offered but Not Prov ees, accu Participate in Employ iders With for a racy. W That o in W rker Smartphone Th Use ellness ere ar Earnings and Records Health Information e also Program, Participating or other of er's Ta Prov Inflation, 1988 blet, W possib A ellness iding m by on in l e sources of e V T g Program, echnolog a High-Qualit W rious Program, orkers Whose ?2010 Health- y 201 rror (HIT) y 1 Care in all surveys that may and CDHP, qual 60 ity in perc fo ent rmation, part were very icipation or somewhat in we illness pro nterested in gra u ms, sing a opinions n app to ab check out provider enga the balance i geme n thnt, cost-sharing e HSA or HRA. EBRI-ERF, or their staffs. Neither EBRI nor EBRI-ERF lobbies or takes positions on specific policy proposals. EBRI invites a b c Opinions About Provider Engagement Exclusive, (Jan. 10, 2007): w195 ?w203. a b Tradi c tional HDHP CDHP 50% December 2011 • No. 365 Figure 5, Familiarity With and by Current V Co Combined ans rious umer-Driven Healt Related Employ Doctor Cost-Sharing Incentiv With Low er Purposes and Offers W Does h T Not er Pl radians Cost ellness Program, tiona Use ,l 2011 Ty Sharing, by HIT pe es HDH ..................................................................... 9 ,of Health Plan, 201 and by P T T y ype pe of CDH T by y of P pe THealth Health yof Plan, 201 pe of 1Plan, Plan, 201 Plan, 201 1 2011 1 1 By Paul Fronstin, Employee Benefit Research Institute insurance, HRA and HSA Indivi duals ar 20 the cost of c %e able to enrollme roll n are, t is ogrowi satisfaction ver fun nds g, but fro wi t mth hea h one HSA i e market lth c pen are, nto another esatisfaction tration r HSA emai with h witho ns relative e ualth t su care pla bjecting t ly small, an ns, reason he distri d the amount of bution s for choosin to i tim ncome an g a e d be more serious than theoretical calculations of sampling error. These include refusals to be interviewed and other The combination of a tax-preferred payment account with a high-deductible health plan is what is commonly incentives I h rela ave ted to hea pla lth in n ty su pe, a ranc nd value e thro-based insuran ugh a governce design. ment pla n such as 18.6% comment on this research. Health plan provides information on quality of care provided 52%* 45% The 2011 EBR 90% I/MGA Consumer Engagement in Health Care Survey included questions regarding the ways in which 70% (Among Those Who Use a Smartphone or Tablet) 40% plan, indivi penalty d and sour uals taxe ha s ve been as long as the ces of healt in the h is rollover n e pla formation. ns is sho does It not exc ralso presents ter thae ne th d 60 e t f idays. Rollover contributions me oth indings f ers ha rom t ve been he 200 enrol 5, 2006 le from Arc d , and in tra 44% 20 dh 0 ition er 7 EB MSAs are a al covera RI/Common ge. A lso w m ealth ong forms Claxton, of nonr Gary,es et a pons l. “H e, ealth the effe Bene ctsfits In of qu 2 es0 tion 08: wor Premium ding and qu Moderately estion order, Higher, While and sc E reenin nrollment g. Wh in ile C attempts onsumer-D are irec made ted to referred to as a consumer-driven health plan (CDHP). These account-based health plans include either a health Where the world turns for the facts 45%Medicare, Medicaid, or Vetera 65%* ns benefits on U.S. employee benefits. ...................................... 1 a c by doctors You can make changes on your own 29% 44% 33% 35%* 40%* 18 50% % a b Figure 6, Conc providers lusio of Cost hn e -Conscious Decision alth c are ser 17.1% vices en Maki gage t ng,h by eir Type of H patients. Nearl ealth yPlan, 90 perc 2011 ent of plan ....................................................... participants, regardless of plan 9 type, PremT iu radi m Iti nona crea l se HDHP CDHP 16.7% 40%*40%* Traditional 13% 15% a 67%bc Fun permitte indivi dPlans Rises Consum duals d. Ear witerism in h nings o traditional In Small n Healt contr Firms.” ch oi Care Surv verage, butions aHealth A are 18ey, and the 2008, 20 percent al ffairs. so not subject Web Exclusiv had been i to incom n0 th e (Sept. 9 an eir d e ta pla 2 2 010 nx4 for e, s. EBRI 2 thre 008): /MGA Consumer e to w4 92 four yea -w50 27% 2 rs an . Engagement d 44 percent in fo Health r five or minimize these factors, it is impossible to b quantify th c e errors that may Traditiona result l HDH from t P CDH hem. P savings accou I h 40 80% % ave nt (HSA health ) or in asu health ranc reim e thro buug rsement arra h my job o ngrement the job (HRA), descri bed in more detail below. Health plan provides information on cost of care provided by 77%* Traditional HDHP CDHP Copyright Inf Normation: utrition informatio T n his report is copyrighted by the Employee Benefit Research Institut 28%e (EBRI). It may be 75%* The Cost- strongly or so 2011 C EBR ons 35% mewhat Ic /MGA ious Beh Cons agre ued that m avior er Eng their agem do ector communi nt i a n Hea 44%* b lth Care cated c Suwith them so that t rvey finds continueh d gro ey could wth i rea n con lly u sumer-dr nderstan iven d wh health at the 60 40 %% 16% Traditional HDH WorP ker EaCDH rnings P Increases 57%* 29% Care S more years. T urvey. The 2011 EBR his compares with 26 I/MGA Consu percem nt er Engagem and 21 perc 72%* ent i ent, n res Hea pectiv lth Care S ely, amon urvey g w pe arsons in a s conduct CD ed within HP (Fi the gure Uni 3).t While ed of a doctor no sther Y f ou d amily memb o not have enough ti er (su me to parc tih as cipate spouse or 25% parent 14.7% ) ................... 41 27% 30 2 * 31* Retirement and health benefits are at the heart of worker 42% s’, employers’, and our nation’s Figure 7, Trends in Cost-Conscious Decision Making, 35% by Type of Health Plan, 2005–2011 ............................. 10 used without permission but citation of the source is required. 9 Fronstin, Paul. Consumer-Driven Health Benefits: A 69% Continuing Evolution? Washington, DC: Employee Benefit Research plans: The doctor w theory 7 perce as sa beying hind account nt of(Figu the po re pu 1 -based pla 6lation ). About was e thre ns a nn r e-quarters o o d lled in plans a C with D f i H high nP divi , up from eduals a r deducti 5 gr percent b eles is t ed that t h in at t h20 eir h10 e cost-shari doctor wo . Enrollment rked with ng structure in HDHPs i them wil n to crea l find sed Health Reimbursement Arrange 35% ments 35%* Permitted ins 70% urance also includes workers’ compensation, tort liabilities, and liabilities related to ownership or the use Health Savings Accounts 52% Introduction 66% Overall Inflation 26% States betwe Findings From the 2011 EBRI still lower thae O nn the f August 9 thos percenta e w hos ange o d Au e plans fgust in p divi r23, ov du ide als with 201 in1, thro fo o traditi n q ugh ualo a 1 it/MGA Consumer Engagement in y nal covera , how 5-minute many ge, I n the ternet num survey ber o. The f persons w a natio b nial th CDHPs a or base c sampl nd the e was economic security. Founded in 1978, EBRI is the most authoritative and objective source of I h 35% ave health insurance that I purchase from a health 40% Traditional HDHP CDHP 14% General health information Extremely or very familiar Somewhat familiar Not too or not at all familiar 26% Institute, 200 30% 2. encoura from realistic c 14 perc ge mo hanges they co en re peopl t in 2010 e to uld to 16 perc be en make to im gaged, ent in 201 specifica prove their 1. Over lly com health, and all, 15. pare 8 mi d with that llion thos the 62% adults a e enro doctor underst ges lled i 21– n 64 more tradition ood them pers with private insura al covera onally. Abo nce, ge. T uhis t 48% 28% 50% 61% of property (such as automobile insurance). 28% Employment-based h A healt h reimbursement a tried tY oou d u esalth o n e ot n 60% itrra f benefits are the most common form eed orngement d it bec ocau tor ses yo (HR u areA al) is a ready hn eal emplo thy yer-fu 22% n of ded heal health plan th insura5 23% n 0 that reimburses ce in the Unite 51 d employees for quali States. In 54 2010, fied drawn Figure length from 8, Avai of time Sy l a they have be novate’s onl bility and Use of in en e pane e Quality nrolle l of d in these plans ha In an ternet d Cost I users w nformhation Provi ve o ha been ve agr incr deed ed to easing (Figur by He partici alth pPlan a e 4). ate in researc nd Efforh s t to Find urveys. About 2,000 A healt information on these critical, complex issues. h savings account (HSA) is 12.1% a tax-exempt trust or custodial account that 27% an individual can use to pay for health insurance company ..................................................................... 3 Recommended Citation: Paul Fronstin, “Findings Fro 30%* m the 2011 EBRI/M 58%GA Consumer Engagement in Health Care Health Care Survey 30 60% % 57% 45% 26% 34% 26% 56% 56% study fi representin 70 percnds ent or g evi 13.1 slightly mor denc perc e that ent o adults in e agree f that mark d CDHPs that it et, was extr were eith and HDHPs emely er in we a CD or very re mor HPe impor or likwere in ely than t tant that an h HDHP ose i their n traditional that doctor w was eligi as pl 1ans to e ) bacces le for sx an HSA ible hibit by a but 30% 11.2% 33%* 12% Of those w hose plans provide info on cost, how many tried medical expenses. HRAs are typically combined with a high-deductible health plan, th 24% ough this is not required. HRAs 156. _____ 1 mil ___. lion “H iealth ndividuals Savings und Accounts an er age 65, or d Other Accou 59 percent onft - that po Based Healt pulatio h Plans.” n, had em EBRI ploy Issue ment-Brie based f, no he . 27 alth 3 ben (Employ efits ee adults (n=1,9 Wei 90) a ght man gage es 2 men 1 - t or64 who have health insurance through an employer or purchased directly from a carrier care expenses I hav. Contributions e other healt to the accou h insurance (sp nt are eci deducti fy ________ ble from taxa _______ ble income, ) .................. even for individua 4 ls who do not Survey,” EBRI Issue Brief, no. 365, D 24% ecember 2011. 10 Information Fr 25% om Other Sources, 2011 ......................................................................................... 