Adults in a consumer-driven health plan (CDHP) were more likely than those in a traditional plan to exhibit a number of cost-conscious behaviors, according to new research from EBRI.

• The 2012 EBRI/MGA Consumer Engagement in Health Care Survey finds continued slow growth in consumer-driven health plans: 10 percent of the population was enrolled in a CDHP, up from 7 percent in 2011. Enrollment in HDHPs remained at 16 percent.
• Overall, 18.6 million adults ages 21–64 with private insurance, representing 15.4 percent of that market, were either in a CDHP or were in an HDHP that was eligible for an HSA. When their children were counted, about 25 million individuals with private insurance, representing about 14.6 percent of the market, were either in a CDHP or an HSA-eligible plan.
• This study finds evidence that adults in a CDHP and those in an HDHP were more likely than those in a traditional plan to exhibit a number of cost-conscious behaviors. While CDHP enrollees, HDHP enrollees, and traditional-plan enrollees were about equally likely to report that they made use of quality information provided by their health plan, CDHP enrollees were more likely to use cost information and to try to find information about their doctors’ costs and quality from sources other than the health plan.
• CDHP enrollees were more likely than traditional-plan enrollees to take advantage of various wellness programs, such as health-risk assessments, health-promotion programs, and biometric screenings. In addition, financial incentives mattered more to CDHP enrollees than to traditional-plan enrollees.
• It is clear that the underlying characteristics of the populations enrolled in these plans are different: Adults in a CDHP were significantly more likely to report being in excellent or very good health. Adults in a CDHP and those in a HDHP were significantly less likely to smoke than were adults in a traditional plan, and they were significantly more likely to exercise. CDHP and HDHP enrollees were also more likely than traditional-plan enrollees to be highly educated.
• A significant portion of the population reported using a smartphone or a tablet. Among them, as many as one-third reported using an application (app) for health-related purposes. Among those not using an app, about one-half were very interested in using one.
• As the CDHP and HDHP markets continue to expand and more enrollees are enrolled for longer periods of time, the sustained impact that these plans are having on cost, quality, and access to health care services can be better understood. The eight years of consumer engagement surveys reported here provide unique data from which to measure future changes in this evolving type of health insurance.

plan. Summary Figure 7, Trends programs Distributio Opinions about Provider Engagement ? Specific Diff (Figure ns f erenc I have health insurance a of Findings o lly, about r non in e 22 s w Cost-Consc q ). T uali ere 3 hfie er in foun e d wer 10 C me d am ious Decisio dical e D no HP ong C e diff and xpenses are through a government p e Dr n 1 in HP ences i Making, enr 4 HDHP o nllees, HDH subj th by e e ec Type use nt to r rollees sou of smartphone or of H P e enrolle gu elar alt lg an such a h income ta es, an h Pla t other n, 2005–2012 d traditio tablet source x as s s for h well nal-pla s of in as a ......................................... eformatio alth n enro 20 -related pur percent llees n, wh wh pe ile en it p abo nalty oses by came u t one to . 10 - Appendix—Methodology Paul Fronstin is director of the Health Research and Education Program at the Employee Benefit Research Institute Findings from the 2012 EBRI/MGA Consumer Engagement in 9 Medicare, Medicaid, or Veterans ben Figure 3 Figure 10 efits ................................... 1 The specific question was as follows: Does your employer offer any of the following wellness programs? fifth (incr plan of type, eased fro tradit choosing wit ional-plan h m the 10 percent doct except enrol ors based on t io in of ln e 2 es did so. 010 medical c as heir a re use of laims history, sult of t hehe alth in Pa Figure 18 Figure 22 Figure 14 Figure 12 Figure 16 Figure 20 Figure wher tient Prot Figure 5 formatio e it 1 was n tech ection and Afforda found that nology (HIT 11 ), perce ble with Care n CDHP enrol t of Act o CDHP enrol f 201 lees 0 (PPACA lees reportin us)), ed g a The (EBRI fin ). This dings Ipssue Brie resentedf in was writte this Issue Brief n with assistance from were derived from the the Institute’ 2012 EBRI/M s research GA Co and nsumer En editorial staffs gagement . Any views in Health Care The In 2 20 012 12 , 1 EBR 0 percent I/MGA of t Cons he upopul mer Eng ation agem was enrolle ent in Hea d lth in aCare CDHP, Survey i up fro nm clude 7 perc d qu ent estions regar in 2011 and d 5 ing t percent he ways in in 20 wh 10; ich Definitions Health Care Survey Figure References 8, Availability and Use of Indiv Number Quality idual aof nd Cost I Participates Years nCov form eatio red in W n Provi by ellness Current ded Program by He Health alth Offered Plan a Plan, nd Effor t to Find Information I have health insurance through my job or the job Interest Likelihood Reasons Premium Percentage in A Familiarity g Enrolling Percentage reem of for Changing Participating en Increases t of With in With Indiv Plan of Doctor Consumer-Dri Indiv Statements A iUsing duals m in io duals Employ ng if Reporting Cost Select Employ Reporting about ers v Sharing eNetw n ers W Health V That ellness aorks With rious They was They Plans, Composed 10 or Program, Prov Low Used Wer ider ould 2012 More or Higher 2012 of Only which such an is app, c greater waived o i like mpared with f thlih e o ood of wner of t switch 6 percent he H inS g to amo A di es, becom doctors who ng tradition es disabled, use al-plan d HI and 5 per T i or f th is e ere ligi cent amon was ble for M a financial g H edicare. DHP enrollees. inc entive to do so. Also, while Survey, an online survey that examines issues surrounding consumer-directed health care, including the cost of providers expr enrollme essed i n of t in n t h HDHPs incr e his report are alth care se eased rvth ices ose of from engag the 14e pe a their u rcent i thor an patie n d sho 201 nts. 0 Over 8 uld to 16 not percent 0 be perce ascribe nt of in 2d 011 pla to t an n hpart e officers, trustees, or other d re icipants mained at t , regar ha dtles level s of in pla 2 spo 012 n ty n pe, sors ? Health-risk assessment, where you answer a by Employer A by m T on ype g questionnaire Those of Health Offered Plan, and then a 2012 W a me ellness dical professional examines y Program, o ur health From Other Sources, 2012 ........................................................................................................................ 12 of another f W Employ Medical hen Using Probably an amily me ees, Engagement Prov App Doctors W iders More o rker Earnings mb Participate er (such as With Than WT ho ools, Records Once Use in by Employ Increases, Health spouse or p for Tyof pe a Smartphone Prov of Information er Health W and iding ellness Program, arent) Inflation, High-Qualit Plan, ................ T or T echnolog 2012 ablet, 1988–2012 y 2 y Care (HIT) Chernew, Michael E., Allison B. Rosen, and A. Mark Fendrick. “Value-Based Insurance Design.” Health Affairs. CDHP enrollees were somewhat more likely than traditional-plan enrollees to report that they would be insurance, Cons of EBRI, umer- EBRI the cost of c -ERF, or Driven Health Plan their are, s satisfaction taffs. Neith swi e r th hea EBRI nor lth c EBRI are, -ERF satisfaction lobbies or takes p with healtho care pla sitions on ns, reason specific policy proposa s for choosing a ls. strongly or so (Figure 2). Thmewhat e 10 perce agr nt o eed that f the po their pulado tioctor communi n with a CDHP cated reprwith them so that t esents 11.6 million a hey dul could ts ages rea 21– lly u 64 n with derstan private d what the 60% (Percentage Strong Ely xtr or em Som ely or e v we hat ry f Ag amirlieeing ar W So ith m e St wat hat em faent mili,ar Among No T t too hose w 26% or no ith t at Usual all fami Sour liar ce of Care) by Type of Health Plan, 2012 December 201 20 2% • No. 379 Figure 8 and by by VCombined Current a rious Various Health-Related Doctor Financial With Does Low Incentiv er Not Purposes Cost Use es Sharing, HIT and and , by Ty by pe T Ty y pe pe T of ype of of Health Health Health of Plan, Plan, Plan, Plan, 2012 2012 2012 2012 histoI have health insurance ry to identify any conditions yo that I purcha u may have or that you se from a health might be at risk of developing. Indivi Participation in Wellness Programs Among those duals are able to who have roll nev Re o duc e ved r used a er fu premnds iumsnfro ap m p for one HSA i health-related nto another pur HSA poses, about o without su nbjecting t e-half were eit he distri herbution very or 44%* to i somewhat ncome and 18.6% Web Exclusive, (Jan. 10, 2007): w195 ?w203. interested in using select networks of high-quality doctors when combined with lower cost sharing, when it plan, and sources of health information. It also presents findings from the 2005, 2006, and 2007 EBRI/Commonwealth insurance, doctor was sa EBRI invit By Paul Fro es c wh 90%o ying a in lmment on e th stin, Ph.D e 16 nd repor perc this research. ., Em ent ted t with hat th plo an H y eir ee D doctor was in Benefit Research Institute HP representfo s 19. rmed a 3 mill nd up-to-date o ion people. Amon n thg th eir me e 1dical 9.3 mill hision in tory (Figu dividuals re 16 with ). 38%* 100% (Among Those Who Use a Smartphone or Tablet) These refer to 40% account-based health plans that include either a health savings account (HSA) or a health Figure 9, Employer Offers Wellness Program, by Type of Health Plan, 2012 ...................................................... 84% ........ 12 45% insurance company Availability and Use of Quality and Cost Information ..................................................................... 3 intereste penalty tax d ie n Co s u mmu as long as the sing on nicatese wifor th th you so rollover ings lik that you ca e n does n ru eal trit ly not exc uion in nderstand w formatio eehat d 60 days. Rollover contributions n, exercise programs, weight mana from Arc geme her nt or MSAs are a diets, lso Premium Increase Worker Earnings Increases Overall Inflation 18% Employers and insurers offer a number of different types of wellness benefits—programs designed to promote health 87% came to s aw 16.7% itching doctors if their doctors were not in the network, there was little difference by plan type. Fund Consumerism in Health Care Survey, and the 2008-201 42%* 1 EBRI/MGA Consumer Engagement in Health Care Survey. an HDHP, Roughly 80 36 percent r percent e(or ported that t 7 million) re heir port doc ed t tor was acc hat they e wse sre ible eligibl for ap e poin for an HSA 23% tments but when di d not the res have pondent such an s were sick. account. Thus, they are saying Traditional 13% 19% 63% a c reimbursem ? Programs fo ent arran r impro gement ving yo (HRA ur ), health, described in like fo more detail r weight loss,belo walking o w. r other exercise, nutrition, stress mana b gement, 17.1% 27% 88%* 90% Offered incentive prize Provided by Health Plan and Effort to Find s Tradi 33%* tional HDHP CDHP I have other health insurance (specify _______________) .............. 