Health Plan Switching: A Case Study--Implications for Private- and Public-Health-Insurance Exchanges and Increased Health Plan Choice

When workers are offered more than one health plan, who switches their plans, and does it lead to adverse selection, causing healthy workers to leave certain health plans saddled with only high-cost sick workers? Evidence suggests it’s mostly younger workers or higher-income workers without family coverage who switch?which does indeed raise the risk of adverse selection, according to a new analysis by EBRI.

This Issue Brief examines the experience of a particular large employer, and a subset of its employees, with respect to a recent increase in the number of health plans that employees could choose. In 2014, this employer offered employees a choice of four health plans--an HSA-eligible health plan, an EPO, a PPO, and an HMO--all with the same carrier. In 2015, it added six new health-plan choices--HSA-eligible plans, EPOs, and PPOs--from two additional carriers. As a result, employees saw their plan choices increase from four to 10.

This examination of the data produced the following findings:

One-third of health plan participants enrolled in both 2014 and 2015 switched health plans between 2014 and 2015.
Workers enrolled in the HSA-plan in 2014 were more likely to switch plans than other workers.

One-half of HSA plan enrollees switched plans, compared with 27 percent among EPO enrollees, 24 percent among PPO enrollees, and 13 percent among HMO enrollees.

While HSA plan enrollees were more likely to switch plans, those who did switch were most likely to switch to the same plan type with a different carrier.

About 88 percent of HSA plan enrollees in 2014 who did switch plans for 2015 chose an HSA-plan with a different carrier.
Sixty-three percent of EPO enrollees in 2014 who did switch plans for 2015 switched to an EPO with a different carrier, and 72 percent of PPO enrollees switched to a PPO with a different carrier.
Because only one HMO was offered in 2014 and 2015, 100 percent of the HMO enrollees who switched chose a different plan type with a different carrier.

Very few HSA-plan enrollees who switched plans switched to a different type of health plan.

Among workers switching health plans, 5 percent of the HSA plan enrollees in 2014 who switched plans for 2015 changed to a PPO, EPO or HMO with the original carriers, and 7 percent changed both their plan type and carrier.

EPO and PPO enrollees in 2014 who switched health plan types were more likely than HSA plan enrollees to switch carriers.

Twenty-four percent of EPO enrollees and 21 percent of PPO enrollees in 2014 who switched plans for 2015 switched to a different type of health plan with a different carrier, while 13 percent of EPO enrollees and 7 percent of PPO enrollees switched to a different type of health plan with the same carrier. In attempting to explain plan switching, certain demographics and prior use of health care services appear to be predictors of plan switching, but health status is not a strong predictor.

For this employer, it appears that:

Older workers were less likely to switch health plans than younger workers.
Higher-income workers with employee-only coverage were more likely than lower-income workers to switch carriers. However, higher-income workers with family coverage were less likely than lower-income workers to switch carriers or switch plan type.
The longer an employee was enrolled in his or her health plan, the less likely he or she was to switch plans.
More actual use of office visits for both primary care physicians and specialists was linked to less plan switching.