11 24% 26% 26%* By Paul Fronstin, Employee Benefit Research Institute 10.1% Only Medicare enro dietsllees age 610.1% 5 and older are allowed to pay insurance premiums from an HSA. A Medicare enrollee number had phone; not o 2 of )p too cost-conscious ene kd responsi the acco bilit unt. be y for coor haviors. Specif When their dinat cing t hildr ically, those h eeir n ar care e co in with unted, CDHPs a ot abo her n u pro d H t 21 mi viders, speciali DHPs w llione in re m dividuals sts, or testing ore like with ly tha prn ivate insura faciliti those i es; an n tra nc d dei3) t, ional to use it f Th o er pr d og orc am i tor s s not conveniently located for you 14% 23% 46 45 49 With respect to familiarity with a CDHP, 57 percent of those with a CDHP were extremely or v 38% 25% ery familiar with it (Figure 40% 22% ( can als Fron Bene EBRI focus stin o be ,fit Resear 20 25 50 of % %11 fere ). In d on es solel ch ev Institut a s ery ye tan yar si e, d-a on emplo Sle one nptem ce 19 bas ber 20 98, p isy or w ee r0 e benefits research — no lobb 4 m ith com ). ium inp cre rea hensive ses have insur exceed ance t edh worke at doe ying rs earn not use or advocacy ings a h incr igeh ases and in de ductible. fl ation were draw30 n ra % ndomly b from the Synovate sample for this base sample. This sample was stratified by gender, age, itemize their taxes, and tax-free distributions for qualified medical expenses are not counted as taxable income. Tax- EBRI E I d 10 m 25ploye % % o no e B t h ene av fit R e h ese eaalth rch Inistit nsuranc ute Issue B e cu rief rr (IS e Sn Ntly 08 ............................................ 87 ?137X) is published monthly by the Employ5 ee Benefit Research Institute, HDHP 13% 23%* 63%* 23%* 23% 27%* coverage to s representin under coached them age 65 g a T a about cannot use r b y that they had checked ie out d to 12 perc staying healt find an inent of the mark fo HSA to rmatih oy rath npay from wh in e s r than e surance et, were o th ur er t ce just treating h se p premi ot eith he lan er in r t w uh ms. a on u a C h ltheir d c eD a o HP or ltve he h r c pl aa l an HSA a th pro n 22%* r e (59 b lems - pel eigi rc.e b n And a le t CD plan. HP bout an on d 5 e-hal 5 pefr o ce f i nn t HD dividuals HP1 vs. , 5). In contrast, 13 percent of individuals 21% with traditional coverage were extremely or very familiar with a CDHP, and Report availability: 1100 13th S EBRI stand t. NW, Suite This r 8s alone in em 78, W eport is ashington, availa Dpl C,oyee ben 2 ble on th 0005-4051, efits rese e I atn $3 te00 rnet per ar at ych a ear www or si san inde . ie nc blri ude .org d pend as part 23% eof nt, nonprofit, and no a membership subscription. npa P rtisan eriodi- Employees ar (Figure 1). Hee eli alth insur gible for a ancen prem HRA only iums ha whve more t en their emplo han doubl yer offers suc ed, while worker h a health ear pla ninngs have . increased 4 21%*6 percent. Figure 9, Employer Offers Wellness Pro 8.0%gram, by Type of Health Plan, 2011 ................................................. 12 region, incom 20% e, and race. The response rate was 37 percent (30 percent for the base sample or national sample, and free distributions are also allowed for20% certain premiums. Exercise programs 7.5% 25% ________. “The Future of Employment 19% -Based Health Benefits: Have 7.3% Employers Reached a Tipping Point?” EBRI Issue cals postage on c rate opai st an d You j in d W usq a t d ual sh o no init gto t k y of now n, D eno c C a , r ugh and e pr ab aout o ddi vthe itio de nal pr dogr by mam ail doc ing otffi oce rss. POSTMASTER: Send 24 address cha2 nge 7 s to: EBRI31* Issue Brief, 1100 20 40% % 6% 28% 48 regar perc dles ent tra s20 of 8% %orga plan ditional nization. It analyzes a type, ); agr asked for eed that t a ge hneric eirnd rep doctor us drug o i rtns re stead ed m sea eof dical rch data a bran termi d without spin o n na olme (53 percen ogy during rpat unde t CDHP, ient- rlying a provid 54 percent HDH er gend disa. All fin cussionsP .d O vs ing nly . s, 8.1% 25% 6.9% 13 percent of individuals with an HDHP were extremely or very familiar 18% with a CDHP. SEVENTH ANNUAL SURVEY: 30% This Issue Brief presents findings from the 2011 EBRI/MGA Consumer Engagement in 44 percent for the oversample). The margin of error for the national sample was ±2.2 percent. [IF Q1 = 1,5, SKIP TH 13th St. NW, Suite 878, W 17%* ashinE OTHER 2 QUESTIO gton, DC, 20005-4051. Copyright N 20S] 11 by Employee Benefit Research Institute. All rights reserved. No. 365. 6.3% 6.1% 6.1% 6.1% 6.1% The 20 Brief, 11 EBR no. So 31 I/MGA urc 2 e (Employe : EB Cons RI/M uGA m e B er Eng Ceonefit nsum a Researc gem er Enga ent i gem h n Institute, Hea ent in H lth ealt Care Dec h CS aeu rmber ervey s Surv 2 ey u007 , 2 ggests that C 01). 1. DHP enrollees are somewhat more whether on financial data, options, or trends, are revealing and reliable — the reason EBRI information is 46 betw perc een ent tra 23 pedr-ce itional nt an ); ta d lke 29 p d to t ercent heir tho doct ught or about that t pr heir escripti doctor s on treatm hould be ent o acces ptions and costs (41 percent C sible by e-mail, the only ques Dtion HP vs wher . e Employers hav In resp Figure 10, onse to rising health Individual e a tremen Partic do ipates in us amount o costs, emp Welln loy f e ers have b flexi ss Program O bility in e de en seekin fsig fere nin d g h by Empl g ways to mana ealth pla oyer Thos ns that gee th inc Of em. Dur orporate fered a W ing th an H ellne last e RsA. For s deca exam de, ple, t he 20% 5.5% HSAs are o 15 w %ned by the individual with the high-deductible health plan and are completely portable. There is no use-it- The Health Ca 2011 EBR re Su Irvey. T /MGA Cons his study is umer Eng base agem d oe nnt i ann onli Hea ne su lth Care rvey of Survey 4,70w 3 a privately s made pos insur sible ed a with dults fund ages in 21 g from Amer –64 to pro icvan ide 14% 14% 6% 15 30% %a 15B %alance of HSA or HRA Traditio nal = health plan with no deductible o r <$1,000 (individual), <$ 2,000 (family). cost conscious in t the gold sta heir decisi ndard fo on makin You d r priva o nog t b tha elit ev e analysts a e i n those t will help yo in tr u nd de ad 7% itional cision plans. make 25%Whil 13% rs, gove e CDHP rnme enrollees, H nt policym D13% H ake P enro rs, the media, and llees, and The study also finds the following: 37 amount of a diperc ffere ent tra nce mo wney that d as itional foun 12% )d ; ta is by pla lke plc an typ ded to t in t heeir h . e a doct ccoor about unt, the other level of treatment 13% the de 12% ducti optb ions and costs (39 le, and the comprehe perc nsive ent H ness of t DHP vs. 33 he he percent alth employers have turned their attention to account-based health plans—a combination of health plans with deductibles of To examine the issues mentioned above, the sample was divided into one of three groups: those with a consumer- Express, Bl or-lose-it nationally ________. rul repr “A ue e vailability, Cross Blue associated esentative Con Shi wit datth e a ributions, Acc HSAs, as a ld Association, De regarding th ny money l o e gro unt Ba ere wth lances & Co of eft i co n ., Deseret , and the accou nsumer-driven Rollov Mut net rs at the en u in Accou al, Metro health plans (CDHPs) and d o n pt-B olit f ta h an Lif sed Hea e year e, autom Nation lth Plans, 20 hi a al Rura tically rolls gh-de06 l Ele ducti -20 c o ble tri 09.” vc er Program, by Type 20% 11%of Health Plan, 2011 ......................................................................................... 12 b 2. Which of the following best describes yo 2.5% ur health plan's deductible: a HDHP = high-deductible health plan with deductible $ 1 ,000+ (individual), $ 2,000+ (family), no acco unt. the public. 10% 10% traditional plan enrollees were equally likely to report that they made use of cost and qua Traditility in onal formation provided by 4% traditional); asked their doctor to recommend a l 2.1% ess costly prescription drug (42 percent HDHP vs. 35 9%* pe 9%* r-cent insurance at least $1,000 for are 10 10 20% % % all subject employee-only to variation. Em coverapl ge a oyers often nd tax-pr co efer 11%ver red savings or sp certain preventive servic ending accounts that es in full, not workers and subjecting the their m to driven hea10 lth % plan (CDHP), those with a high-deductible health plan (HDHP), and those with traditional health and EBRI N is availa Yo ou a bl tes, Pe in rirce un es n for the o co. 11 pr mfo e fol s rc t (Em abl ript le p ow ionar p ing y tic loy ipati ee B ng ear. in e thi ne s kifit nd oRes f progr earch I am with nstitute, November 2009): 2 ?12. Cooperative health plans (HDHPs), a A c ssociation, an nd td T he im he Commo pact of tnwealt hese plans a h Fund n.d consum er engagement more generally on the behavior and The Employee Benefit Research Institute (EBRI) was founded in 1978. Its mission is to CDHP = consumer-driven health plan with deductible $ 1 ,000+ (individual), $ 2,000+ (family), with acco unt. 7% 11% 18% b ? Individuals in CDHPs were more likely than those with traditional coverage to 7%*exhibit a number of cost- their health plan, CDHP c drugs enrollees were more likely to try to find information about their doctor’s cost Major reasonand quality from your coworkers 10% CDHP 13% HDH 6%* P the traditional Figure deductible 11,) Employer O ; developed a . Employers c ffers buCash Incentiv a dget n of to ma fer comprehensive nage e or 57%* health Reward for car hee al ex th insur Partici penses p an atin (26 ce t g perc hin at covers Well ent ness Program, 20%* CDHP 100 percent vs. 18 percen Amo of h 22% neg Workers t traditio alth c * are cost nal) ; s after checked families can use to pay their out-ofcontribute to -pocket healt , to encourag h care expe e, an nses. Empl d to enhanc oyers first star e the developmen ted ot of sound empl ffering account-based h oyee beneefit alth coverage. Individuals were assigned to the CDHP and HDHP group if they had a deductible of at least $1,000 for attitudes of2% adults with private health insurance coverage. Findings from this survey are compared with EBRI’s findings Cost-Sharing Incentives * Difference between HDHP/CDHP and Traditio nal is statistically significant at p = 0.05 or better. [A deductibl 10% e is the amount you have to pay before your insurance plan will start paying any part of EBRI explo 5% res the breadth of employee benefits and related issues conscious behaviors. They were more likely to say that they had checked whether their plan would cover car e; ________. 