4 Claxton, Gary, et al. “Health Benefits In 2008: Premium Moderately Higher, While Enrollment in 78%* Consumer- pres permitte criptd. Ear ion 80% drnings o ug prices n contr , medical ibutions claims are hal isso not subject tory, and gene to incom ral health e ta infx oe rmation s. (Figure 23). Among individuals with a 77%* 49% and to prevent disease. Nutrition inform Th atioe n 20 a12 84%* EBRI/MGA Consum c er Engagement in Health Care Survey e 38%* xami 30% ned availability and 50% b The 2012 EBRI/MGA Consumer Engagement in Health Care Survey was conducted within the United States between overall, 18.6 Roughly 70 pe million adu rcent reporte lts ages 21– d that their 64 doc with tor un privat ders e intan surance, ds them re as a prese person, i nting 15.4 nclu per dicent of ng their that work m 81% arket, w and personal ere eit lih fe, er in Figure 10,40 In 35% %dividual Partic Tradiipates in tional HDHWelln P CDH ess Program O P ffere c d by Employer Among Those Offered a Wellness Program, 16% a b 81% 38%* 32% smoking cessation, and so on. Copyright Inf I do not have health insurance curr ormation: This report TradiInformation From Other Sources, 2012 tiona is lcopyright HDHP ed by the Em CDH ently P ........................................... ploye 79% 14.7% e Benefit Research Institut c 5 79%e (EBRI). It may be Informed and up-to-date on medical history a b 83% Directed Plans Rises In Small Firms.” 78% Health Affair 78% s. Web Exclusive (Sept. 24, 2008): w492 -w502. CDHP, ? A signi 54 perc ficant ent were very portion ofor somewhat the population interested in reported using using a a sn m a artphone or pp to checka tabl the bal et. Amo ance o nfg t thh e H em, as m SA or HRA. any as on e- 77% 77% Introduction 80% Traditional HDHP CDHP 32%* participation in three types of wellness programs: a health risk assessment, a health promotion program that 45% included a August 8 and August 17, 2012, through a 15-minute Internet survey. The national or base sample was 83% drawn from a CDHP and beli or i efs, na n an HDHP d that th that eir doctor coaches was eli 69% gible for an H them on SA but stayi 74% had ng he not o althy p rat eneher th d th ae acco an just t unt. b reating their h When their c childr ealth en ar problem e counted, s. Just by Type of Health Plan, 2012 .................................................................................................................... 13 Health Savings 73% Accounts Wanted to impr 73% ove health 73% 73% 44% 70% used without permission but citation of the source is required. Traditional HDHP 25% CDHP Health Reimbursement Arrangements 9 66% 35 14% % 70% 37% 70% Findings from the 2012 EBRI/ third reported using an application (app) for health MGA Consumer Engagement in -related purposes. Among those a not using an a bc 77% pp, about one- General health information 33% 69% 27% number of different types 64% of benefits, and biometric screening. 68% Synovate’s on In every year 30% lsince 1998, U. ine panel of InS. employmen ternet users w t-based h ho have agr ealth ee care prem d to particiium pat increases e in researc hav h seu exceeded rveys. About worker-ear 2,000 ad nin ults gs 25.2 over one-hal ? millio Biometr n i 70f % n report t dividuals w ic scree hat th nings, which ar ith eir private doctor insur e measurements or blood proa vn ides in ce, reformat presenio ting n on 14. after wo 6 rk to perce -ho determine yo urs care, nt of the Tr mark adi and 21–28 tiona ur health sta let, w 63% HDHe P percen re eith CDH tus, P t report e including blo r in a C that DHP or toh d eir an Accessible for appointments when sick 80% Health plan provides information on quality of 28%* 29% Fronstin [IF Q1 = 1,5, SKIP THE , Paul. Consumer-D 12.1% riven Heal OTHER 2 QUESTIONS] th Benefits: A Continuing Evolution? Washington, DC: Employee Benefit 64% A health savings account (HSA) is a tax-exempt trust or custodial account that an individual can use to pay for health 40% 22% half were very inter 62% ested in using one. 82%* Figure A healt11, h reimbursement a Employer Offers care provided b rra Cash Incentiv ngement y doctors (HR e or A) is a Reward n emplo for yPartici er-fun 11.2% p ded atin 47% health plan g in Wellness Program, 35%* that reimburses 44%Amo employees for quali ng Workers Whose fied Health Care Survey increases a 60 n% d inflation (Figure 1). Health insurance premiums have nearly tripled, while worker earnings have increased (n=2,004)12 ag %es 21 - 59%* T64 o av who oid pre mhad ium inhealt creaseh insurance through an employer or who 28% purchased directly from a carrier were HSA-eli doctor is Recommended C gible pl ac pressure, cesan. sible cho itation: by emai lestero l, lPaul . weight, Fronstin, height, “Fi etc. ndings from the 2012 EBRI/MGA Consumer Engagement in Health Care 30% Research In stitute, 2002. 23% 72% 60% 33%* Conclusio Wei n ght man agement or 35%* care expenses Under . Contributions stands you as a pers to the accou on, including your wo nt are rk life, pe deducti rsonal ble from taxable income, even for individuals who do not The survey fo 1 und that CD Health plan provides information on cost of care HP enrollees are more likely than traditional-plan enrollees to report that they had the option 10.1% 53%* 10.1% 25% 26% 71% medical expenses. An HRA is typically combined with a high-deductible health plan, though this is not required. An HRA Survey,” Employer O EBRI Issue Br ffers Wellness Pr ief, no. 379 (De ogram cember 20 , by Ty 12 pe of Pla ). n, 2012 .......................................................................... 13 52 perc drawn ran ent. dom ly from the Synovate sample for this base sample. This sample was stratified by gender, age, region, diets life, and beliefs 23% 23% 23% 2. Which of the following best describes your health plan's deductible: 27% b provided by doctors25%* 40 30* 34* 73% 10% 31% The By Paul Fronstin, Ph.D., Employee Benefit Research Institute remainder of this report examines the findings from the 2012 EBRI/MGA Consumer Engagement in Health Care 10 itemize their t HDH axes, an P d tax-free distributions for qualified medical expenses are not counted as ta 8 xable income. Tax- to fill The 20 out 12 a h EBR 50% ealth risk asses I/MGA Cons 13%um sment. Specifi er Engagem 25%* ent i cally, 4 n Hea 9 perce lth Care nt of S CDHP urvey en finds conti rollees r nue e 60% porte d slow d that growt their employer o h in consumerffered a -driven 50% 25% Co 21% nvenient to work 31% HRA and HSA In theory, a ra EBRI Employe enrollme e ndom sample of 2,000 yields a Benefit R nt is esea growi rch Instit ng, ute I but ss t ue B he market rief statistical prec (ISSN pen 0887e ?tration r 13 ision of plus or 7X) is pu emai blishn ed s relative m minus 2.2 percentage points (with 95 percent onthly by ly s the m Eall, mploy an ee d th Benefit e amount of tim Research Institute e, can also be offered on a stand-alone basis or with comprehensive insurance that does not use a high deductible. 69% income, and race. The response rate was 37 percent (32 perc 8.1% ent for the base sample or national sample, and 43 per- ________. “Health S avings Accounts an Of those whose plans provide info on quality, d Other Account-Based Health Plans.” EBRI Issue Brief, no. 273 Coaches you on staying healthy, rather than just treating your 29% 30% 8.0% 28%* 23% Survey as they relate to differences and similarities among individuals enrolle 7.5% d in traditional69% health plans, CDHPs, and 1100 13th St. NW, Suite 878, Washington, 21% DC, 20005-4051, at $300 per 42% year or is included as part of a membership subscription. Periodi- free distributio 20% ns are also allowed for certain premiums. 27%* health health Figure pla risk assessment, com 12,n Rea s: 10 sons for Part percent of ic the pipating ared popu with in Employers Wellness Program, lation 33 was percent of tra enrolled i 41%d n 7.3% itional a CDHP, -plan up 2012 en from 7 rollees ...................................................... percen and 25 t in percent 2011. of Enr Ho D llment HP enrolle in HD es ......... HPs 14 Report availability: In response, employers hav This re he e b port is alth p een seeking roble availa ms ble on th ways to manag e Internet e th at e cost increases. During www.ebri.org the last decade, employers have 8% Exercise progr how man ams y tried to use it for doctors 46 47 26% 53 confidence) of what the result indivi Medical Homes Employees ar duals hae eli ve been gible in for a then ss would be HRA only e pla 20% ns is sho wh if the entire population ages 21– en th rter tha eir nemplo the tiy me oth er offers suc ers ha64 with ve been h a health private health insur enrol plaln e. d in tradition ana ce coverage were l covera 26%* ge. Among 72% 6.9% cent for the o 40%versample). The margin of error for the national sample was ±2.2 percent. [A deductibl (Employee Benefit Researc e is the amount you have to pay before h Institute, September 2004). your insurance plan will start paying any part of cals postage rate paid in Washington, DC, and additional 25%* mailing offices. POSTMASTER: Send address cha 36% nges to: EBRI Issue Brief, 1100 40% 25% 20% 6.3% HDHPs. The report also examines consumer engageme 6.1% nt more generally. It examin 6.1% 6.1% es health 6.1% care decision 6.1% making, cost To maintain cu Of those whose plans provide info on cost, how rrent health status 35% (Fi remaine gure 9 d at ). As 1ked a 6 percent. bout t Ov heerall, availabil 18.6 ity of mill ion a health dults a -promot gesi on 21– pro 64g wit rams, h private insura 55 percent onfce, CDHP enrollees and 41 perc re65% presenting 15.4 percenent of t of turned their at 13th St. NW, tention to Suite 878, W acc ashio nunt-based gton, DC, 200health 05-4051. plans—a Copyright combination 2012 by Employ o ee f h Be enalth efit R pl esa ens arc h with Institde ute. ducti All right bles s r of at eserved. leas No.t 3$1,0 79. 