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(EBRI). M. Christopher Roebuck is president and CEO of RxEconomics, LLC. 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B nd ee F c o m c eo a nt ro v us ind e rse r )eag iv w m oid e o nly ig uld u an ra a o tls d io ne e ,nr n a o ll oll f should not be ascribed to the officers, trustees, or other sponsors of EBRI, Employee Benefit Research Institute- ACA, and private exchanges regarding the advantages and disadvantages of offering a wide array of health-plan employee-only coverage. Because most enrollees who switched plans switched to the same type of health plan with March 23, 2017 •I m No. pac t4 o3 f D 2e mographics, Health Status, and Use of Health Care Services on Plan 100?999 Employees 1,000 or More Employees no. 11 (N2015 ovemb sw eri 2005) tched :t 1130 o a di-ffe 9. rent type of health plan with a different carrier, while 13 percent of EPO Buchmueller, Thomas C. "Does a Fixed-Dollar Contribution Lower Spending?" Health Affairs, November/December 1998: 228- H le b F in the e iM s gur ne tss he O e he fe 2, w it ho ne a sas ,lt us w p h P o ri y e p fer c ho find la e ec r ,n ld e ent iv cd o -oid l,p e s age of e ttu vio n e a sr ns lh ls o v a l,ari int lri ele n e P ab o g a sr , v it wh va lhe ing c eo stn o e we ne s le -su s wi s w m re ec s - te p c he ttr la or h hs e e a n E a d lts tc hy iam s fho srtfo ab ae ic m e cn t e l as iirts s o o h hm n lle m e th , a e H p e ent y s ro M e b in O v F m s e i d i O tp h gur s he e la e o r fd e fy n er e o n. e te ro e i ig tng H 4 -w c lina e h ovo rk e l o e ls he sal ,m e s a te a p h I las t en h c ns u eip al re w la ur is zc ns .e a a d nc r. r T p ie e o ro r T m g ahat n ra itdig m O n a se t,fe w fg er a e pg o lT a a gn in w rap o or s ty th p tie his c . Mor c,o t vhe e e H rag e eal , an th d choE icdeu sc t ao t io ind n a ivnd idua Re lss.e Ia sr c ith pF oun ssib d le (E t BoRI c-rE eR atFe) ,a o m r tah re kier tp stla ac ffe s .w N he eir th e eind r Eiv BR idI ua no lsr aErB eR oIf-fE eRF red l o ab c bho iesic o er otfa k he es a lp th osp itla ions ns to ha n t By Paul Fronstin, Ph.D., Employee Benefit Research Institute, and M. Christopher Roebuck, one of the new carriers, this study examined only these types of plan switches. Findings are presented separately for 90%Switching, Among Enrollees With Employee-only Coverage, by Type of Plan Switch Findings are prese ent nre od lle in esF a ig nd ur e 7 8 p e fo rcre e nt m o pflo P yP eO es e wi nrto hlle fa em s isly w it co che ver da g to e .a T dhifefreer ewe nt rtey p ae n o ufm he be arlt o h f p dla ifn few rein th cets he b e stawe me e n 235. Where the world turns for the facts Percentage of Private-sector Employees on U.S. employee benefits. Working in Establishments Offer ing m em eas plo uyre ers I ns p orfur o q vanc u idal eid t e y f.P ina A lans n nc ind ia , b l iv inc yid E ua es nt tl ab iw ve o lis s uld h to m cnud ent hoo S gse ei z p te, he eo 1 pp 996 le la n w? iw t20 h ith v 14 a a r tio ................................ trus ib uhe tea s ltmo h rsis t kssu t ite o d e nr to ................................ o his ll in otrhe he ne r p w re p fe larns en................... c M eso . r e 6 specific policy proposals. EBRI invites comment on this research. does not lead to adverse selection? Ph.D., RxEconomics PPO, EPO and HSA plan enrollees. Individuals enrolled in HMOs before the introduction of the new plan options were Strombom, Bruce A., Thomas C. Buchmueller, and Paul J. Feldstein. "Switching costs, price sensitivity and health plan choice." Any Sw itch Sw itch Carrier Sw itch Plan Type Sw itch Both t W S he thile a g tis r o etup m icp a w lo l A it ye h na rs e m h c ly a p av s rri lo is ey e e a r.e n -u only mb e cr ov oe f rto ag oe ls an thd e yt he can g ru osup e to w it trh y fto am m ily itig co ave te ra ag ga ein . T stho as de v ew rs ite h sfe ale mcily tio c n, o va end rag te his we st re ud m y ore Two or More Health Insurance Plans, by Establishment Size, 1996?2014 spec ifically, the employer lowered employee premiums, increased HSA contributions, and eliminated cost sharing for Figure 6 80% not examined because the new carriers did not offer an HMO option to switch to. Demographics Journal of Health Economics 21 (January 2002): 89-116. Buchmueller, Thomas C., and Paul J. Feldstein. "The Effect of Price on Switching among Health Plans." Journal of Health e lik F Axa d igur e vly m ers ine e 3, to e d b s P e eo le nly m er ca tcio le ent on ,ne o is age of ld e a e m rkp ,e lo a y nd P yce ro irv to nc , at it e ha e r is n -v sp e a ec o shig s sts o or ib che E ia letr m e tin ha d pl cw t o o y it a m e d h ev es .he e F r W s a ae lt m o h s ilre y k ple ila he ng i cn ta io c lt n E n ho h w s ic s till e a tabl .te us T xis his i sw thm a d ose c ent s m cp ur e its a s e O s w b ur fe he fe s er d tn ie ng T b tfo y fo otr he tm w s a o or tm n oy ae xim he lim Mor ain u ltm e a hy t H e ind ind ea it.iv iv lT tid h hi id uu s a a li s ls Less Than 10 EmpF loy igur eese 12 10?24 Employees Retirement and health benefits are at the heart of workers’, employers’, and our nation’s p In rim ad ad ry it io ca n re to o sfo fir cteing vi so itfs m an em d b ge ernse int riN c oa d t ru he ur g as e lt. of h p la H ne sa in lth P 201l4a a n nd S w 20it1c 5hi as ng, A descrm ibong ed, as well as an examination of Male -0.01 -0.01 -0.01* -0.005 In attempting to explain plan switching, certain demographics and prior use of health care services appear to be 25?99 Employees 100?999 Employees Economics Im , A pp ac rilt 1997: of Dem 231 og-r 247. aph ics, Health Status, and Use of Health Care Services on Carrier s C are H o ha me eal r cls o th o nin cne It g ns ind n h P tth 70 ra ur ea % x tanc t es d pcl ro ie P ia n v r a etn S te h ly ans e ie - slld e ec ,ss e 1 w td o996 e rin xp i et m te ? he chi ns p 2l 014 o iv fy ae e m ng: rs a ................................ ilnd ym ( ay i. le e s .A h s , av tche C oem p cpa o ern resse S c h o le u nns d in eiv ................................ d p ,e o as t he oudy re tah s lte th h ad p e ? la al on p tI h s ti,m ). o an n T opl h dfe ................................ ti o n pio c rcat e re m vas a aln e ey n dic lon p e elss an of - he s f h ch ig aoh ltic hy or b e ........................ lo h ind o as div p sid lro eu w sa sels ur d .e a r , e 6 economic security. Founded in 1978, EBRI is the most authoritative and objective source of Workers Switching Health Plan, by Plan Type Introduction T bihe vari rea a te re m Asge e oan me s ,no thtie s w stou rd thy y c foind nding ucts e. dF m irsult t, iv ve arry ia fte ew an v -a 0. aly r 005* ia se bs l*e *o s fwe pla re n -rs0. e w l004* a ittcehi d **ng to a wshy a fau -n 0. nc ind 002* tioiv n **id oua f tl he enr sus o -lle 0. p001* e dc in te **d a n EPO Copyright Information: This report is copyrighted by the Employee Benefit Research Institute (EBRI). It may be 1,000 or More Employees Established in 1978, the Employee Benefit predictors of plan switS ching witch , ib nut g, A he m alt oh ngs E tan tus rol lie s ens o W t a ith st F ro an m gi lp yre Cd oic vt eorr. a gFeo,r bty h T isy e pm e o plo f H ye er, a litth ap Plp ae nars that: S d in Sim y ts t u he lip ila dy id rm ly S eo ,m a re the ia m ,epl xp d slo ia eew b ns e etiv re -e t sh , a an C nd HF -e m x , pe as ore c th t e m cd oa, m a do p CO re pt he PiD ons ,n an io vfe d pr he die va p alt re te h - sh p sile o aal n ns t wa h . -T ins s hi m s u ruc caanc h n e hig re e sxc he ulth r a in in ng af e a so s m a -ili cnd a elle s tthe d ha “ n d pe la aam tteh o ang uing spir ind a l” oiv f? c id in ho uw a icl hi e c sh inc th ee information on these critical, complex issues. 