10 “ 5% % Sources of Coverage and Characteristics of the Uninsured: Analysis of the March Mi 201 nor r 1 Curr eason ent Population sources other Who we are than the health plan. CDHP enrollees were more likely than traditional plan enrollees to take advantage 5% c programs and sound public policy through objective research and education. EBRI is the only the In ord price of a er to quservice befor alify for tax-fe ree contr getting care (34 ibutions6% to an perc HSA, ent HD the i HP vs ndivi . 28 dual perc mus ent tra t bed cover itionael) d ; an by a d hea used a lth pla n onli n that ne cost-t has racking an the plans i deductible n 200 You a 1, re wo wh has rrien a ed t been hat ha yo met urnd emfplo or th ul of yer em wil ey may l kno ployer w youroffer ps be ersonal covera gan to health of gef with er he cost sha alth reimrbursement ing after the arr deductible angements is (HRAs). In met. If emplo 2004, yers individual coverage or $2,000 for family coverage. To be assigned to the CDHP group, they must CDHP also have an account, from earlier Whose Emplo surveys. yer Offers Wellness Program, by Type of Plan, 2011 11% 16% .................................................. 13 your m There we as di no cal bills.] difference by plan type when it came to changing doctors if cost sharing was lower or higher when using EBRI studie Medical claims hists or the worl y d of health and retirement ben 6% efits — issues such as 401(k)s, IRAs, retirement information Survey.” asked for EBRI a Issue Br generic ief, dru ng o i . 36 n privat stead o 2 (Emplo e, nonprof f a br yee B an it, nonpar d nam enefit tisan e; talk Re, search Institut Washington, DC-b ed to their doct e, Se ased organi or about ptember pr zat 201 es ion com cription 1). mitted exclusivel options and cos y to ts; of a health ris 0% k assessment, but they were no more likely to participate in health promotion pro 2 grams. In addition, The survey found that CDHP enrollees were more likely 11%* than traditional plan enrollees to report that they had the annual deductible of not less than $1,200 for self-only coverage and $2,400 for family coverage (minimum deductible choose to tool providpay ed 0% by the less than 100 perc health plan (21 ent o perc f health car ent CDHP e vs. 1 expenses 1 percent after tra the ditional) deductible (Fighas been m ure 6). et, they then have the employers were able to start offering health plans with health savings accounts (HSAs). By 2010, 16 percent of such as a health savings account (HSA) or health reimbursement arrangement (HRA) with a rollover provision that they Table of Contents 0%income adeq uacy, consumer-driven b 0.2% enefits, Social Security, tax treatment of both retirement and health a doctor who 0% used or did not use HIT. About one-quarter of individuals reported that they would change doctors to one 0% public policy research and education on economic security and employee benefit issues. Less Than One Year 5 Years or More develo 0% 0% ped a budget to manage health car 1–2 Ye ear e sxpenses; checked 3–4 Y the ear pr s ice of a service before getting care; and financial incentives mattered more to CDHP enrollees than to traditional plan enrollees. ENROLLMENT CONTINUES TO GROW: ExRe treduc meled y I Dr nter ug C ested ost SharV iner g y Int The eres Intced r survey finds eased Dr Some ug Cos wha t S t I c ha nter o ring es ntinue ted Reduc d Nogrow t ed V O ery ffic Inte th in e Vi res sitt Co consume ed N st Sh oar t at ing Ar llI n -driv Inter crea es se e te d O n d D healt ffice Vio sh in't t pl Cos Know ans: In t Sharing 2011, option to complete a health 0%* risk assessment. Specif 5%* 10ically %* , 44 percent 15%* of CDH 20%* P enrollees 25%* reported th 30%* at their35 em %* ployer amounts are Figure 12, Rea insde ons for Part xed to inflic ation but ar ipating in Health Risk AsEmployer's Wellness e r sessm emainin ent g at $1,20Program, 2011 0 and $2,400 in................................................. 2 H012 ealth Pr ). om Certain otion Progprev ram entive services 13 can be e option o mployefr s des wiith gnin 10g th –49e 9 w plan ork with ers a or nd 23 witho pe It ur ct a ma c oe sts n to t o o m ximum f th uchose out-o with 500 f-pocket or more limit. work ers offered either an HRA or HSA- Fronstin, can use to Paul, -2 pa %benefits, cost y for m and Sara edica R. l manage expenses or t Collins. “Fin ment din h, worker a e a gs From th bility to ta nd e 20 ke th employe 8% 07 EB eir accou RI/Com r15% attitude nt wit monwealt s, policy reform p h them s h Fu hould they nd Consumeri ropo chsals, and p ange sm in Hea jobs. In elth ndividuals sion assets HeLo alth wer EBRI’s member R iCo sk As st Sh -1 se .1 ar ssm % ing ent ship includes a cross-section of pension funds; businesses; trade associations Hea H ltih ghe Prrom Cos otito S n Pr harog ing ram ; 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% who used HIT if cost sharin No deductible g was lower, and about one-quarter reported that they would change doctors to one who Figures ....................................................................................................................... used an online cost-tracking tool. .............................. 2 There has be 3en no clear increase in the share of CDHP enrollees who report cost-conscious decision-making over the offer 7 percent ed a of he t alh th e risk popu assessment (Fi lation was enro gur llee 9), compared with 34 d in a CDHP, up from 5 percent of tradit percent in 2010.ion Enr al pl ollment an enroll in Hees and 27 DHPs increase perd cent of from covered in ful and fundi l and are not ng. There is wi subject to labor un the de spread ions; h deductible. ealth recog car Th e prov ne ition that if employee be out iders and insur -of-pocket maximum ers; government org n m efits data exist, EBRI kno ay not e anizations; xceed $5, and service firms. 950 forw sel s it. f-only eligib Survey.” le plan. EBRI (See Issue Br pgs. 23–2 ief, 4 for no. 21 detaile 5 (Emplo d expl yee B anations enefit ofRe HRAs search Institut and HSAs.) e, March 2008). with only a flexible spending account (FSA) were not included in the CDHP group. used HIT i Individ f no Source: Source: t doin u EBR EBR al I/M g so I/M or G G A A Single Coverage C C onsumer incr onsumer eased t Engagement Engagement heir in H in H co ealth C ealth C st sharing aa re Surv re Surv ey ey , , 2011. 2011. (Figure 17). These findings are unchanged from 2010. Source: Source: Source: EBR EBR EBR I/M I/M I/M G GA A G C A C onsumer onsumer Consumer Engagement Engagement Engagement in H in H in H ealth C ealth C ealth C a are Surv re Surv are Surv ey eyey , , 2011. 2011. , 2011. It is not clear Source: Source: from the EBR EBR I/M I/M G G data AA C C onsumer onsumer wheth Engagement Engagement er th in H e in Hdi ealth C ealth C ffer aa re Surv e re Surv nces ey ey , , 2011. in co 2011. nsumer engagement can be attributed to plan design -4% Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2011. 0% 10% 20% 30% 40% 50% 60% 70% Figure 13, Rea aa sons for Not Participating in Employer's Wellness Program Among Those Offered but Not There seven years o is no st aa a atutory re f a the survey quir (Fi ement t gure 7). hat a n employee have a high-deductible health plan in order to also have an HRA. 14 perc ? ent Indivi in a a TT T r201 aditional = rduals raditional = aditional = 0 to we H H H ealth 16 ealth ealth re slightly mor p plan w plan w plan w ercent i ith iith th no no no deductible deductible deductible n 201 e like or or or 1. <$1,000 (indiv <$1,000 (indiv <$1,000 (indiv The ly to r 7 eperc idual), <$2,000 (family iport that th idual), <$2,000 (family dual), <$2,000 (family ent of th ey h e ). ). ). pop ad uprovider lation with a quality in CDHP re formati presents on than 8.4 they millio did cost n adults HD Introductio HP enrol nlees. W .................................................................................................................. T T T rraditional = raditional = T aditional = raditional = hen H H H ealth ealth ealth H asked ealth plan w plan w plan w plan w i ab th iith th ino th no no ou no deductible deductible deductible deductible t theor ava or or <$1,000 (indiv or <$1,000 (indiv <$1,000 (indiv <$1,000 (indiv ilability of idual), <$2,000 (family iidual), <$2,000 (family dual), <$2,000 (family idual), <$2,000 (family health promotion ). ). ). ). programs, 52 percent o ............................ 