00 surveyed with individuals witcomplete accur h traditional co average, cy. There are 20 percent also other poss had been i ible sources of error in al n their plan for three to l surveys that ma four years and 49 y be more serious than percent for five or 22% 28%* 5.5% In 20 your medica 12, the EBRI/M l bills.] GA Co nsumer Engage Is acce ment in ssAT A GLAN ible by ph Hea one lth Care Survey for t CE he first time ad 62% ded a series of questions 6% The HSA is o 30% wned by the man individual y tried to use it for doctors with the high-deductible health pla 42n and is compl 42 etely portabl 53* e. There is no use-it- and Figure qual 13, ity in Rea 15% fo srmation, part ons for Not Picipation articipati in ng in we llness pro Employers gra We ms, llness Pro medical g 20% h rao m Among Tho mes, opinionss about e Offere provi d but der en Not Partici gageme pat nting , cost- 65% traditional Employers hav that market, -pla were eith ne enro a tremen llees er reported that in doa CDHP us amount o or th were in f eir em flexi an bilployer ity in HDHP de o th ffer sig at nin ed such a was e g health ligi program. b pla le for ns that an HSA One-thir inc but orporate d the (34 perc enro an H llent) of HDHP ee h RA. For a ad not o exam pple, t ened he for employee Ba-only covera lance of HSA or HRA ge and tax-preferred savin 19% gs or spending accounts that workers and the 14% ir families 4.1% can use to To examine the issues mentioned above, the sample was divided into three groups: those with a consumer-driven theoretical calc more ________. “The Future of years. This 15 30 % % ulations of sampling erro comparTried to find information from sources other than es with 27 Employment-Based Health percent r. These include refusals to be intervie and 26 percent, Benefits: Hav respectivee ly, amon Employer wed and other forms of nonresponse, the g pe s Reac ople in hed a CDH Tra Ti aditiona P (Fi pping l gure Point?” 3). Whil EBRI e 20% 30% related to whe Wantted t her a o lear n n m in or divi e abou dual ha t ow 18%* n hed alth a “medical home.” To have a 13% me 13% dical 13% home, the respondent must have indicated 11% 17%* 71% or-lose-it rule associated with an HSA, as any money left in the account at the end 31% of the year automatically rolls over in Program, 2012 ..................................................................................................................................... 14 sharing ince Taken s r tieves relate sponsibility ford to coordi plan nating type, your car an e witd healt h other prov hid ier ns, formation technology. enrolle amount of the acco es re unt. mo 20 4% po % Whe ney that rted t n th he eir is availa risks 11% health plan on cost and quality of care provided chi plaldren ced bility o in t we fh a re e a he co cc al unted, o th promotio unt, the abo lev ut n 25 mi elpr of ogram, tllion he de in signi ducti dividuals fb icantly le, and the with lowe pr 11% c r ivate insura than of omprehe fer nsive rate nce, re n sess of t among presenti hCDH e nhe g a P an alth bout d 27% 69% p health ay the pla ir ou n (C t-of DHP), -pocke those t heaw lth ith a care high-de expense ductibl s. A h e h and ealth ful of plan employers (HDHP), first started offerin and those with traditional g account he -based h alth cove erage. alth plans effects of ques still low Issue B er thr aief n tion wording a the , no percenta . 312 (Employee Benefit n ge o d question f individu order, and scree als with Research In traditi no ing. While attempts are nal covera stitute, Decem ge, the b num er 2007). mad ber o e to minimize these factors, it is f peoplea with a CDHP and the No deductible 10% 10% b a specialists or testing facilities that he Table of Contents or she had a personal/family doctor; had timely access to care; had a doctor who knows medical history; had a 70% HDHP Traditional 10% Traditional and is available in the fol blow y doctors ing year. 8% 21 25* 31* 10% Prices for prescription 20% c 8%* traditional insurance 14.6 percent are -pla o n all subject f enro the market, llees. to v When asked a were eith ariation. Em The Em er b in pl oplo oyers often u a CDHP t biom yee Benefi etric-s or a co t Research Institut n cver HSA-eli reen 13% certai ing pro gible n pre gpl reams, 44 an. v entive servic (EBRI) was founded in 1978. Its percent of CDHP es in full, not en subjecting the rollees r mission is to eported that m to in 2001 with health reimbursement arrangements 8% (HRAs). In 2004, employers were able to start offering health savings Individuals ? were assign The 2012 EB ed to RI/MGA Con the CDHP an sumer Engagement in Health d HDHP group if they had a deductible o Care Survey finds contin f at least $1,0ued slow gr 00 for individua owth in l impossible to q length of time 10% Individual or Single Coverage CDH they uantify the P 11% have Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2012. err been e ors that may re nrolled in that pl sult from them. an have been increasing. In 2012, 2 54% 6 percent of CDHP e b 7%* nrollees 2% drugs 62%* 18% 18%* provider who knew him or her as a person; and had a provider who was coordinating care. Forty cpercent of traditional- Required by employer 13% Figure 14, Percentage of Individuals Repor 2.1%ting 2.5%That 9% They Would Probably Participate 6%* in Em 6%* ployer Well HDHPness Program, Introduction .................................................................................................................. b ........................................ 4  a Provides information on after hours care 53% CDHP 2 contribute to, to encourage, and to enhance the development of sound employee benefit 21%* HDHP 10% Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). their the ________. “A deductible employer. Employers c vailability, C offered sucho an of ntribution a pro fer gram, comprehensive s, A coccount Bal mpared with he aal nc 32 percent th insura es, and Rollovers in Accou nce t amo hat covers ng tradition 100 percent al-plan nt-Based Health Plans, enrol of h lees ealth c and are cost 26 percen s after t accounts ( coverage or HSAs) $2,000 .My deductible is le By for fami 2012, ly coverage. 36 percent o ss tha To be assign f employers n $1,000 ed witto th h 50e 0 or more CDHP gr workers oup, they mu offers e 57% td als either o have an h HaRA- or d an accou HSA-n eli t,g sibl uch e reported that consum they haer-dri d been ven health pl in that health ans: 10 percent of the p plan at least 5 years, up fr opulation was enrolled in a C om 8 percent in 2006 (FiguD reHP, up from 4). 7 per- 5% b c 5% plan In ord enrol Who we are er to lees, qualify 42 percent for tax-f of HDHP ree contrenroll ibutioees, and 44 ns to an HSA, pethe i rcent of ndivi CDH dualP mus enrolle t bees w cover ere ed det by a ermine health d t pla o have n that a me hasdi an cal by Var 10% ious Financial I HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. ncentives and Type of Health Plan, 2012 .................................................................... 16 Cost-Cons 0% cious Behavior programs and sound public policy through objective research and education. EBR CDHP I is the only 11 6% Summary of Findings The 2012 EBR 0% I/MGA Consu ........................................................................................................... mer Engagement in Health Care Survey continues to find that CDHP c .................................. 5 enrollees are somewhat   15% 27% Permitted insurance also includes workers’ 2006 -2009.” EBRI Note c s, no. 11 (Empl compensation, oyee Benefit tort liabil Research In ities, an stitute, N d liabilities rel ovem ated to ownership or the use ber 2009): 2 ?12. of among H the deductible DHP Me enrollees. has dical cbeen laims his met tory or they may offer coverage with cost sharing after the deductible CDHP is met. If employers plan, covering 16 percent My deductible is $1,000 If employer of that If emplpopulatio oyer If r 5% en qui , up from ror more ed to If emp 32 loy percent offeri er If employng suc er If emp h a pla loyern and 13 If employerpercent enro made If employer llment in as a health sa cent in 2011. vings accou To address spec CDHP = consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. in fict he Enrollment in (HSA) or alth problemhealt HDHP h reims remai bursemn ent arra ed at 16 per ngement cent. (HRA) wit h a rollover provision that they 0.2% 12% privatIe, nonprof s accessible by it, nonpar email tisan, Washington, DC-b 21%* ased organization committed exclusively to home annualbased o deductn ible the of criter not lia a ess than bove, tho $1,20 ugh 0 fthe or self dif-only co ferences were verage not and $ statistically sign 2,400 for family ificant (Fi coverage gure (mi 17 nimum ). deductible 11%* offered $50 cash offer ed $250 participate to offered time 14% off offered increased additional reduced The more cost con theory 3 behind account scious in th * Difference between HDHP/CDHP and Traditional is statistically significant at p eir -based pla decision maki ns anng t d plans han t with hose high in tra er d deducti itional plans. While b 28% les is t = 0.05 or better. hat t CD he cost- sh HP enrol arin lees, g structur HDHP ee nrolle will be es, and 0% Cost-Conscious Behavior ........................................................................................................................................ 8  With respect t choose to property (such as auto pay less than 100 perc o familiarity mobile insurance) with a C ent o DHP, f. health car 62 percent o e expenses f those with after a the CDHP were deductible extremely or v has been me et, they then hav ry familiar with it e t(Fi he gure (See p ageDon’t know amount of individual ded 24 for detailed ex public planatio poli ns cy r of HRAs esearch an and d HSAs uctible educat.)ion on economic security and employee benefit issues. 201 could 1. use to -2 0% 0% % pay for medical expenses or the ability to take their account with them should they change jobs. incentive cash incentive-1.1% enroll in prefered discounted premium for non- contribution to contribution to Figure 15, Percentage of Individuals Reporting That They Would Probably Participate in Employer Wellness Program, Extremely interested Very interested Somewhat interested Not very interested Not at all interested Don't know amounts are indexed to inflation but remain at $1,200 and $2,400 in 2012). Certain preventive services can be covered 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 0%* 5%* 10%* 15%* 20%* 25%* 30%* 35%* 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% CDHP enrollees were more li ________. “S more likely to traditional-plan enro ources of Cov engage in llees He dividuals in we alth rire abo kely than e skrage and Ch asLo sewer ssut m their c ent oequa stradi t shar h hele iaracteristic al ly likely n talth c ional-plan g th plan are, co to re enr He 0% s of port alt mp h pr ollees to the Unin ared w om that th otion 20 pr pr % partic ith em ogr ey sur iu a people m m made eip d: Analysi ate 40 enro % pa use o in rtic H healt ip ighe lle ants fs quality i d in mor r of the Mar co 60 h st % -risk assessments, health sh BHRA iom arinn etr ge /HS format i tra c s A 80 ch 2 creen d %iting ional cover ion provi 012 Current HRA/HS 10A 0% deage d -by their . This EBRI’s membership includes a cross-section of pension funds; businesses; trade associations; 5). In co ? ntrast, 13 Overall, 18 Family percent Co.6 ve o million adults rage f individuals w ages 21–64 ith traditional with private coverage were extr insurancemely or e, representing 15 very familiar .4 percent of that with a CDHP, and option o Availability f des anignin d Use o g thfe Cost planand Q with or uality witho Inu formation t a maximum ................................................................................................. 