100% Household size (individuals) w P de otri uld erm v sina a witte nt ch s to-ou and P a tline ned w aEbPoO C v. ubl han e.M ge F eo n d rC i we e ac a rric r er- e h H O le d nlic s yeal s ho lik to eC m t ly han o h tus ha ge - I d P n dn ew lan T psur o em nd ype ee n O nt anc t nlo yv m ara iake be E Cle han t ho ge is f d B sxc sw w ot it it h C c cha hing har . rA ier nnge b ad nd e ha in Pd laviv n T ios and id r y,pe ua a ls p rw ob itit h m hig od h eb l lo wo ad s used without permission but citation of the source is required. Employers and commentators point to several key reasons employers offer health benefits to workers, including to Endnotes Char lson, M. E 60% ., P. Pompei, K. L. Ales, and C. R. MacKenzie. "A New Method of Classifying Prognostic Comorbidity in Figure 4, Percentage of Private-sector Employees Working in Establishments Offering TH w So or A-Elig ib Mor le e Health Annual earni R ngs esearch Institute (EBRI) is the only 0.01*** 0.01*** 0.001 0.001 2 r wo is 0k 0 rs 8 k e a (rnd a ss , m d co is osc stu tsls ya s e b ss d eo ca c aia b uo s te v ee d o a w f n tith dh e s tho p he re w s m n eo n in rcee F eig oxp fur sep e ns o 4 u iv )s e e m sa a . nd y A s r e m sfu le oc rch et , c eto m om tp al p lo ru y es e he e rs ns o ’ fre iv hle e u al cpttla an hn c cse are r a to p sid ie nly rv cre ircis a es e se ,wa s ho es al t h m ta hu t- c p th he lahig n ecm he ho pric lo a eytse trhe or a b c p T es re oti s b m s eu a inc re ted we lud . Sre ub ed m sin eo qt rue he e lik nt ae ly na ly , ly m ttha ic ara n gl ina tsho am l see pf le fw e,cit tind ho s w u ive tid rit e u ta cols a ls ch w ul ait a dct h e to .d B b fe o ec r a au acll tsiv e ind e ind , efp ull iv eid - nd tiua m ent e ls, w v no aitrnuni h iab he le o asn lt a h etm cto he pnd lo iry it e rio e es n sp sa e w g ce to is v uld e 1 8 m b –e e 64 a e ns x (a p fs e o co r tf ed recruit and retain workers (those workers who value health plan coverage), increase worker productivity, 100% provide • Older workers were less likely to switch health plans Pt Pha O n younger woE rk PO ers. Health Plan Increased Health Plan Choice Longitudinal Studies: D evelo pment and Validation." Journal of Chronic Disease 40, no. 5 (1987): 373-83. Years in plan -0.05*** -0.04*** -0.01*** -0.001 Insurance Plans, by Establishment Size, 1996?2014 .................................................................................. 7 90 10% 0% EBRI focuses solely on employee benefits research — no lobbying or advocacy. b ins faem c ur a ilus e y rle ene voee fl d a ts n h a tin o n a c ab o tilit ntthe inue y tind o a tiv o vo iinc d id ua rae l da le vse v ere stl. e he s e ple re cm tio iu n. m s, thus exacerbating the trends toward the concentration of the more REBR eco I m Em m plend oyee ed Bene Cfiitt a Rt es io ear n: c hP Ia ns ul titu Fr teo Ins ssue tin Brie and f ( IM SSN . C 08 hr87 ist ?o 137X phe) ri sRo publi ebsuc hek d ,by “H the ea E ltm h plP oy laee n S Bene witc fithi Rng esea : A Ca rch Ins se tit ute, 1100 Demoindependent nonpr graphics ofit, nonpartisan to p Ja 1 r e nbs . e e1 nt le , 2015 a ss tio lik n 50) e % in .ly Fu tthe ha rth n re er tsho m ulotsr se e t,w a e b itm le ho p sut . loS y tc eat o end s is tha it icio al dn ts so i g tha o n ifsv iw c ean itbce c h e e p n bla as cns oe nt ,d inuo tu hipso u fnind s ly st ing an enr d m o ard lle ay d e ind rro in ic a rs a he itse a dtlte ha h nt o p tla ind en d iv in as id 2 ua fo 0l1 lls o 4 w w asind th : * h e *ig nr * h p o< llbe0 lo d.o 0in d 1 ; workers and their families with protection from financial losses that can accompany unexpected serious illness or injury, Health Status Health savings account. 