4 f CDHP enrollees and coverage and T$11, raditional = 900 for Health plan w family covera ith no deductible or ge, <$1,000 (indiv with the idual), <$2,000 (family deductible counti ). ng toward this limit. The minimum allowable b 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 b b b bHDHP = High-deduc bHDHP = High-deduc b tib tib le le health health plan plan w w ith ith deduc deduc tible tible $1,000+ (indiv $1,000+ (indiv idual), $2,000+ (fam idual), $2,000+ (fam ily ily ), no ), no ac ac cc ount. ount. bMy deductibl HDHP = High-deduc HDHP = High-deduc HDHP = High-deduc tib tibtib lle e e lhealth health e is less than $1,000 health plan plan plan w wiith th with deduc deduc deduc tible tible tible $1,000+ (indiv $1,000+ (indiv $1,000+ (indiv iidual), $2,000+ (fam dual), $2,000+ (fam idual), $2,000+ (fam ily ily), no ), no ily), no ac acac c count. ount. count. HDHP = High-deduc HDHP = High-deduc tib tib le le health health plan plan w w ith ith deduc deduc tible tible $1,000+ (indiv $1,000+ (indiv idual), $2,000+ (fam idual), $2,000+ (fam ily ily ), no ), no ac ac cc ount. ount. differences orHDHP = High-deduc whether vario tible u health s pla plan n design with deductible s attract a c $1,000+ (individual), $2,000+ (fam ertain kind o ily), no f in ac dcividual. R ount. egardless, it is clear that the Taylor, Humphrey. “Does Internet Research ‘Work’? Comparing Online Survey Results With Telephone Surveys.” cc cc c c EBRI’s work advances knowledge and understanding of employee benefits and their This However, EBRI delive Issue Brief it is cCDHP = Cons cCDHP = Cons CDHP = Cons standard pract presents rs a stead um um um er-driv er-driv er-driv fin en en en dhealth iings health ce amon health y plan from stream of invaluable research and anal plan plan w w w ith iith th g the deduc deduc deduc em tible 20 tible tible ployers that $1,000+ (indiv $1,000+ (indiv 11 $1,000+ (indiv EBRIi/M dual), iidual), dual), aGA Consum n$2,000+ (fam $2,000+ (fam $2,000+ (fam employee ily ily ily ), w ), w ), w er m ith iith th Engagement u ac ac ac st also choos cc c ount. ount. ount. ysis ine a Healt high-de h Cardu e Survey. T ctible heahis s lth plan i tudy is n 42 ages 21– Indivi perc duals ent o information, 64 we wi f CDHP = Cons CDHP = Cons CDHP = Cons Source: traditional re as th CDHP = Cons privat EBR si a gn um um I/M um n e um ed er-driv er-driv G d er-driv pla i A er-driv n to both Csu onsumer en en n en the rance, whil en enro health health health health CDHP HDHP Engagement plan plan plan llees plan w w w and HDHP ith iith w th reported that ideduc gro th deduc deduc e deduc in H th tible tible u tible ealth C e 16 perc p i tible $1,000+ (indiv $1,000+ (indiv $1,000+ (indiv f$1,000+ (indiv t a en re Surv hey rollees ey th ent with did i, dual), iidual), 2011. dual), eir em idual), no $2,000+ (fam were $2,000+ (fam $2,000+ (fam t have $2,000+ (fam ployer a HDHP less likely than an ily ily ily ), w ), w ily o ), w a ), w i r ffer th iith th ccount use ie ac th ac ac presents 19. c ac ce c ount. ount. ount. cd such a ount. traditiona d fprogram. o 3 million r healt l plan h One-thir car peo enroll ep le. Among the expenses ees to d of HDHP rewith port t a h at deductible and maximum o Participat CDHP = Cons ing in Pro umer-drivu g en t-of-pocket ram, health plan 2011 with deduc li ................................................................................................ mit are indexed to tible $1,000+ (individual), $2,000+ (fam inflation. ily), wNetwo ith account. rk plans may impose higher deducti ..... 14 bles and Just like the general question on HIT and cost sharing as incentives to switch to a doctor who uses HIT, when more Summary of Findings ................................................................................................................................. 4 * * Differenc Differenc e e betw betw een HDHP/CDHP een HDHP/CDHP and T and T raditional raditional is is s s tatis tatis tic tic aa lly lly s s ignific ignific ant ant at at p p = = 0.05 0.05 or better. or better. * * My deductibl Differenc Differenc * Differenc e e betw betw e betw een HDHP/CDHP een HDHP/CDHP een HDHP/CDHP e is $1,000 and T and T and T r raditional aditional raditional or mor is is s s istt s atis atis tatis tic tice tic a ally lly a lly s siignific gnific signific ant ant ant at at at p p = = the p 0.05 0.05 =or better. or better. 0.05 or better. * Source: M * Differenc Differenc e ee rcer, betw betw een HDHP/CDHP N een HDHP/CDHP ational Survey of Em and T and T ploy raditional raditional er-Sponsored is is s s tatis tatis H tic tic ealth aa lly lly s Plans s ignific ignific , ant and Bureau of Labor Statistics. ant at at the p p = 0.05 = 0.05 or better. or better. under Availability lying ch * Differenc aracteristics of the po and Use of Cost and Quality e between HDHP/CDHP and T pulatio raditional ns enroll is statistica Information lly ed in signific ant thes at p e = 0.05 plans ar or better.e different: Adults in CDHPs were significantly International Journal of Market Resea importance to rch. V th oe nation’s econo l. 42, no. 1 (August 200 my among policy 3). makers, the news media, and the public. It EBRI publications include in-depth coverage of key issues and trends; summaries of research order to have an HRA. 19.3 based on a millio the n i n o plan ndivid nline provi u survey o als w ded cost or ith fan HDHP, 4,703 qu private ality in 38 perce ly insure formati nt (or odn. In t a7.3 mill dults ages erm ion) re s of21 the - po 64 use rted t , and ofh in was at th formation des ey were igne pro eli d to v gided by i provi ble fod r a h e natio heaelalth thn pl ally savings ans, enrolle rollover es re provision or ported thportabili e availability o ty if thfey a he chan alth promotio ged jobs. This n pr grou ogram, p in wh clud iceh is lo s indivi wer duals (by w a statistically s ith HSA-eligiblie gni he ficant alth amo plans but unt) out-of-pocket limits for out-of-network services. Individuals can have a health plan with a deductible and maximum specific questions were asked few differences were found among CDHP enrollees, HDHP enrollees, and traditional plan Don’t know amoundoes this b t of individual y conducting deducti and p ble ublishing policy research, analysis, and special reports on Cost-Conscious Behavior ............................................................................................................................ 8 less likely to What we do have a health problem than were adults in HDHPs or traditional plans. Adults in CDHPs and HDHPs were findings and policy developments; timely factsheets on hot topics; regular updates on legislative and The Figure ince 14, ntives Perc of C entage of DHPs ar Ine dividuals designed Re to por promote he ting that They ightened sensitivit Would Probaby to cost an ly Participatd e in Em qualityployer in peo 's Welln ple’s dec ess isions about representative data regarding the growth of account-based health plans and high-deductible health plans (HDHPs), and than offer account may also inc (HSA) but CDHP e rates among lude nindiv rolle did e idua not h sCDH , HDHP e ls a P with ve such and tra n high roll an d ees, an de itio a ductibl nal ccount. Overa d tra plans es who ditenrol ional alll, rees. plan e no 15.8 mi enr t elig o llion ible llees adults a to contribute t were eg qes ually lik 21o –64 an HSA. ely to with r priva e In port t ditviduals e insura hat the with nce, y made use out-of-pocket limit that qualifies them to make a tax-free contribution to an HSA, but they are not required to make a employee benefits issues; holding educational briefings for EBRI members, congressional and enrollees. CDHP enrollees were found to be more likely than traditional plan enrollees to switch doctors to one who Family Coverage regulatory developments; comprehensive reference resources on benefit programs and workforce significantly less likely to smoke than were adults in traditional plans, and they were significantly more likely to HRAs are typically set up as notional arrangements and exist only on paper. Employees may view the account as if their health care. Yet the ability of people to make informed decisions is highly dependent on the extent to which they Availability and Use of Cost and Quality Information ................................................................................ 8 representin the impact o of the g 13.1 f these informa perc plans a ent o tion. CDHP nfd consum that mark e federal agen nrollees er e et, n were eith gagement were cy st al aff, and th so more like er m in oa re genera e news CDHP ly or media; to try to lly we on the re in and sponsoring public opinion survey find information about their an behavi HDHP that or and attitu was eligible for des of a do s on emplo dults ctor’s cost and an HSA with y but ee traditional Program, by Various health coverage include those Financial Inc with entives a broad r and Type of Health ange of plan t Plan, ypes, incl 2011 udi ......................................... ng health maintenance organi 14 zations contribution or to open an account. used e-mail to answer patient questions (Figure 18). Generally, about one-half or more of plan participants, regardless My deductibl issues; and major survey e is less than $2,000 s of public at for me and my family titudes. exercise. money w Peo as ac ptually le in CDH bein Pg s w deposited into ere also less li an accou kely to be o nt, but em bese compare ployers d do not with adults incur e en xpe rolled in nses associated wit a traditional h health the plan. benefit issues. EBRI’s Education and Research Fund (EBRI-ERF) performs the charitable, CDHP e have acc ne rolle ss to usefu es werel more inform likely than ation. traditional plan enrollees to participate in the health risk assessment, but not the private health insurance coverage. The sample was randomly drawn from Synovate’s online panel of more than 2 mil- had (HMOs), pre not o quality pen fe erred provi d from s the acco ources other dunt. er organiz When t ations (PPOs), their han th ch e h ildr ee alth n ar other pla e co n mana . unted, ge abo d ca ut re21 mi plans llion , an in d di plviduals ans with with a bro pra ivate insura d variety of nc ce, ost- Participation in Wellness Programs ......................................................................................................... 8 of plan type, a EBRI re likely to c meetings hoose a present an doctor based on d explore i his o srsues her use o with fthou HIT. ght leaders from all sectors. My deductible is $2,000 or more for me and my family educational, and scientific functions of the Institute. EBRI-ERF is a tax-exempt organization Figure 2 CDHP and HDHP enrollees were also more likely than traditional plan enrollees to be highly educated. As the CDHP and arrangement until an employee incurs a claim. By contra Figure 14 Figure 20 Figure 10 st, were employers to set up the HRA on a funded basis, they health Figure promoti 15, Perco entage of n program. Individuals Three-quart Repor ers t(73 percent) o ing that They Figure 18 Figure 12 Figure 16 Figure 22 Figure 6 Figure 4 Wo f CDH uld Pro P enrollees partic bably Participat ipated in e in Em th ployer e health 's Welln risk assessment, ess Both individuals and employers are allowed to contribute to an HSA. Contributions are excluded from taxable income if representin lion Internet g u as bers who out 12 perc have agreed to ent of the mark paret, were ticipate in eith rese er in arch surveys. a CDHP or an HSA This survey -eligible plan. used a base sam ple of 1,990 to sharing arrangements. The shared characteristic of this group is that they either have no deductible or deductibles that EBRI regularly provides congressional testimony, and briefs policymakers, member organizations, ? CDHP enrollees were more likely than traditional plan enrollees to report that they had the opportunity to fill supported by contributions and grants. Opinions Endnotes Abou Don’t t Provider En know amount of family deductible gagement ....................................................................................................... 