8 out-of-pocket limit.   Less Than One Year 1-2 Years 3-4 Years 5 Years or More Individuals with only a flexible spending account (FSA) were not included in the CDHP group. by Various Cost Sharing Incentives and Type of Health Plan, 2012 .............................................................. 16 12 in full and are not subject to the deductible. The out-of-pocket maximum may not exceed $6,050 for self-only coverage -4% labor unions; health care providers and insurers; government organizations; and service firms. Only Medicare Population Su enrollees ages 65 and older a rvey.” EBRI Issue Brief, no. 376 (Employee Benefit Research Insti re allowed to pay insurance premiums from ant HSA. A Medic ute, Septemb ae re enrollee under r 2012). promotion pro study fi health pla nds n, C eviD g dHP e rams, encen that rolle and bi adults in es wer ometric e mor a C scree e D lik HP nings. Thre ely to and those use cost e-quarters in an HD informat HP (77 w ion a pe erercent) of n more l d to try to ikely t CDH fin h P enro d an those information llees in pa a t rticipate about t raditiona d h eir in l plan do health- ctors’ to Additionally, e Source: m Source: ployers EBRI/M EBR GA I/M hav C G onsumer A e Consumer be Engagement en inter Engagement in H ested in brin ealth C in Health C are Surv are Surv eygin , 2012. eyg , 2012. aspects of consumer engagement into health plans for many Source: Source: market, were either in a C Source: My deductible is le EBR EBR EBR I/M I/M I/M G G G A AA C C C onsumer onsumer onsumer Engagement Engagement Engagement ss tha in H in H in H D ealth C ealth C HP or wer ealth C a n $2,000 for are Surv a re Surv re Surv ey ey ey , , e 2012. , 2012. in an HDHP 2012. me and my that was eligibl family e for an HSA. When their children 13 percent o Source: Source: Source: f i Source: n 19divi 88 EBR EBR EBR EBR 19 duals I/M I/M 89 I/M I/M G G G 19 A A G A 90 C A C C onsumer onsumer wit C onsumer 19 onsumer 91 h an 19 Engagement Engagement Engagement 92 Engagement HDHP 1993 19 in H in H we in H 94 in H ealth C ealth C 19 ealth C ealth C re e 95 19 a a a re Surv re Surv re Surv x a 96 re Surv tremely 19ey ey 97 ey ey , , , 2012. 2012. 19 2012. , 2012. 98 o 19 r very 99 2000familiar 2001 2002 with 2003 20a CDH 04 2005 P 20. 06 Familiar 2007 2008ity wit 2009 20h 10 a C 2011D20 HP 12 among Participat Cost-Sharing Incentives ion i a a n Well a ness Programs ......................................................................................................................... 11  a a a a a T a T raditional raditional Traditional = H = H ealth plan w ealth plan w = Health plan w ith ith no deductible no deductible ith no deductible or <$1,000 or <$1,000 or <$1,000 (indiv (indiv (indiv idual), idual), idual), <$2,000 <$2,000 <$2,000 (family (family (family ). ). ). and $12,100 T f Tro r T aditional aditional rr family aditional = H = H = H ealth plan w ealth plan w cove ealth plan w rage, iith th ith no deductible no deductible no deductible with the or <$1,000 or <$1,000 or <$1,000 deducti (indiv (indiv (indiv iidual), dual), b idual), le co <$2,000 <$2,000 <$2,000 untin (family (family (family g tow ). ). ). ard this limit. The minimum allowable deductible and T T T rraditional r aditional aditional = H = H = H ealth plan w ealth plan w ealth plan w iith th ith no deductible no deductible no deductible or <$1,000 or <$1,000 or <$1,000 (indiv (indiv (indiv iidual), dual), idual), <$2,000 <$2,000 <$2,000 (family (family (family ). ). ). risk assessments, comp exhi There costs and age 65 cannot use an HSA to pay insur bit a is num no st qual bbber o atutory re ity from sourc b f cost-co quir ared with 64 ement t ne scious be s other h than at a p ahavi e nce rcen n employ ors. Speci premiums. the h t of tradit ealth ee f pla icall hav ional-pl n e y. CDHP a , those in hig an h-de enroll en a du roll e Cctible e ees w D s (Figure HP an hea ere d t mor lth h 10 ose in plan i ). One e like an nl or -y tha hal HDHP der to f (53 n tr perc also have were aditional ent more )- of plan an lik C ely than D HRA. HP b b b b HDHP = High-deduc HDHP = High-deduc tible health tible health plan w plan ith deduc with deduc tible $1,000+ (indiv tible $1,000+ (indiv idual), $2,000+ (fam idual), $2,000+ (fam ily), no ily), no account. account. years. As far Individuals we b b b HDHP = High-deduc HDHP = High-deduc HDHP = High-deduc re as ack as 1 My deductible is $2,000 sign978, edtib tib to tib l t le e le health the health h health ey a HDHP plan plan plan dopte w ww iith th ith deduc deduc gro deduc d S tible tible tible up i ec. 1 $1,000+ (indiv $1,000+ (indiv or more for me and my f $1,000+ (indiv f t 2hey 5 cafet did iidual), $2,000+ (fam dual), $2,000+ (fam idual), $2,000+ (fam e no ria t have plans an ily ily an ily ), no ), no ), no d a ac ac ac ccount use fc clount. ount. cexi ount. amily ble spen d di fong acco r healthunts care(FSAs). Mor expenses with e re a cently, those with a C were coun HDHP = High-deduc HDHP = High-deduc DHP increase ted tib tib l, e d bet abou le health health plan w plan t 25 mi ee ww ith n ith deduc 20 deduc llion individuals with priv 1 tible 1 tible an $1,000+ (indiv $1,000+ (indiv d 2012, idual), $2,000+ (fam idual), $2,000+ (fam but was uncha ily ily ), no ate insurance, r ), no ac n ac g count. ced for ount. individuals wit epresenting about 14.6 per h traditional coverage or cent of Figure 16, Agr HDHP = High-deduc HDHP = High-deduc eement With tib tiblle e Statements a health health plan plan w wiith th deduc deduc b tible tible out Vario $1,000+ (indiv $1,000+ (indiv us Pr iidual), $2,000+ (fam dual), $2,000+ (fam ovider Enga ily ily), no ), no gement Too ac acc count. ount. ls, by Type of Health Plan, 2012........ 17 c c c c c Opinions Unlike past ye abou c cc c CDHP = Cons CDHP = Cons ars, there t Provider En CDHP = Cons um um w er-driv er-driv um e er-driv gageme ren e en diff health health en health erenc plan plan nt w plan w ..................................................................................................................... ith ith e deduc ws deduc ith by plan ty deduc tible tible $1,000+ (indiv tible $1,000+ (indiv $1,000+ (indiv pe. idual), idual), Abou idual), $2,000+ (fam $2,000+ (fam t on $2,000+ (fam e-fift ily ily ), w ), w h (21 ily ith i), w th ac ac ith cc ount. ount. percent account. ) of individuals with traditional 15  maximum out-of-pock CDHP = Cons CDHP = Cons CDHP = Cons um um e um t lim er-driv er-driv er-driv en it en en are health health health plan indexe plan EBRI’s work advances knowledge and unders plan w wiw ith th ith deduc deduc d deduc to tible tible tible infl $1,000+ (indiv $1,000+ (indiv $1,000+ (indiv ation. A iidual), dual), i n dual), e $2,000+ (fam $2,000+ (fam tw $2,000+ (fam ork plan ily ily ily ), w ), w ), w m iith th ith ac ac a ac cy impos count. o cunt. ount. tanding of emplo e a higher deduct yee benefits and their ible and an out-of- Fronstin, Paul CDHP = Cons CDHP = Cons CDHP = Cons , and S um um a umra R. er-driv er-driv er-driv en en en Collins. “ health health health plan plan plan w w w iith th ith F deduc deduc deduc indings From tible tible tible $1,000+ (indiv $1,000+ (indiv $1,000+ (indivth iidual), dual), idual), e 2007 EBRI/C $2,000+ (fam $2,000+ (fam $2,000+ (fam ily ily ily ), w ), w ), w iith th ith ac ommonwealth Fund Consu ac ac c cc ount. ount. ount. merism in Health Source: Mercer, National Survey of Employer-Sponsored Health Plans, and Bureau of Labor Statistics. enrollees part However, those wit enrollees to ta hit is tra * Differenc id cipated i ke adva standard pract itional * Differenc Don’t know amount of family deductible e betw covera e ntage n een HDHP/CDHP betw he een HDHP/CDHP alge to of various th-promotio ice amon say that and T and T raditional g wel em rn aditional lprograms, co n they ha ployers that isess program statis is s tic tatis ally d c tic sa ignific lly h sec a ignific mpare ant s, such as health- n ked at ant em p = at whet 0.05 ployee d w p = 0.05 or better. ith her t or better m 41h u percent e st also choos plan risk a wou ssessments, health-p of tr ld cover car aditional e a high-de -plan e du (56 percent enrolle ctible romotion hea es. Nea CDH lth plan i rly P ann d employers hav * * * Differenc Differenc Differenc e bee e gu e betw betw betw n to een HDHP/CDHP een HDHP/CDHP een HDHP/CDHP take a broa and T and T and T rrder vi aditional aditional raditional ew o is isis s s s ttatis atis tatis tic tic ftic cons a ally a lly lly s s is ignific gnific ignific um ant ant ant er en at at at the p p p = = 0.05 0.05 ga = 0.05 or better. geme or better. or better. nt in health care. In 2001, they formed a coalition rollover provision or * the market, * Differenc Differenc e e betw portabili betw een HDHP/CDHP een HDHP/CDHP were eith ty if tand T h and T ey er in a CDHP or raditional c raditional hanged isis s s tatis tatis jtic o tic abs lly ally s. T is gnific an HSA-eligible plan. ignific his ant ant grou at at p p = 0.05 = 0.05 p ior better. nclu or better. ded individuals with an HSA-eligible health plan with an HDHP. * * Differenc Differenc e e betw between HDHP/CDHP een HDHP/CDHP and T and Trraditional aditional is is s sttatis atistic tica ally lly s siignific gnificant ant at at the p p = 0.05 = 0.05 or better. or better. importance to the nation’s economy among policymakers, the news media, and the public. It coverage reported that they would change doctors to one who used HIT if cost sharing was lower, compared to 23 per- pocket l Survey.” imit for out-o EBRI Issue Brief, f-network services no. 215 (Emp . Individloyee Benefit uals can have a Research In health plan stitute, with a de March 2 ductib 008). le and maximum out-of- Medical Homes ..................................................................................................................................................... 15  four-fifths 54 order to programs, a Figure perc17, ent H have (78 Individual Has n Don't know if have deductible D d biometr an HRA. HP vs percen. t) of 45 i c scr per aC "Medical Home," 2012 D eenin cHP e ent tra gs. In nrolle ditiona addition, es partic l); as ipate ke fina .............................................................................. d for a d ncia in l inc ge biom neric entives m etric sc drug reenin i attered more nstead o gs, com f a br p tared o and CDHP with name enrol 63 (5percent of tra 3 le perc es than .................... ent to CDHP ditional and 17 - to report but may hea also have lth-care in-provi cluded indivi der qua dlity meas uals withures a high dedu , and toda ctible y the who grou are p is not compos eligibled e to not contribute only of em to plo an HSA. I yers butn als divi oduals of does this by conducting and publishing policy research, analysis, and special reports on What we do cent among HDHP enrollees and 28 percent among CDHP enrollees (Figure 18). Similarly, 23 percent of individuals pocket limit that qualifies them to make a tax-free contribution to an HSA, but they are not required to make a 4 Cost-Sharing Incentives ........................................................................................................................................ 15  The study a ? lso fin This study ds the fo find llo s evidenc wing:emplo e th yee benef at adults in its issues; holding educational br a CDHP and those in an H iefings for EBRI memb DHP were more likers, congressional and ely than those in a plan 52 traditional perc enrol ent H l-ees. pla Dn enro HP vs. 41 perc llees. ent traditional); talked to their doctors about prescription options and costs (38 percent consumer groups and organized labor. In 2005, employers started to focus on value-based insurance designs that with traditional health coverage included those in a broad range of plan types, including health maintenance Taylor, Humphrey. “Does Internet Research ‘Work’? Comparing Online Survey Results With Telephone Surveys.” with traditional coverage and HDHP enrollees reported that they would change doctors to one who used HIT if cost contribution or to open an account. HRAs are ty Figure 18, Likelihood of Cha pically set up as n notional ging Doctor if Cost Sharing federal agen arrangements cy staff, and th and was Low exist e news only media; e on r orpaper. A High and sponsoring public opinion survey er n Wh em en plUsing Doctors oyee may view th Who e acco s on emplo Use Heal unt as if yth ee 3. Do you have a special account or fund you can use to pay for medical expenses? The accounts traditional plan to exhibit a number of cost-conscious behaviors. While CDHP enrollees, HDHP enrollees, CDHP and 39 percent HDHP vs. 30 percent traditional); talked to their doctors about other treatment options and costs Patient Use of Technology ..................................................................................................................................... 15  seek to e organiz ations (HMOs), pre ncourage the use o ferred provi f high-value der organiz services w ations ( hile discouraging t PPOs), other h manage e use of d ca serv reices w planshen , an the d pl ans bene with fits ar a bro e no ad t International Journal of Market Research. Vol. 42, no. 1 (August 2003). benefit issues. EBRI’s Education and Research Fund (EBRI-ERF) performs the charitable, sharing was higher, compared to 32 percent among CDHP enrollees. CDHP e money w It is not ? Indivi nclear Information Technolo rolle as ac duals i e from the tually s were n bein a CDHP also m data g deposited into o wheth were re like gy (HI e more likely th lr th y tha T) and Curr e n di an accou traditio fferences ent Doctor an those wi nal-pla nt, in co but an nnsumer e enro Does th employe traditional llees Not Use HI n to ga r does gement c report t cov T, not i erage by Ty hat th an nc to u be pe o r e eir em exhi attribute xpe f H bit a n nses a ployer ealth Plan, d to ussociated w o mber of plan ffere 2012 d a cash design cost- .............. ith the 19 are sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement and traditional-plan enrollees were about equally likely to report that they made use of quality (35 percent CDHP and HDHP vs. 28 percent traditional); developed a budget to manage health care expenses (26 per- justified by the costs (Chernew et al., 2007). Conclusion .................................................................................................................... variety of cost-sharing arrangements. The shared characteristics of this group were that they ....................................... either had no deductible 18  educational, and scientific functions of the Institute. EBRI-ERF is a tax-exempt organization Figure 11 Both individuals and employers are allowed to contribute to an HSA. Contributions are excluded from taxable income if Figure 2 Figure 21 Figure 13 Figure 23 Figure 17 Figure 19 Figure 15 Figure 4 Figure 6 conscious behaviors. They were more likely to say that they had checked whether their plan would cover care; incentive arrangem differences or Accounts (H or ent re until a ward for wheth ne emplo r vario parti RAs), Personal care accounts, Personal medical funds, or C y c uee in ipatin s placurs a n g i design n a cl waim. By co s attract certai ellness progra ntram. Ne st, were n kindarly t s of an in w employer to di o-thir viduals. R ds (63 set e per gar up the HRA o cent) re dless, it hoice funds, ported a cash is clea n a r that t fund inc ed h and are e ba enti sis, the ve or information provided by their health plan, CDHP enrollees were more likely to use cost information cent CDHP vs. 16 percent traditional); checked the price of a service before getting care (32 CDHP and 27 percent supported by contributions and grants. or deductibles that were bEmploy elow curr er ent t Offers hresCash holds that Incentiv would e or qua Rew lify a fo rd r HSA ta for Participating x preference, in and that they did not have a b Appendix—Methodology Like the responses on HI Distribution .......................................................................................................... T and cost shar of Indiv ing as i idual ns cent Cov ivee sred to switch by Priv toate a doctor Health who Insurance, uses HIT, whe .............................. n more specific 22  made by the employer aCost-Conscious nd Reasons Likelihood deLikelihood Percentage ducti Interest Length b for le from Indiv Not of in Changing of of Using adj Decision of iParticipating dual Choosing TIndiv ius me tan Has ed With i gros duals A to Making, p a "Medical p Select Doctor s HRA income for in Employ Reporting a by or HSA Smartphone Netw by if m T Home," y Their pe ers ork aThat de , of 2005–2012 W if by th Use Health 2012 ellness Current They or e i of T ndi Health a W Plan, blet, vidual. Program ould Doctor 2012 The maximum annual Figure 19, Likelihood of Choosing Doctor by Their Use of Health Information Technology (HIT), by Type of Health different from employer-provided Flexible Spending Accounts. r employer under eward lying ch as foked for wou r paaracteristics of the po rt ld ic in a ipcur t a ge ting neric he in the full dru ex h g iea pense nslt tpulatio h ead o ri at t sk asse f a n hs enroll e time brssme and nam of ed in n the t; oe n thes c ; talk eo -h ntributio e ae lf plans ar d re to t pon, ev r heir ted e different: doct a c en iafor about sh an em in Adults in cent plo pr ivye ee ha es ocription a C r red w Dnot i a HP rd f options wer n ocrurred any e p si a and rgnifica ticip cos at in nttly g s in ; a This Issue Brief presents findings from the 2012 EBRI/MGA Consumer Engagement in Health Care Survey. This study is and to try to Wellness find informati Program, on abou At thei mong r doctor Worker s’ co s Whose sts and qu Employ alityer from sour Offers ces other than the HDHP vs. 23 percent traditional); an d used an online cost-tracking tool provided by the health plan (23 percent CDHP (Percentage of privately insured adults 21–64 who received health care in last 12 months) an HRA-based plan. by Type of Health Plan, 2005–2012 Endnotes Figure 9 questions 50wer % e asked, statistically signific AInformation moProbably ng WThose as Not T Participate by a echnolog Offered in nt di Health-Related Select fferen but y Netw c in e(HIT), s Not Employ were fou ork, Participating by Function, by T er n y d a T pe W ype m ellness Program, of ong C of 2012 Health in Plan, D Program, HP Plan, 2012 enrollees, H 2012 2012DHP enrollees, and contribution is 50% $3,100 for self-only coverage and $6,250 for family coverage in 2012. Definitions Plan, 2012 ................................................................................................................... .................................................................................................................... ........................................ ........................... 24 19  developed a budget to manage health care expenses; checked the price of a service before getting care; and health exp more like enses. promoti ly to report on probei gram, a ng innd excell nearly ent or Wellness two very goo -thirds Program, (6 d4 hper ealth. Adults in cent) by Ty reported a cash pe of a CDHP Plan, an 2012 inc d th enti ose in a ve or r HDHP eward wer for a e si biometric gnifican tly based on an online survey of 4,498 EBRI Issue Briefs privately insured is a monthly adults ages periodi 21 - cal 64 with and i was n-depth des evalu igne atd ion of em to provi plo de natio yee benefi nally t issues health plan. (Among Those Who Never Used an App for a Smartphone or Tablet) vs. 11 percent traditional) (Figure 6). 100% by Employ Various Cost er Offers Sharing Wellness Incentiv Program, es and by T Ty ype pe of Health of Health Plan, Plan, 2012 2012 45% 70% 46% traditional -plan enrollees. CDHP e nrolle es were found to be more likely than traditional-plan enrollees to report that 70% Yes and trends, as well as critical analyses of employee benefit policie 45% s and proposals. EBRI Consumer-Driven Health Plans ........................................................................................................................... 