15 Distribution of Individuals a Covered by b Private The survey asked if an individual’s health plan provided information on providers’ cost and quality. Individuals were Indiv Likelihood of iPercentage of dual Participates Changing to Indiv in Wellness Program Offered iduals Select Reporting Network that They If Current W by ould Doctor Employer HDHP markets would incur the f continu ull expense e to Reasons Cost-Conscious e xat the pan Interest A Likelihood gd reem Length for Participating a time nd mo en in Using of t With of T re en the contr Decision of Choosing ime With HRA rolle Statements an es ar ibuti in Employ A Making, pp oe enro nDoctor for , eve a Smartphone A lle by n or HSA er's b id o f by an T u for l yt V W pe e Their ellness Program, o ,a m nger of Health Plan, 201 rious ployee 2005 Use Health pe or T ? Prov riods ha 201 a d blet, 1 ider not incu of time, 201 rred a the 11 su nstained impact y expenses. that compared with 62 percent of traditional plan enrollees (Figure 10). One-half of CDHP enrollees participated in a health made by the employer and deductible from adjusted gross income if made by the individual. The maximum annual The draw inci 2011d surv enceey ex rates and the medi amine for per d o sp ons with inions a on employe regarding account-based health r benefits. the appropriate plans a use o nfd HDHPs, an lower cost sh d t ah ring as an e base sampl incee n was tive to compl chan ege the mented are below Program, by Various current thresholds that Cost-Sharing would quIncentiv ality for HSA t es and Ty ax ppe of Healt reference, and h Plan, that 2011 they ................................... do not have an HRA-bas 16 ed plan. out a health risk assessment. They were also more likely to report that they had access to a health promotion Health Insurance, by Type of Health Plan, 2005 ?2011 Don't know Am if ha ong ve Those Probably ded W as u Offered ctibl Not in Select Netw Participate in Employ e a Wellness Program, by ork, er's by Ty W pe ellness Ty of Plan, 201 pe of Health Plan, 2011 Program, 1 more likely to report that th Information ey haEngagement d, an (Percentage of privately d tr T by iechnolog ed to Health-Related Function, 201 use, Tools, y qua (HIT), by lity Ty in insured adults pe of by formatio Type Health n than of Health Plan, they 1 21–64 were Plan, 2011 cost 201 infor 1 mation, and both these Cost-Sharing MORE CO plans ar ST-C 50% Ie havi n ONSCIOU centives ng on c ....................................................................................................... S BE oHAV st, quality, IOR: Individuals in C and access to h DH ealth Ps wer care ser e more vices wil likely tha l be n tho better u se with nderstood. The sev tra .................... 15 ditional covera en ge to years of promotion program, compared with 45 percent of traditional plan enrollees. contribution is $3, E 05 BR 0 for I issu sel es pre f-onlyss rele coveraas gee an s on ne d $6,1wsworthy developm 50 for family coverage ents, and i in 2011. s among the most widely quoted way in 1 with an a divi 10 ddual diti 0% onal ran s use the h dom o ealv th care syst ersample oem. Results sh f these two grou ow across-th ps. More se p- eci boar fically, t d interes he ov t in se ersamples w lect netw eorks compos re: 1) those wit ed o hf only EBRI Issue Briefs is a monthly periodical with in-depth evaluation of employee benefit issues 50% program. CDHP enrollees were also more likely to report that they 25% were offered a cash incentive or reward to 80 70% % by Various Financial Incentives and Type of Health Plan, 2011 Calculated from Figure 1. (Among those (Percentage Strongly who wreceived health care ho never used or Somew an App hat in Agreeing With for a last 12 months) Smartphone or Statement, Tablet) HRAs can be thought of as providing “first-dollar” coverage until funds in the account are exhausted. Leftover funds at CDHP and HDHP enrol 46% lees were less likely than traditional plan enrollees to report that the plan provided the exhibit a number of cost-co Offered in ncscious be entive prizeshaviors. They were more likely to say that t 29% hey had checked whether their plan consumer engageme sount surv rces on eys report employee be ed hen re efits by all media. provide unique data from which to measure future changes in this Figure 16, Agreement With Statements About Various Provider Engagement Tools, by Type of Health Plan, Because the base sample 92% (national sam and trends ple) i, as nclu well as ded onl crit y 15 ical 1 ianal ndivi ysdu es of als in a emplo CDH yee b Pe and nefit 33 polici 0 inedivi s and pro duals pos with als a H . EBRI DHP, Patient Use of Technology ........................................................................................................................ 15 medical either an H provi 10R 0% A ders with or an HSA, recor and d 2) those s of high-qua with lity care a HDHP wh with en combin out an accoun ed with t but low wit er cost s h deductibl haring. e Eleve s that na perc re gener ent o ally h f igh Our 70% 45%* 2005 73%* 2006 2007 2008 2009 2010 2011 participate 89%in a wellness progAmong ram wheThose With n a programUsual was offer Source of ed. HDHP Care) enrollees were less likely to report 3. Do you have a special account or fund you can use to pay for medical expenses? The accounts are the end of each year can be carried over to the following year (at the employer’s discretion), allowing employees to CDHP e information. nrolle 90% T e hirty-fiv s were EBRI direct also m e percent of os re like membe HDHP ly tha rs a e n traditio nnd rollees other constit nal report plan ed ac enro uen cess to llees cies to to the informatio quality i report t a nh format at their em n they need, an ion, compa b a ployerr o ed with c fferd unde ecd a cash 40 perc rtakes ent of new evolving type To be would cove eligibl r care e of he for an ; aske alth HSA, i d f insur 87% on r a d ance. ividuals may gene Notes ric dris a monthly ugnot be e instead of n p rolle e a riod b d in ical pr ran other h d nam oviding curr ee ; t ala th covera lked to ent information on a variety their ge, s 61%* doctor a uch as ab spou out t b of emplo rse’s pla eatment o n y, u ee ben p nless that tions and efit 45% Traditional HDHP CDHP 2 an oversample of individuals 86% with a CDHP or HDHP was added. The oversample included 1,281 individuals with a CDHP 43% 48% 42% Traditional HDHP CDHP indivi enoug dh uals to 2011 .......................................................................................................................... me in CDHPs, 1 et the qu0 alify per ing t cent of hres in hol divi d tduals wit o make ta h HDH x-preferr Ps, an edd 1 contri 2 per butions cent of to in sdivi uch 32% duals wit an account. h tra d High ................ 16 itional cover deductibale ge w s wer ere e More information about HRAs and H 84% SAs can be found in the box on pgs. 23 ?24 and in Fronstin (2002 and 2004). Conclusion .................................................................................................................... 70% a c .......................... 18 having the opportunity Checked whether to f plan wo ill out a uld cover h car ee alth risk assessment an b d to have access to a health 55%* promotion program. sometimes 90% referred to a 58% s Health Savings Accounts (HSAs), H Very Interested ealth R Somewhat e Inte imb restu edrsemen Not Intet Accou rest 87% ed nts 60% research on an ongoi topics. EBRI 82% ng basis. Fundamen Tradittals ional of Employee Ben HDHP CDHP efit Programs offers a straightforward, basic accumulate funds over time, Reduc and, ed prem in ium pri 66% s nciple, creating the key incentive for individuals to make 34% health care purchases incentive CDHP enrolle or Co re e mmu s ward for and 44 nicates wi parti perc th you so ent of cipatin that you tra g i can d n r a itio eal w ly nal u ende llness plan rstand w enrol progra hat lem. Two es (Figure 8). Similarly, -thirds reported a ca 57% 30 percent of HDHP enrol sh incentive or reward for lees reported plan costs; talked t is also a publications high o their -deduct doctor ibl e about health prescription dr plan. However ug opti , indiv ons and costs; d iduals are allowed to h evelopead a ve supplem budget to manag ental 4 coverage 59%* e heal wit th care hout a 56% and 1,432 individuals with a HDHP, resulting in a total sample (base plus oversample) of 1,432 for 42%* the C 88%DHP group and 55% 55% extreme defined as ly int 40 in %di ervidual ested de in ducti using sel bles o ect n f ate leas twor t $1, ks when 000 an 59% com d fb aine mily d d with educt low ibe les r cost shari of at leasnt g$2,0 (Fig00. ure 1 T 9h ).e f CDHP a inal sample nd HDHP they are saying 78% 39% 39% explanation of employee benefit programs in the private and public sectors. The EBRI 60 80 40% % % 62% Whe n it come EBRI maintains an s to participatin d analy g in a w ze elln s the mo 38% ess program, C st compD reHP e hensi nrolle ve databa es were se mor of 401(k) e likely than -type tra prog 88%diti ram onal s in the plan (HRAs), Personal care accounts 53% , Personal medical funds, or Choic 53% e funds, and are different from Appendix—Methodology responsibly. Employers can .......................................................................................................... place restrictions on the amount that can be carried over. ................. 