24  screenin less likely to used a g (Figure 11 smoke than n online ). Why did cost-trackin were adults i they g tool. partic n a tipate? raditiona CD l HP enro plan, and llees were more l they were significa ikely t ntly han more like traditional 44% ly to -plan exercise. enrol Peo lees p to le in Our 70 80 % % repres Because entative the 45% base sample data re 92% gardi (n national sam g the growth 20 ple 05 of accou ) in 20 clu 06ded onl nt- 2007 basyed h 19 20088 i ealth n 20 divi 09 pla du 20 ns als in a 10 and 20 hi CDH 11gh-d 20 Peducti 12 and 33 ble 2 i he ndivi alth pl duals ans with (HDHP an HDHP, s) and Checked whether plan woulb d cover care 54%* 1 a c 76% To be eligibl 60% e for an HSA, an individual may not be enrolled in other health coverage, such as a spo 64%* use’s plan, unless Figure 20, Interest in Enrolli Traditionng i al n Plan HDHP Using S CDHe Plect Networks Composed of Only Medical Providers With Records of they wo Calculated from Figure 1. uld switch doctors 89% to one who had a secure website for p 42% atients to access test results and make app 56%*ointments, Notes is a monthly periodical providing current information on a variety 63%* of employee benefit HRAs can be thought No of as providing “first-dollar” coverage until funds in the account are exhausted. Leftover funds at 90% 42% 87% You can make changes on your own 24% 34% ? CDHP enrollees were more likely than tr 39% aditional-plan enrollees to take advantage of various wellness report t There a CDHP Health S has hat th were be avings Accounts e e inc also less likely n no entive clear pr incr iz ....................................................................................................... 86% to be o es ease in and r the be es duc e sh c eo are of d mpared w premi CDHP ums ith e were adults nrollees the main enroll whoe r reasons de in porte a traditio d cost-c (Figunal h re 12). onscious dec ealth CDHP pla nenrollees were also i. CDHP ............................ sion-makin and g ov HDHP er the 24   the impact o 40%f these plans and consumer eangagement more generally 72%on the behavior and attitudes of adults with an oversample of individua 58%* ls with a CDHP or HDHP was acdded. The oversample included 1,218 individuals with a CDHP 40% b c 55%* 71% 60% Traditional HDH a P CDH b P a Very Interested Somewhat Interested Not Interested that plan is also a high-deductible hea 84%topics. EBRI lth plan. F However undamen 59%, tals indivi of Employee Ben duals b are allow c efit Pr ed to h ograams ve suppleme offers a straightf ntal covera orward, basic ge without Providing High-Quality Care Combine Traditionad l Wit HDH h Lower P CDH Cost P Sharing, by Type of Plan, 2012 ................................ 20 41% used a publications tablet or handheld computer to review health37% records and add updates during office visits, and used e-mail to ? Indivi 40% 60duals i Not sure % n a CDHP were 82% as likely as those with Traditi trad onal itHDH ional cover P CDHPage to report that their plan provided doctor the end of each year can 55%* be carried over to the following year (at the employer’s discretion), allowing employees to 70%A programs sked for gene, su ric drug ch as he instead of br alth and--r naisk a me drug ssessments, health-promotion programs, and biometric scre 52%* enings. In more likely th seven years o 2 enrollees were also more likel 40%an traditional f the survey (Fi -plan gy than ure 7). enrol tradit l ees io to report nal-plan that enrol they participat lees to be high ed to ly educate avoid pr d. emium i ncreases and that their 60% private and 1,2healt 76 indi h v insurance iduals with cov an e HDHP, rage.explan Th resul e sa ation mple ting of in a was ra emplo total y nee b d sa omly mple enef drawn it progr (base f ams rom Synovate’s online plus oversam in the privat ple) of e and1,4 public pa 1nel 6 fo sec of more r the t 66% ors. CDHP The than gr EBRI 2 mil oup - Health Reimbursement Arrangements ............................................................................................. 38% 57% ................... 25  More information about HRAs and HSAs 78% can be found in the box on pg. 24 and in Fronstin (2002 and 2004). 53%* 65% a high deducti 80%ble for such things as vision 56% care, dental care, specific diseases, and insurance that pays a fixed amount 64%* 64% interact with patients (Figure 19). 37% You do not have enough time to participate 25% 29% accumulate quality 35 f %u inform nds over ation an time, and, d t hey in wer prin eci le ple, c ss likel reatin y to re g th port tha e key ince t their ntive for plan in provided in dividuals to make formation on h 63% ealth c cost are of care purchases 49% 52% 49%* 74% 36% 62% addition, financial incentiv Databook on E es mattered mployee Benefits more to CD is a HP statis enrollees th tical referenan to tr ce work on em a aditional-plan b ployee bene enrol fit program lees. s employers r 50e %quired participation. 61% 53% 51% 53% c lion Internet 50% users who have agreed to participate 11 in research surveys. This survey used a base sample of 2,004 to and 1,608 for the HDHP group. After factoring out the base sample—the 198 individuals wit 50% h a CDHP and the 332 Figure 21, 35 Likelihood of Cha % nging to Select Network if C32%* urrent Doctor Was N To radi t in 30% tiona Se l lect N HDHPetwCDH ork, b P y Type of Plan, References ........................................................................................................................................................... 26  per day (or other period) for hospital 59%* ization. Individuals enrolled in Medicare are not eligible to make HSA 51% While panel I 50 Tal % n keternet surv d to doctor about p eys are rescriptiononran n options an do d c m, studies 58% osts have demonstrated that such surveys, when c 39%* arefully designed, provide 60% d by doctors. Howevand work for er, when cost ce-reinformation lated issues. w as available, C50% DHP enrollees were more likely than responsibly. 3 As the CDHP and H Employers can DHP markets continue place restrictioto expand and more ns on the amount that enroll canees are enrolled be carried over. for longer periods of time, the 43%* 33% 70% 38%* See www.mercer.com/pressrelease/details.htm?idContent=1491670 2005 2006 2007 2008 2009 2010 2011 2012 draw individ inci uals d 50 en wit %ce h an rates for people with HDHP—there wer e acco 1,4unt-based hea 74 individuals lin th th plans a e sampl nd eHDHPs, with traditio and tna he l hea base sample was lth coverage. 44%* complemented 2012 .......................................................................................................................... 45% 45% 32% ............................. 20 The 2012 surv 30% ey examined opinions regarding the appropriate use of lower cost sharing as an incentive to change the contributions, although th You do not n ey eed are a it becau ble to wit se you are al h re draw mon ady healthy ey from the HSA 20% for quali 29% fied medical expenses and certain Endnotes ............................................................................................................................................................. 46% 26  obtain results comparable with random-digit-dial telephone surveys. Taylor (2003), 39% for example, provided the results ? It is clear that the underlying characteristics of the populations enrolled in these plans are different: The survey als sustained traditional 30impact that t % o asked r -plan enro heese spo llees plans ar ndents to report t their e havi re ng o hat th asons for n cost, ey trie not qu d to part ality, an us ic eipati the d acc n inform g ien ss to health their em ation. CDHP ploy caer’s welln re services enrollees ess program. were can be also more like better Nearl y ly to Availability and Use of Cost and Quality Information 40% 30% 30% 41% 30% 28% 41% with an additi 12 onal random oversample of these two groups. More specifically, t 36% he oversamples were: 1) those with Talked to doctor about treatment options and costs 35%* 35% way individual 30%s use the health care system. Results show across-the-board interest in select networks composed of only premiums. An individual also may not make an HSA contribution if he or she is claimed as a dependent on another Dis 4 tributio50 ns % from an HRA for qualifi Contact EBRI ed medical e Publications, (2 xpenses are m02) 659-0670; ade on a tax-favore fax publication d basis. orders to An employer c 34% (20 34% 2) 775-6312. an also let an 28% 28% from a num 40 60 40 be % % %r of surveys that were conducted at the same time using the same que 35%* stionnaires both via telephone and try to find info Adults in a C rmation a DHP were bout their significantly mor doctors’ costs an e likely to d quality from sourc report being in excellent es other than or very good heal the health plan. th. 6 understoo See 0 pewww.healthcaredisclosure.org/ rcent re d. Tsp he e onde ight d that the years of co y did not nsumer paenga rticipgeme ate be nt s cause urv th eysey report could make c ed here provi hange de s on the uniquei dat r ow an f (Figure rom whic 13 h to ): 2 4 per- 24% The In ad ince ditio nn to tivesbein of Cg s DHPs ar tratifie ed, th desie b gne ad se sa to promote he mple was aight lso we ened sensitivit ighted by gen y to cost an d 27% er, age, 27% e d d quality ucation, in re peo gion, income, ple’s decisions about and Figure 22, Pe 25%rcentage of Individuals Reporting They Used an App More Than Once for a Smartphone or Tablet, by either an H 40RA % or an HSA, and 2) those with an HDHP without an 30%* 30%* account but with a deductible that is generally high The pr 26% ogram is not Subscriptions to convenient 23% ly located for EBRI you Issue Bri 16% efs are included 23%as part of 26% EBRI membership, or as part of 26% a 25% 37% 37% medical providers with records of high-quality care when combined with lower cost sharing. Eleven percent of person’s tax return. employee use an HRA to purchase health insurance directly from an insurer. Since unused funds are allowed to roll online. He found that the use of demographic weighting alone was sufficient to bring almost all 39% of the results from the 10 Orders/ 30%Adults in a CDHP and those in a HDHP were significantly less likely to smoke than were adults in a cent cit measure ed this futur as a major e changes in t reason, and 34 his evolving ty percent cit pe of health ed i in t as surance. a mi 34%* nor r eason for 35% not participating. Lack of tim 35% e was the race/ethnicity to reflect the actual 21% proportions in the population ages 21–6 21%4 with private health insurance coverage. Figures their health Various Health-Relat Ask ca ed doc re. Yet tor to rec the 33% ommen abi d les lity to make ed Pur s costly pr poses escripti in on and formed decisio drugType of Health Pla ns is highly n, 2012.................................................................. dependent on the e 38%* 34% xtent to which individuals have 21 $199 annual subscription25% to EBRI Notes and EBRI Issue Briefs. Change of Address: EBRI, enough to meet the qualifying threshold to make tax-preferred contributions to such an account. A high deductible was 50% 20% 5 23%23% 32% individuals in CDHPs 40% and 10 perc32% ent of individuals with HDHPs and with traditional coverage were 40%* extremely interested over, an ? CDHP enrollees were more li employee is able to accumul kely than ate funds over traditional-plan time. An enr employ ollees to er can repor allow t that a f th ormer em ey had th ploy e o ee to pport use a unity to ny leftover fill out See Appendix for more detail on the methodology. 