21 3 78%* 46% partici access to cost informat pating in the health ion, c risk assessm ompared with ent and 57 52% 31 37% percpercent reported a ent among CDHP enr cash incen ollees antive or rewar d 41 percent amon d for partici g trad pitional ating i pl n a an high expe-nses; ch deduct 80ibl % ee cked a for such t price o hinfgs as vision service befor caere, dental getting car care e; and , speci use fic d an disea online ses, and cost-tra insur cking tool. ance that pays a fixed amount Figure 17, Likelihood of Changin g Doctor If Cost Sharing Was Lower or Higher, When Using Doctors That Use 1,762 for the HDHP Asked for gg ene roup. ric drug After factor instead of brand n ing out o ame drug f the base sample—the 151 individuals with a 38%CDHP an 54%* d the 330 See www.mercer.com/press-releases/1400235 55% 36% 75% 75% 55% Databook on Employee Benefits is50% a statistical reference work on employee benefit programs enrollees were also more likely than included 1,432 in HDHPs with eit 74% her a 74% tradit n HS io A or HRA nal plan enrol (consumer-dr lees to be iven somewhat health pla inter ns, ested aor CDHPs), in the co 75% 1, c 762 ncept, in HDHPs with 40 per- without 60% world. Its computer simulation analyses on Social Security reform and retireme b nt income adequacy 49% 73% 73% 53%* enrollees to ta Works with you to Want fin ke adva ed t d rea o i limpr stic c ntage ov han e hea ges lth y of the h ou can ma 72% 9ke ealth to im r pri ov sk asse e ssment but not the health promotion pro44% gram. Among those employer-provided Flexible Spending Accounts. 53% 71% Traditional HDHP CDHP 50% health enrolle promoti es. on program (Figure 11). Wh 70%y did they participate? CDHP enrollees were more likely t 76% han traditional plan per day (or other period) for hospitalization. Individuals 5 enroll 47%ed in Medicare are not eligible to 41% make HSA Definitions ................................................................................................................... 51% 69% and work force-related issues 69% . ........................... 23 70 35% % your health individuals with a HDHP—there are 1,509 individuals 68% in the sample with traditional health coverage. 67% 33% 50% cent of accounts, an CDH Health I 70P % d and H 1,50 n are uni form 9 i Dn HP ation Techno more que. enro traditio llees in lo nal terest gy (HI heed a alth T) an n plans. d 3 d Current Doct 5 per cent of tra or Does ditional Noplan t Use HIT enrollees i , by Tnytereste pe of 75% Health d. There Plan, was about 37% 66% 52% Dis CDH tributio P ENROLL ns frEES MORE EN om an HRA foGAGED IN r qualified m WE edical LLNESS PROGRAMS: expens 32% es are ma CDHP enrolle de on a tax-favore es wed rebas more l is. Emplo ikely tyh ers an trad can a itional lso le t plan 4 participating, the reasons they gave were that they were offered incentive prizes and reduced premiums. 50% Talked to doctor about prescription options and costs 41% 63% 63% enrolle See App es to r ende ix f port that or more the de ita ncentive il on the methodology. prizes and reduce d premiums were the main reasons (Figure 12). contributio ns, although they are able to withdraw money from the HSA for quali 29% fied medical expenses and certa 42% in Wanted to learn more about own health 73% 41%* 41% 30% 30% 30% 60% Consumer-Driven Healt 50Un % derstands you as ah per Pla sonn , in s cl.................................................................................................. uding your work life, personal ........... 23 the same amount of interest in changing doctors to one in a select network combine 30% d with lower co 40% st sharing, and 58% 2005 2006 2007 2008 2009 2010 2011 employees use an HRA to purchase health insurance directly from an insurer. Since unused fun 75% ds are allowed to roll enrollees to r Yes Among those 2011 .......................................................................................................................... 10 eport thatnot parti they had t cipati he o ng, th ppor e r tunity to easons given fill out a h were ealth that they risk assessm could make c ent, and t hanges on their o hey were ................ 17 also more likely to wn; they CDHP, HDH 30 60 P % % , and traditio risksnal plan enrollees were about equally likely to use information provided by their health plans. 60 30% % 40% life, and beContact EBRI liefs Publications, (202) 659-0670; 45%fax publication 36% orders to (202) 775-6312. In addition to being stratified, the base sample was also weighted by gender, 28% age, education, region, income, and premiums. An individual also may not make an HSA contribution if he or she is 33% claim 44%ed as a dependent on another 74% Findings from this survey ar 53% e compared with findings from the 2005, 2006, and 2007 EBRI/Commonwealth Fund EBRI makes information freely available to all 27% 41% there wer 5 e no Tal statistically ked to doctor abosi ut t gnif reatm icant di ent optionffer s and eco nces by plan sts type (Figure 20). 39%* 40% over, employe report t Health S hat th avings Accounts ey ha es are d acc able e 26% to ss to a h ....................................................................................................... accumulate e Subscriptions to alth pr fu omotion pro nds over EBRI time. g Issue Bri ra Employers ca m. CDHP efs are included enron allo llees w were as part of former 26% also more like employ EBRI membership, or as part of ees to ly to report ............... 23 use any le that fto they ver a 8 The survey als However, C No lacked time; D Ho P asked r and HDH ane d t spo Ph enrollees ey ndents were their already wer r ee more likely th asons for healthy. Reasons for not p an trad articipati iti o lack n na g i l p o nlf the a partici n eir em nrop llation di e ploy es to tr er’s w d y to not elln dif fiess program. Sl nd fer by plan informati type. on on c ightly ost Traditional plans include a broad range of plan types, including health maintenanc 36% e organizations (HMOs), preferred 29% 69% race/ethnicity 40% Co to refl aches you on ect th stae ying hea actual lthy, r proporti ather than ons in t just treating yo he ur population ages 21–64 with private health insurance coverage. person’s Orders/ tax r 50% EBRI assume eturn. s a public service responsibility to make its findings completely accessible at www.ebri.org Consumerism in Health Care Survey, and the 2008, 2009 and 2010 EBRI/MGA Consumer Engagement in Health Care 37% Convenient to work 37% 28% 40 25% % 71% Figure 18,50 Likelihood % of Choosing Doctor by Their Use Health Information Technology (HIT), by Type of $199 annual subscription to EBRI Notes and EBRI Issue Briefs. Change of Address: EBRI, money in the HRA to continu he e to alth p cover roblems qualified medical expenses. Funds can be used for out-of-pocket expenses and had been o Not ffe sure red a cash incentive or 23%35% 23% reward to participate in a wellness program 35% when a pro 36% gram was offered. HDHP more than provider and qual orga ity fro 60 nizations percent res m sources oth (PPO pos), other neded that r than th man they di e ha eged car alth d not plan. e part pla Spe n ics, an ipate becaus cifically, d pl about ans 22% with e they nearly a coul broad variety of cost-sharing arran 1 in d make chan 3 CDHP an ges 73% d HD on th HP enrol eir ow lees s n (Fi gements. o gught ure Health Reim ? Few diff bursement erences wer Arr ea foun ngements d among CDHP ............................................................................................. enrollees, HDHP enrollees, and those enrolled in tradit ...... 24 ional plans The CDHP As an 30 ked %— so that all deci doc d HDHP ov tor to recommen ersamples d less s coio stlns that ywere prescri w pti relate to emp on eight drug ed by gend loyee ben er, age, inc efits, wheth ome and rac er m e/ethnic ade in Cong 42%* ity, usin ress or bo g the demogr ard room aphic s or 21% a Survey. Past reports used “Comprehensiv 1100 13th St. NW, Suite 878, Washington, e” as the descriptive label for what DC, 20005-4051, (202) 659-0670; fax number, is now labeled “Traditional” health plans. 21%21%32% 38% Traditional 21% 40% 69% 31% premiums enrolle Subscriptions es w Health Plan, for erei less like nsurance, 2011 ly to r lon ............................................................................................................. 20% ge -term port care, having C tO hBRA, an e opportu d r ne ity tiree to fhealt ill out a health risk assessm h benefits. Employ 30% ers are ent and to not require 20% have access t .......... 17 d to make o a 13), other sources with 29 percent of information citing this as a m , whil19% e on 19% e-qu ajor reason a arter of traditi nd 33 perc onal plan ent as a enro minor r llees did so. eason for not participating. Lack of time Indivi Patient Use of Technology The shared ch duals wh families’ ho aracteristic o o have reach me fe s, are this grou d age based 55p an is t d on the highe h are not at they yet eith en er st qualit rolled have no in y, most depe Med deductibl icare may mak e or nda deductibl ble informatio e catch- 30% es that up cont n. EBRI’s Web are below curr ributions. In ent site 2011, po a sts 20% when it came to choosing a (202) 775-6312 doctor based ; e-mail: on his orsubs her criptions@ebr use of health i i.org n formation Membersh tecip Information: hnology (HIT). Also, wh Inquiries ile profile of the 40% CDHP and HDHP respondIe s a nts in the omnib 18% ccessible by phone us survey describ 18% ed below. 69% 20% To maintain current health status 29% Refer A label c ences hange was 30 ............................................................................................................................... % appropriate given that these plans are not as comprehensive as they were in th ............... 25 e past and may no 30% 18% 32% 71% b unused balanc Deve es availa loped budget to ble to mana workers ge health cawh re ex epe n they nses leave. 