31% online survey 20 30 %%close to the replies from the parallel telephone survey. He also found that in some cases propensity traditional plan, and they were significantly more likely to exercise. CDHP and HDHP enrollees were second-most-popular reason for not 1100 13th St. NW, Suite 878, Washington, participating, with 25 percent citing itDC, 20005-4051, (202) 659-0670; fax number, as a major reason, an 5d 29 percent reporting 20% 18% The access to usef CDHP and HDHP ov ul information. You jersamples ust do no t know eno were ugh w abe out ight the ed by program gender, age, inc 21% ome an 21% d race/ethnicity, using the 21% demographic 11% 27% Indivi defineduals d as a wh n indivi o have dual reach deductibl ed age e of 55 at and least are not $1,0 yet 00 an end a rolled family in Med ded ic uctibl are may mak e of at lee ast $2,0 catch-up 00. cont Thributions. e final sam In ple 2 012, a Figure Subscriptions 1, 30 Premium Incr 30 % % eases Among Employers 20% With 10 or More Employees, Worker Earnings Increases, an 20% d Inflation, 16% in using select networks when combined with lower cost sharing (Figure 20). CDHP and HDHP enrollees were more a healt 20% h risk assessment. They were also more likely to report that they had access to a health promotion money in the HRA to continue to cover (202) 775-6312 qualified m ; e-mail: edical exsubs penses. criptions@ebr Funds can i.org be us Me ed mbe for out rship Information: -of-pocket expens Inquiries es and weighting (meaning the propensity for a certain type of person to be online) reduced the remaining gaps, but in other 20De % also more likely than traditi veloped budget to manage health care exo penal-pl nses an enrollees to be h 18%ighly educated. it as a m Figure 23, inor r Int 40%e erest in Using ason. Forty-fian App ve percent for a di S d not martph partici one or pate be Tablet, by cause they wer Health-Related e already healthy Function, 2012 (20 percent report ............................ ed it as 21 26%* profile of the CDHP and HDHP resp 18% ondents to the omnibus survey described below. 6 25%* 14% 26%* included 1, 30 416 % in an HDHP with either an HSA or HRA (consumer-driven health plans, or CDHPs), 1,608 in an HDHP $1,000 catch-up contribution was allowed. The catch-up contribution is not indexed to inflation. Traditional plans include a br 1988–2012 ..................................................................................................................... 15% oad range of plan types, including health maintenance organizations (HMOs), preferred provider .......................... 6 likely than traditional-plan enrollees to regarding 12% be 12% somewhat i EBRI membership an nterested in d/or con the tconcept, ributions to EBRI-ER with 38 perc F should be dir ent of CDHP e ected nrolle to EBRI es, 15% premiums program for in an surance, d to a 13% lon biometric g-term care, screenin CO g BRA, an program. HDH d retiree P enrolle health be es nefits. An were less likely th employer is not an traditio require nal-pla d to n enro makllees e the to 20% 16% 16% cases it did not reduce the remaining gaps. Perhaps the most striking difference in demographics betwee a n telephone The survey asked if an individual’s You d hea o not b lth elievp e i lan t willprovide help you d i8% nformation on 27% providers’ cost and quality. Individuals were a major reason, and 29 percent reported it as a minor reason). For th 6 e most part, there were no differences in the Traditional 23% 19% President Dallas Salisbury at the above address, (202) 659-0670; e-mail: salisbury@ebri.org without an 10acc % ount, and 1,416 in a more traditional health plan. 20% organizations (PPOs), other managed care 30% Checked price of service before gettin plans, and pla g care ns with a broad variety of cost-sharing arrangements. The shared 42 percent of HDHP enrollees, and 33 percent of traditional-plan enrollees somew 27%* hat interested. There was also report ? As the CDHP havin 10% g access to such and HDHP m proga rams. rkets contin ue to expand and more enrollees are enrolled for longer unused balance available to a worker when he or she leaves. and online surveys was the under-representation of minorities in online samples. 13% To e more likely to fficiently id report t entify res hat th poney ha dents d who quality wo uld informat qualify ion t for han th the Cey DHP a were that t nd HDHP ov hey h ersamples, th ad cost inform e stu ation. CDHP dy use b d Synov enrollees ate’s answers to this series of 9% questions by plan type. 32%* 20% 15% HDHP Distributio 10 10 20 ns %% % from an HSA can be made at any time. An individual need not be covered by a high-deductible health plan Figure 2, Distribution of Individuals Covered by Private Health In12% suranc 12% e, by Type of Health Plan, 2005–2012 ............. 6 8%* You are un 13% comfortable participating in this kind of program with 13% characteristics of these plans are that they either have no deductibles or deductibles that are below current thresholds that interest in changing doctors to one in a select network, and there were few statistically signi 11% ficant differences by plan periods of time, the 12% sustained impact th 12% at these plans are having on cost 7%, quality, and access to 8% 22% 10% c omnibus surv Editorial Boeard: y of mor Dallas L e tha . Salisbur n 45 y,00 , publisher 0 onlin ; Stephen Blakely e panel mem , editor bers who . Any views met the stu expressed in this p 26% dy’s crit ublicat eria ion and th (having ose o private insur f the authors sho ance an uld d were equally likely to use quality and cost information when their health plan provided that i Majon r re formati ason on. Both CDHP and your coworkers CDHP Findings from this survey are compared with findings from the 2005, 2006, and 2007 EBRI/Commonwealth Fund to withdraw 20 0% m % oney from the HSA (although he or she must have been covered by a high-deductible health plan at the 10% Checked quality rating of doctor/hospital 9% 27% 16% 16% 5% 5% ? CDHP enrollees were more likely to report that they were offered a cash incentive or reward to participate in a would quality for tax-preferre not be ascribed to the officers, 10% d HSA contributions trustees, members, or or that are generally ass other sponsors of the Employe ociated with HRAs. e Benefit Research Institute, the EBRI Educ 8% ation and type (Figure 21). 30% 4% 4% 5% health care services can be better understood. The ei 14%ght years of consumer engagement surveys Figures 14 5% and 1 H5 as co a sentain cure w fi ebsndin ite forgs from Uses s a ociseries of al media to qu Us estions relat es a tablet or 13% hane dhe d to the ld Uses impact email to in th terac at fin t with ancial Is able inc to usentives cou e real-time, ld have bein HDHP e g ag ne rolle 2 101 %– e64.) s were The less l follo ikely than wing thr tra ee qu dities onal-plan tions wer enro e usllees ed into th report e June that their and July om plan nibus surv provided the i eys to ide nformation. ntify likel Thirty- y Figure 3, Number of Years Covered by Current Health Plan, by Type of Health Plan, 2012 Mi ........................................ nor reason .. 7 time the funds Consumerism in Healt were placed h Carein the HSA) Survey, and t . Dih stributions ar e 2008–2011 e 11% EBRI excl 11%uded fro /MGA Co m nsumer En taxable inco gagement me if they in H are eal used to th Care Surv pay feo yr . Past You are worried that your employer will know your personal health Research Fund, or patie their nts to staffs. acces Nothin s test g her provie de g in is to be co eneral inform nstr ation ued as an attem computer to re pt to aid or view your hinder the adoption patients of any vi pending le rtual visits to o gislat ffer "ion, face-to re-gulation, 10% wellness program when a program was offe 9% red. When it comes to participating in a wellness program, CDHP 12% 17% 11% 10%reported here provide unique data from which to measure future changes in this evolving type of on participat 100% ion in % wellness programs. As i information n past years, t 7% here were very few differences by plan type. 7% There were no results, make appointments such as health tips, local health record and add face' consulatations CDHP and HDHP respondents: five 7 percent o Used f HDHP online cosenroll t tracking to ees report ol provided b ed ac y healthcess to qua plan lity informat 11% ion, compared with 44 percent of CDHP enrollees and or interpretative rule, or as legal, accounting, actuarial, or other such professional advice. www.ebri.org reports used “Comprehensive” as the descriptive label for what is now labeled “Traditional” health 5% plans. A label change qualified medical expenses as defined under Internal Revenue Code (IRC) Sec. 213(d). Distributio 4% ns for premiums for See Fronstin (2007) and 0% Hehttp alth ris://ehbs.kff.org/pdf/2012/8345 k assessment Health pro .pdf mo tion program Biometric screening 23%* 3% 0% and get health information we llness event links, and updates during your office enrollees were more likely than traditional-plan enrollees to take advantage of the program. The top reasons 0% b 2% c a Figure 4, Leng health in th of Tim surance. e With HRA or HSA, 2005–2012 ............................................................................................ 