20% health promotion pro all resea grram. ch finding s, publications, and news alerts. EBRI also extends its education and public service was the For the thresholds secon first time, the 2011 t 30 h % at d woul most-cit d qual ed r itEBRI/M y for a eason for regarding tax GA Co not -pre nsumer En f partici EBRI erred HSA membership an patin gagement co g, with ntributio 25 percent reportin d/or con in H n or eal tth C th ributio at are gener are Surv ns to EBRI-ER g it ey asked a aas lly associated with a major rea F should be dir bout HDH consumer sP on and 27 HRAs. ected to use of percent EBRI $1,000 catch-up contribution was allowed. The catch-up contribution is not indexed to inflation. CDHP enrollees were somewhat more likely than traditional plan 26%* enrollees to report that they would be 16% a16% 20% longer fit that label. Prior research has shown that cost sharing has been increasing across the 70% Tradi boa tionarld in the form of Figure 19, Interest in Enrolling in Plan Using Select Networks Composed of Only Medical Providers With Records Endnotes Participation in Wellness Program T ...................................................................................................................... a15 ke% s responsibility for coordinating your care withs other providers, .......................... 25 role to improving Ameri President/ASEC cans’ finan Chairm cial knowle an Dall dge as Salisbur through its a y 24% at the above ward-win address, (202) 659-0670; e-m ning public service campaign ail: 30% While panel Internet surveys are nonrandom, studies have demonstrated that such surveys, when carefully designed, To e reportin fficig ently it as i a mino dentify res r reaso pondents n. Forty who -five percent would qua di lify d not for partic the CD ipate because th HP and HDHP ov ey sai ersamples, th d they were al 71% e stud ready y used healthy Synov a te’s technology to engage in health-related activities. The survey found that about 28% 40 6percent of the adult population with To avoid premium increase 21% c interested in u spec sing sel ialists, ore tes ct n ting e fac tw iliti orks of es high-quality doctors when combined with lower cost sharing 20% , there was 20% ® 13% 20% 6 higher deductibles a Ch 11% ecn ke d co-pa d price of s yer ments, and t vice before getting c here are has been a return to coinsurance. 31% 70% CDH b P FINANCIAL INCENTIVES MATTER:salisbur Wheny it @comes ebri.org to pa rticipating in a wellness prog 28% ram, CDHP enrollees were more 12%12% 20%ChoosetoSave and the companion site www.choosetosav 18% e.org HDHP Dis Se tributio e Fronn sti s f n r( om an HSA 2007) and c htt an b p:/e /eh ma bs.kff.or de at any tim g/pdf/2 e01 . An 1/ i 82 ndivi 25.p dual df need not be 34%* covered by a high-deductible health plan obtain results comparabl of Providing High-Q e wiuality C th random-digit-dia are Combined l telepho With Lower Cost ne surveys. Sharing, Taylor (2003), by Type o for ex f Plan, ample, 2011 pro ............... vides the resu 19 lts Employers and insurers offer a number of different types of wellness benefits—programs de 11% signed to promote health omnibus surv private (22 percent reported it healthe insurance y of more as a ha tha 9% d some type of n major reason 87,000 onlinand e pa smartphone 23 percen nel mem a bt repo n ers who d about rted it a met 7 pe the stu srcent h a minor da y’s crit d reas a taeria on). blet. Amo 9% (havin For th ng e m g thos private insur ost part, th e with aan ere wer ce and e a no difference by plan type when it came to switching doctors if their doctor w 51% as not in the network. 10% 15% Traditional 20 10% % 8% 8% likely than tra ditional plan enrollees to take advantage of the he 17% alth risk assessment but not the hcealth promotion Uses medical terminology when explaining something to you 16% 27% 54% 10 10 % % 7% to withdraw money from the HSA (although he or she must have been covered by a high-deduct CDHPible he balth plan at the from a and to pr num even bet disease. r of surv To address seys th pec Th ifice he 20 at wer alth p 11 ro EBRI ble e co m ndu /MGA Consum cted at theer saEnga me time 14%gement usin ig the n Healt same h Car que e Survey e stionnaires 8% xami bo ned availa th via tele bilit pho y and ne and ages 21– no differenc 64.e ) The s in t 12% h follo e Ch answer ecwin ked qu g three qu al s to this seri ity rating of d estion octores of /hos spwere itaquestio l usen ds in by p the lan ty Junepe. an 14%d July Omni 27% bus Surveys to identify likely CDHP smartphone or Editorial Board: tabl Dallas L et, ne.arly Salisbur 30 yperc , publisher ent used a ; Stephen Blakely n app for , editor nutriti . Any on 13% views infoexpr rmation an essed in this p d aublicat bout one ion and th -quart ose o er use f the author d it for s sho gene uld ral 56% HDHP 7 10% 11% 11% 15% 27% ? A significant portion of the population 10% reported using 11% 11% a smartphone, and 1 in 5 reported using a tablet. Among program. The specific EBRI is sup Among t questions w hported b ose participating, the reasons they ere y as follows: organizations from all industries and sectors that appreciate the value of Does your emgave ployer offer a were that ny they were of the foll offe owing red wellness p incentive rprizes ograms? and re duced Figure 20, Likelihood of Changing to Select Network If Current Doctor Was Not in Select Network, by Ty 4% pe of 5% 9% c time the funds Summary not be ascribed to the officers, of Findings were placed in the HSA) trustees, me.m Di bers, or stributions ar other sponsors of the E e excluded fro mploye m taxa e Benefit Research ble income if Institute, the EBRI Educ they are used to pay ation and for online. He 10fou % nd that the use of demographic weighting alone was suff29%* icient to bring almost all of 3% the resu 3% lts from the participation in two specific types of wellness programs: a health risk assessment and a health promotion program that and health HD in HP resp forma 10% 0% tondents: ion, weight management or diets, or e 7% xercise programs (Figure 21). There were no CDH dif Pfere 7% nces in the Figures 11% Is accessible by e-mail 17% 23% them, about one-quarter reported using an app for health-related purposes. Among those not 5% using an app, unbiased, reliable information on emplo Research Fund, 0% or their staffs. Nothing herein is to be construed as an attem yee benefits. pt to aid or Vis hinder it the adoption www.ebri.o of a rg n/about/join/ y pending legislat for more. ion, regulation, premiums. Am Usedong those onlin If emp e cosltoy -trer ac not king too partici If emp l prolv oy ided p eratin by he g, t If r ale th p qui hle re an red to 7asons th If employ ey 10% ergave were If employer that they If emp could loyer If emp make loyer chan made 4%geIf emp s on th loyereir own; 3% Required by employer 14% This survey Figures 14 an fin d 1 ds that 5 contain in 20 fi 1ndin 1, 7gs from percent a ofseries of the popul qu aestions relat tion was enrol ed to the led in a CDH impact P, u thp at fin from a 5 perc ncial inc ent i entives cou n 2010, a ld nhave d qualified me Plan, 2011 dical ex.................................................................................................................... penses as defined under Internal Revenue Code 23% (IRC) Sec. 213(d). Dis 2%tributions .............. 19 for premiums for online included a survey number o close to th f dife r fere ent types of plies from th benef e paralle its. l te lephone survey. 21%* He also found that in some cases propensity 1% 1% use of smartphone or 0% Ca offer n sed $50 end la tablet b te cash st res for h su oflts fer to ed $25 e Aalth ll0 ows-related pur pa pa tie rtn icts ip to ate or set upp ofoses by fer Aed tim llows pa e o plan tie ffnts to type rof eque fered s, with t W the ill a inn cr s e ea wer pa se xc de tie ption nt's ad of ditio medi Isnal able to u cal claims ser real educe -tim d e,history, 15% or interpretative rule, or as legal, accounting, actuarial, or other such professional advice. www.ebri.org ? Health risk 0% assessment, where you answer a questionnaire and then a medical professional examines your nearly one-half were interested in using one. Figure 1, Premium Increases they lacked time; and they were Among Employers With 10 or More Employees, already healthy. Financial incentives were Worker Earnings, and In more a factor for CDH flation, P enrollees than for 0% patients by e-mail appointments online and receive referrals online questions via e -mail virtual visits to offer "face-to- incentive cash He in alce th R ntiive sk As en se rossm ll in pr enef t erred discounted prem Hiu ea m fo lth Pr r non omo - tio cn Pr ontrog ibut ra ion m to contribution to on participation in wellness programs. This year, CDHP 0% enrollees appear to 20% 40be mor % e respon 60% sive 80to % higher premiu 100% ms and COBRA 4 percent (Cons in 2o 009; lidate an d Om d enni robus B llment udget in HD Re HP conciliation s increase Ac d frt of om 14 1985 pe ), lon rcent in g-term 2010 care to 1 in 6surance, h percent in e 2 alt 011 h insura (Figure nce 2w ). The hile weig hting (meaning the Extremely pro Likely pensity for a Very Likely S certain tyom pe ew of hat Li pers kely N on to be o ot Very L nline ikely N ) reduced the ot at A ll Like remain l y D ing ga on' t Know ps, but in other a 0%* 10%* 2b 0%* 30%* 40%* 50%* c 60%* 70%* where it was 0%found that 11 percent of CDHP enrollees used such an app, compared with 6 percent among traditional 0% Traditional 0% health p 5% lan 10% 15HDH % P 20 pr% emium 25% par30 ticip %ants 35% HRA CDH /HS 40% fa P Ace" co45 nsHRA % ultatio /HS n50 sA % health history to identify any conditions you may have or that you might be at risk of developing. traditional Figure 21, p Per lan c enro entage of In llees wh dividuals en it came Repor to partici ting th pat atin They g in Us weed a llness pro n App gMore Than O rams. nce for a Smartphone or Less Than One Year 1–2 Years 3–4 Years 5 Years or More Nutrition Information Exercise Programs Weight Management General Health Prices for Medical Claims Balance in HSA or 7 percent cost sharing. 1988 of t ? CDHP e h 2010 .......................................................................................................................... e popu nlation rollee s with were a CDH found t P re oprese be more nts 8.4 like million ly than tradit adults io ages nal plan 21– enrol 64 with privat lees to re e i port nsu ................... 