1% 1% 7 differences 0% between CDHP T a radi ntid tra onal ditional-plan enrollees when HDH it P came to cash incentives, time o CDHPff, or premium 47 percent of traditional-plan enrollees offic (Fi e-hog urure chan 8 ges ). Similarly, 30 visits percent of HDHP enrollees reported access to cost Extremely likely Very likely Somewhat Likely Not very likely Not at all likely Don't know the Consoli was appropr dat iaNu ted Om e giv trition ie nfo n t nibus B rmati hat t on E u h xe dget R ese rciseplans ar progr econcil ams e not as com iation Act Weight of p1 re G 985 hens ener (CO al hea ivelth B as th RA), ey w long-t Prices e for re erm car in the Me e past a insura dical claim nn sd may ce, Bala he no lo nc alth e of HS insuranc nge A orr fit t eh w at hile 0% Reduced drug cost sharing In It cr ce oa ss ts e to d dr o m ugu c co hst shar 6%ing 12% Reduced office visit cost sharing Increased office visit cost sharing Patient Use of Technology 0%* 10%* 20%* 30%* 40%* 50%* 60%* CDHP enrollees gave for participating were that they were offered incentive prizes and reduced premiums. c [ALL THRE 0% E QUESTIONS TO a BE ASKED OF THOSE AGE 21 -64] Source: EBRI/MGA Consumer Engagement in Health Care Surv management or ey, 2012. informatiob n prescription drugs history HRA* dif 8 ferences (Figure 14). And unlike in 2011, CDHP enrollees are no longer more responsive to higher cost sharing for EBRI Issue Brief is registered in the U.S. Patent and Trademark Office. ISSN: 0887 ?137X/90 0887 ?137X/90 $ .50+.50 Traditional HDHP CDHP information, co Source: a mpared with EBRI/MGA Consumer 34 perc Engagement ent am in Hong C ealth Care Surv DHP eyenr , 2012. ollees and 40 percent among traditional-plan enrollees. While growing, the CDHP market is still below 20 percent enrollment. According to the Kaiser Family Foundation, Health label. Prior reseTarch raditional has sho = Health plan w wn t ith no hat cost s deductible or <$1,000 (indiv haring has idual), be <$2,000 (f en in am creasin ily). g across the board in the form of higher deductibles receiving unemployment Less T co han O mpensation, ne Year and indi suranc 1- ets 2 Yearse while eligible for Medicare 3-4 Years other than 5for M Years oe rdi Mor gap, e are also tax 0% ? A significant N bote: To have a medical portion home, the respondent of the population r must: have a personal eported using /family doctor; have timely a sm access artphon to care; hav e e a or a t doctor wa ho blet. A knows medical mong them history; , as Figure 5, Fami Among thos liarity With e not parti Cons cipati umer-Driven Healt ng, the top reas h Pl ons ans given , 2012 we ................................................................................. 9 re that they could make changes on their own; they The survey fo und that a HDHP = High-deductible health plan w bout three-fifths o ith deductible f the a $1,000+ (indiv dult po idual), pulation $2,000+ (fam w ilyi), th no account. private health insurance had used a smartphone Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2012. Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2012. 0% 10% 20% 30% 40% 50% 60% 70% prescription drugs or office visits (Figure 15). Financial incentives to 7 participate still mattered to all individuals, Source: EBRI/MHe GAalt Consumer h risk asEngagement sessment in Health Care Survey, He 2012. alth promotion program Biometric screening Source: hav c e a EBR prov I/M ider that know GA Consumer s them as a person Engagement in H; ealth C and hav are Surv e a prov ey ider w , 2012. ho is coordinating care. Research and Education Trus a CDHP = Consumer-driv t 2012 surve en health plan with ydeductible $1,000+ (indiv , 19 percent of idual), workers were enrolled in a CDHP (see $2,000+ (family), with account. a Traditional = Health plan with no deductible or <$1,000 (individual), <$2,000 (family ). free. and co This -payments, and ther mea Source: Traditional ns that EBRI/C = H ommonw ealth plan w distributions used to ealth e has iFund th no deductible Cbeen onsumerism a or <$1,000 return to in pay M Health (indiv Care e idual), coinsu di Surv care ey <$2,000 , 2005–2007; rance. Part A or (familyEBR ). I/M B, GA Medicar Consumer Engagement e Advan in tage Health C plan are Surv premiums, and th ey, 2008–2012. e a a Source: EBR T a raditional = H I/Cealth plan w ommonwealth Fund ith no deductible Consumerism or <$1,000 in Health C (individual), are Surv <$2,000 ey, 2005-2007; (family). EBRI/MGA Consumer Engagement in Health Care Survey, 2008- Traditional Traditional = H = H ealth plan w ealth plan w ith ith no deductible no deductible or <$1,000 or <$1,000 (indiv (indiv idual), idual), <$2,000 <$2,000 (family (family ). ). 1. lacked time; Which of the many as one-third reported b and t following be hey were already st describ using an app healthes your current health insu y. Reasons for lication lack (app) of partici for health-rel pation di rance status: ated purposes. Am d not differ by plan ong those not type. within the past year, a a b * Difference betw nd about 40 een HDHP/CDHP and percen Traditional t had used a is statistically signif t icant abl at p et. = 0.05 or better. Among those with a smartphone or tablet, 27–32 percent Traditional HDHP = High-deduc = Health plan w tib ith le no health deductible plan wior th <$1,000 deductible (indiv $1,000+ (indiv idual), <$2,000 idual), $2,000+ (fam (family). ily), no account. CDHP, HDHP, bHDHP = High-deduc and traditiotib nal le health -plaplan n ewn ith rolle deduce tible s were $1,000+ (indiv aboiu dual), $2,000+ (fam t equally like ily), no ly t ac o c use ount. quality information provided by their health regardless of b 2012. plan b type. It was found that, concerning most questions, between about 60 percent and 80 percent of HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. HDHP = High-deduc Source: HDHP = High-deduc EBRI/MGA tib C ltib e onsumer health le health plan Engagement plan with with deduc deduc in H tible tible ealth C $1,000+ (indiv $1,000+ (indiv are Survey idual), $2,000+ (fam , idual), $2,000+ (fam 2012. ily), no ily), no acc ac ount. count. b c http://ehbs.kff.org/pdf/2012/8345.pdf cSource: CDHP = Cons EBRI/MG um A C er-driv onsumer en health Engagement plan ). Mercer (see with in H deduc ealth C tible a$1,000+ (indiv re Surv www.m ey, 2012. idual), ercer.com $2,000+ (fam /pressrelease/details.htm?idContent ily), with account. =1491670) found HDHP a CDHP = Cons = High-deduc umer-driv tible health en health plan plan with w deduc ith deduc tible tible $1,000+ $1,000+ (indiv (individual), idual), $2,000+ $2,000+ (fam (family), no ily), w acc ith ount. account. employee Figure 6, Cost shar c -Conscious Decision e of the premium for Maki emp ng, loyment-based by Type of H re ealth tiree Plan, health 2012 benefits ar ........................................................ e allowed on a tax-free basis. ........... 9 c CDHP = Cons c Health reimbursemen umer-driv t arrangement. en health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Source: CDHP = Cons CDHP = Cons EBRI/MG um Aum er-driv Consumer er-driv en en health Engagement health plan plan with win H ith deduc deduc ealth C tible tible a$1,000+ (indiv re Surv $1,000+ (indiv ey, 2012. idual), idual), $2,000+ (fam $2,000+ (fam ily), w ily), w ith ith acc ac ount. count. using an app, about one-half were very interested in using one. c used a smartphone a CDHP = Cons * As * Differenc ked of CDHP o e um betw per-driv plicati een HDHP/CDHP nly.en health on, or plan “app,” f w and T ith deduc raditional tible or nutritio $1,000+ is statistic (indiv ally n s idual), i gnific information; $2,000+ ant at p = (fam 0.05 ilyor better. ), w 25–29 perc ith account. ent used one for general health * b Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. plans, while C a D Health sav HP en ings account. rollees were more likely to use cost information. However, CDHP and HDHP enrollees were more partici pants sa * Differenc id they woul e between HDHP/CDHP d partici and T pate in welln raditional is statisess ticallypro signific gant rams at p = 0.05 if th or better ere was some type of financial incentive to do so. * TDifferenc r* aditional Differenc e = H betw e betw ealth plan w een HDHP/CDHP een HDHP/CDHP ith no deductible and T and T raditional ror <$1,000 aditional is s is tatis s (indiv tatis ticia tic dual), lly a lly signific s <$2,000 ignific ant ant at (family at p = p 0.05 =). 0.05 or better. or better. that 16 percent of workers were enrolled in a DCHP in 2012. b HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. information; 23–27 percent used one for weight management or diets; and 23–26 percent used one for exercise likely than tra c ditional-plan enrollees to try to find information on cost and quality from sources other than the health CDHP = Cons © 2012, Emplo umer-driven health plan yee B with e deduc nefit tible Research Institute $1,000+ (individual), $2,000+ (fam ?Educ ilyation and Re ), with account. search Fund. All rights reserved. * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org A ebri.org ebri.org ebri.org ebri.org ebri.org monthl ebri.org Issue Brief • December ebri.org Issue Brief • December ebri.org Issue Brief • December ebri.org Issue Brief • December ebri.org Issue Brief • December ebri.org Issue Brief • December ebri.org Issue Brief • December ebri.org Issue Brief • December ebri.org Issue Brief • December ebri.org Issue Brief • December ebri.org Issue Brief • December Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri y research e e e e e e e e e e e e e effffffffffffff • December • December • December • December • December • December • December • December • December • December • December • December • December • December report from th2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 e EBRI 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 2012 • No. 379 Education and Research Fund © 2012 Employee Benefit Research Institute 21 19 20 17 12 16 13 14 9 6 7 11 23 15 22 26 18 24 27 25 8 2 3 4 5 Figure 7 Trends in Cost-Conscious Decision Making, by Type of Health Plan, 2005–2012 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 2012 2005 2006 2007 2008 2009 2010 2011 2012 2005 2006 2007 2008 2009 2010 2011 2012 Total Sample 953 1,363 1,794 1,548 1,651 1,601 1,509 1,474 417 802 1,284 1,484 1,693 1,914 1,762 1,416 163 652 805 1,077 972 993 1,432 1,608 Checked whether health plan would cover care 51% 58% 50%^ 55%^ 50%^ 47%^ 48% 45% 61% 62% 61%* 61% 56%* 53%*^ 55%*^ 54%* 60%* 62% 60%* 63%* 61%* 53%*^ 59%*^ 56%* Asked for generic drug instead of brand name drug n/a 48 46 50^ 46^ 44 46 41^ n/a 60* 58* 58* 52*^ 50* 54*^ 52* n/a 54 54* 58* 56* 51*^ 53* 53* Talked to doctor about prescription options and costs n/a n/a n/a n/a 35 35 37 30^ n/a n/a n/a n/a 42 40 41 39* n/a n/a n/a n/a 44 38 41* 38* Talked to doctor about treatment options and costs 42 44 44 45 33^ 31 33 28^ 56* 44^ 49*^ 49 37^ 36* 39*^ 35*^ 58* 46^ 47 46 40* 33^ 36^ 35* recommend less costly prescription drug 27 31 30 36^ 34 32 35 29^ 46* 41* 43* 41 39* 39* 42* 38*^ 45* 39* 38* 36 39* 37 38 40* Checked price of service before getting care 24 20 21 23^ 25 24 28^ 23^ 35* 23^ 27*^ 23^ 29^ 29* 31^ 27*^ 29 26* 27* 25 35*^ 27^ 34*^ 32* Checked quality rating of doctor/hospital 18 21 20 25^ 24 24 27^ 26 22 18 19 22 22 22 27^ 27 18 19 18 23^ 27* 22^ 27^ 30^ Developed budget to manage health care expenses n/a n/a n/a n/a 15 16 18 16 n/a n/a n/a n/a 18 17 20^ 18 n/a n/a n/a n/a 32 25*^ 26* 26* Used online cost tracking tool offered by health plan n/a 8 8 12^ 12 11 11 11 n/a 6 9^ 10 9* 10 10 11 n/a 17* 20*^ 20* 24* 20*^ 21* 23* Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005-2007; EBRI/MGA Consumer Engagement in Health Care Survey, 2008-2012. 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. ebri.org Issue Brief • December 2012 • No. 379 10

Volume 379

Pages 28

EBRI Issue Brief

Paul Fronstin

Health