6 t rance, hat they whil wou e th ld e receiving unemployment compensation, and insurance while eligible for Medicare other than for Medigap, are also tax cases it did not reduce the remaining gaps. Perhaps the most striking difference in demographics between telephone EBRI Issue Brief is registered in the U.S. Patent and Trademark Office. ISSN: 0887 ?137X/90 0887 ?137X/90 $ .50+.50 plan and HDH Source: P enro EBRllees. I/MGA C onsumer Engagement in Health Care Survey, 2011. Source: Source: EBR EBR I/M I/M G G AA C C onsumer onsumer Engagement Engagement in H in H ealth C ealth C aa re Surv re Surv ey ey , , 2011. 2011. Source: EBRI/MGA Consumer Engagement in Health C or a re Surv Diets ey, 2011. Information Prescription Drugs History HRA* Source: Source: EBR EBR I/M I/M GG AA C C onsumer onsumer Engagement Engagement in H in H ealth C ealth C are Surv are Surv ey ey , 2011. , 2011. Source: a EBRI/MGA Consumer Engagement in Health Care Survey, 2011. ? Programs fo aa a Traditional = r i Hm ealth proving your plan with no deductible healt or <$1,000 (indiv h, like fo idual), <$2,000 (family r weight loss, ). walking or other exercise, nutrition, stress a Source: EBR TT a T raditional = rraditional = aditional = I/Commonw H H H ealth ealth ealth plan w plan w plan w ealth Fund ith iith th no no no deductible C deductible deductible onsumerism or or or <$1,000 (indiv <$1,000 (indiv <$1,000 (indiv in Health Care Surv idual), <$2,000 (family iidual), <$2,000 (family dual), <$2,000 (family ey, 2005 ?-2007; ). ). ). EBRI/MGA Consumer Engagement in Health Care Survey, 2008 ?2011. probably parti Source: EBR c Tripate aditional = in I/C H a ommonw ealth wel plan w ealth Fund lness pro ith no deductible Consum gram erism or <$1,000 (indiv if in H their ealth C em ia dual), <$2,000 (family re Surv plo eyy , er 2005 incr ?2007; ). eEBR ased premiums for nonpartic I/MGA Consumer Engagement in Health Caipant re Survey s , (Figure 14). Among free. 16 perc This ent Tablet, by mea wit a h n Tr a H s that aditional = Var DHP r distributions used to H ious Health-Related ealth epr plan w esents 1 ith no deductible 9.3 m or pay M <$1,000 (indiv Pur illion poses peo edi idual), <$2,000 (family and Ty p care le. Among th Part A or pe of ) Health B, e 19 Medicar .3 mill Plan, ion i e 2011 Ad nvan div ..................................... itduals age plan with premiums, and th an HDHP, 38 20 pere cent and online sur bTrv aditional = eys was th Health plan w e under ith no deductible -represe or <$1,000 (indiv ntation o idual), <$2,000 (family f minorities in ). online samples. b a b b HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. CONSUMER USE OF TECH bHDHP = High-deduc HDHP = High-deduc tib N tib lO e le health LOGY: health plan plan A significant w w ith ith deduc deduc tible tible $1,000+ (indiv $1,000+ (indiv portio idual), $2,000+ (fam idual), $2,000+ (fam n of the poily pul ily ), no ), no aac tion re ac cc ount. ount. ported using a smartphone, and 1 in 5 T2008 raditional = b HDHP = High-deduc ?2011.Health plan w tible ith health no deductible plan with or deduc <$1,000 (indiv tible $1,000+ (indiv idual), <$2,000 (family idual), $2,000+ (fam ) . ily), no account. b HDHP = High-deduc HDHP = High-deduc tib tib le le health health plan plan ww ith ith deduc deduc tible tible $1,000+ (indiv $1,000+ (indiv idual), $2,000+ (fam idual), $2,000+ (fam ily ily ), no ), no ac ac count. count. cHDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. Figure 2, managem Distribution bSource: c c c CDHP = Cons EBR ent, I/M of In Gum Asmoking cessa C er-driv onsumer dividuals Cov en health Engagement plan wtion, an ith in H e deduc red ealth C tible by Pr d so o are Surv $1,000+ (indiv ivat ey n , . 2011. e H idual), ealth I $2,000+ (fam nsuranc ily), with eac , by count. Type of Health Plan, 2005 ? c a HDHP = High-deduc CDHP = Cons CDHP = Cons c CDHP = Cons um um um er-driv er-driv er-driv tible health en en en health health health plan plan plan plan with w w w deduc ith iith th deduc deduc deduc tible tible tible tible $1,000+ (indiv $1,000+ (indiv $1,000+ (indiv $1,000+ (indiv idual), $2,000+ (fam idual), iidual), dual), th $2,000+ (fam $2,000+ (fam $2,000+ (fam ily), no ily ily ily ), w ), w ), w ac ith c iith th ount ac ac ac cc .ount. c ount. ount. CDHP = Cons Health reimbursemen umer-driv t arrangement. en health plan with deductible $1,000+ (individual), $2,000+ (family), with account. (or nonpartic 7.3 mipant illion c )s CDHP = Cons re , CDHP ported enroll um ter-driv hatees were also they en health wer plan we ith e deduc ligmore likely th ibl tible e $1,000+ (indiv for an HiS dual), an A but traditional $2,000+ (fam did not ily), w have plan ith acc enrol ount. such a lees n account. to report that Thus , overall, they would 15.8 million employee shar CDHP = Cons e of the um pr er-driv emi en u health m for plan emp with deduc loyment-based tible $1,000+ (individual), reti $2,000+ (fam ree health ily), w benefits ar ith account. e allowed on a tax-free basis. * Asked of CDHP only. 1100 13 Street NW · Suite 878 c * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. * * b Differenc Differenc e e betw betw een HDHP/CDHP een HDHP/CDHP and T and T raditional raditional is is s s tatis tatis tic tic aa lly lly s s ignific ignific ant ant at at p p = = 0.05 0.05 or better. or better. reported using a ta CDHP = Cons * Differenc Health sav blet. e ings account. betw umer-driv een HDHP/CDHP Among t en health plan hem, a and T with rdeduc aditional botible ut one-quarter is$1,000+ (indiv statistically signific idual), ant re $2,000+ (fam at port p = 0.05 ed usin or better. ily), with ac g an count. app for health-related purposes. Among * * Differenc Differenc e e betw betw een HDHP/CDHP een HDHP/CDHP and T and T raditional raditional isis s s tatis tatis tic tic ally ally s is gnific ignific ant ant at at p p = 0.05 = 0.05 or better. or better. * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. Figure 22, Interest in Using an App for a Smartphone or Tablet, by Health-Related Function, 2011 ............... 20 Washington, DC 20005 participate in a 2011 .......................................................................................................................... wellness program if their employer increased drug or office visit cost sharing (Figur .................. 6 e 15). Financi al adults ages 21–64 with private insurance, representing 13.1 percent of that market, were either in a CDHP or in an those not using an app, nearly one-half were interested in using one. © 2011, Employee Benefit Research Institute (202) 6 ?Educ 59-06 ation and Re 70 search Fund. All rights reserved. www.ebri.org www.choosetosave.org ebr ebr ebr ebr ebr ebr ebr ebr ebr ebr ebr ebr ebr A ebr res i.o i.o i.o i.o i.o i.o i.o i.o i.o i.o i.o i.o i.o i.oe ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org r r r r r r r r r r r r r rg g g g g g g g g g g g g g arIs Is Is Is Is Is Is Is Is Is Is Is Is Is ch su su su su su su su su su su su su su su re e B e B e B e B e B e B e B e B e B e B e B e B e B e B pIssue Issue Issue Issue Issue Issue Issue Issue Issue Issue Issue or r r r r r r r r r r r r rrt iiiiiiiiiiiiiie e e e e e e e e e e e e e from ffffffffffffff • • • • • • • • • • • • • • Brief Brief Brief Brief Brief Brief Brief Brief Brief Brief Brief D D D D D D D D D D D D D D th e e e e e e e e e e e e e ee E c c c c c c c c c c c c c ce e e e e e e e e e e e e e• • • • • • • • • • • mb mb mb mb mb mb mb mb mb mb mb mb mb mb B December December December December December December December December December December December R er er er er er er er er er er er er er er I E 20 20 20 20 20 20 20 20 20 20 20 20 20 20 duca 11 11 11 11 11 11 11 11 11 11 11 11 11 11 • N • N • N • N • N • N • N • N • N • N • N • N • N • N tio 2011 2011 2011 2011 2011 2011 2011 2011 2011 2011 2011 n o o o o o o o o o o o o o o an . . . . . . . . . . . . . . 36 36 36 36 36 36 36 36 36 36 36 36 36 36 d R • • • • • • • • • • • 5 5 5 5 5 5 5 5 5 5 5 5 5 5 e No. No. No. No. No. No. No. No. No. No. No. searc 365 365 365 365 365 365 365 365 365 365 365 h Fund © 2011 Employee Benefit Research Institute 19 13 20 17 16 12 14 10 7 9 6 24 15 25 21 26 18 22 23 11 5 2 8 3 4 Figure 7 Trends in Cost-Conscious Decision Making, by Type of Health Plan, 2005–2011 Base: Adults 21–64 who received some health care in last 12 months a b c Traditional HDHP CDHP 2005 2006 2007 2008 2009 2010 2011 2005 2006 2007 2008 2009 2010 2011 2005 2006 2007 2008 2009 2010 2011 Total Sample 953 1,363 1,794 1,548 1,651 1,601 1,509 417 802 1,284 1,484 1,693 1,914 1,762 163 652 805 1,077 972 993 1,432 Checked whether health plan would cover care 51% 58% 50%^ 55%^ 50%^ 47%^ 48% 61% 62% 61%* 61% 56%* 53%*^ 55%*^ 60%* 62% 60%* 63%* 61%* 53%*^ 59%*^ Asked for generic drug instead of brand name drug n/a 48 46 50^ 46^ 44 46 n/a 60* 58* 58* 52*^ 50* 54*^ n/a 54 54* 58* 56* 51*^ 53* Talked to doctor about prescription options and costs n/a n/a n/a n/a 35 35 37 n/a n/a n/a n/a 42 40 41 n/a n/a n/a n/a 44 38 41* Talked to doctor about treatment options and costs 42 44 44 45 33^ 31 33 56* 44^ 49*^ 49 37^ 36* 39*^ 58* 46^ 47 46 40* 33^ 36^ Asked doctor to recommend less costly prescription drug 27 31 30 36^ 34 32 35 46* 41* 43* 41 39* 39* 42* 45* 39* 38* 36 39* 37 38 Checked price of service before getting care 24 20 21 23^ 25 24 28^ 35* 23^ 27*^ 23^ 29^ 29* 31^ 29 26* 27* 25 35*^ 27^ 34*^ Checked quality rating of doctor/hospital 18 21 20 25^ 24 24 27^ 22 18 19 22 22 22 27^ 18 19 18 23^ 27* 22^ 27^ Developed budget to manage health care expenses n/a n/a n/a n/a 15 16 18 n/a n/a n/a n/a 18 17 20^ n/a n/a n/a n/a 32 25*^ 26* Used online cost tracking tool offered by health plan n/a 8 8 12^ 12 11 11 n/a 6 9^ 10 9* 10 10 n/a 17* 20*^ 20* 24* 20*^ 21* Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005–2007; EBRI/MGA Consumer Engagement in Health Care Survey, 2008–2011 a Traditional = health plan with no deductible or <$1,000 (individual), <$2,000 (family) b HDHP = high-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account c CDHP = consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. ^ Difference from prior year shown is statistically significant at p = 0.05 or better.