13th St. NW EBRI , Suite stand 878, Ws asalone in em hington, DC, 200 pl05 oyee -4051ben , at $30 efits 0 per rese year ar or ch is ia nc s luded an inde as par pend t of a e mn em t, bnonprofit, and no ership subscription. Pre npa sortrtisan ed Male 0.01 -0.03 -0.04** he By alt Pha yul ind Fiv rid ons ualtsi n, in tP he h. le D. ss, eE xp m ep nslo ivye e pe la ns Be ane ndfi the t R le essse he araclth hyI ns indtiv itid ut ue als , a in nd the M m.o C rehr exp ist eo ns piv he e, rm R oo ree buck, Study?Implications for Private- and 88% Public-Health-Insurance Exchanges and Increased Health Plan Choice,” EBRI • Higher-income workers with employee-only coverage were more likely than lower-income workers to switch p ** the rep she s < u0. a re lt 05; h we Cp har a la re nd ln s no on c f* otr p om sa < att or 0. is le bi 10. fas ie ditd ty i Jw ndex an itu h atrhe y 2 q 015. ualit y A so fd e ca sc re rib the ed0. y b 001 reelo ce wiv , e ad s in et a on f 0. ho 01 EPus O e aho ndld t- he ler ve e -0. flo 003 vrari e w ab er le es w w illing as c 0. re 001 toat te ry d a fo d r ifferent a Cn ud tlepr r, D omo avite d M b.e , an tterd S he ar alt ah h. J . Reber. "Paying for Health Insurance: The Trade-Off between Competition and Adverse Figur ste 5, anda rd Hpo eal sttah P ge ra lan S te paid w in it c Dhi ulln es g, ................................ VA. POSTMASTER: Send ................................ address changes to: EBRI................................ Issue Brief, 1100 13th St. ................................ NW, Suite 878, 9 80% organization committed exclusively to data organization. It analyzes and reports research data without spin or underlying agenda. All findings, When it came to A ge plan switching among workers with family -0. c003* ove*r *age, the find -0.ing 004* s* *were compar -0.ab 01* le ** to those for 40% c 2 omprehensive plans and thus toward continually increasing premiums for the more expensive plans. At some point, Ph.D W., ashiRx ngton Eco , DC n , o 20005 mics -405 1. Copyright 2017 by Employee Benefit Research Institute. All rights reserved. No. 432. Issue Bri Hyef, per tens no. ion 432, (Employee Benefit Research Insti -0.02 tute, March -23, 0.02 2017). -0.02** -0.02** carriers. However, higher-income workers with family coverage were less likely than lower-income workers to EP emO p. lo yees with family coverage. Using those variables, this analysis excluded employees with spouses or dependents Exclusiv Se el ec prtov ion id ."e Q r u or ar gta en rly iza Jo tiu on rna . l of Economics, May 1998: 433-466. wheth House ehol r on fi d siznan e (indi cial vidual data, s) options, or trends, 0. are reve 007 aling an0. d 02* reli * able — the re 0.005 ason EBRI information is 78% worker 80 s % with employee-only coverage. Compared with family-plan non-switchers, plan switchers earned more; were Con clusion dissemination, research, and education on Dyslipidemia -0.01 -0.03* 0.01 -0.01 the employer or insurer ultimately decides it cannot spread the costs and risks associated with these plans over a According to the 2015 EBRI/Greenwald and Associates Health and Voluntary Workplace Benefits Survey, workers Figur70 e 6, % sw N itc at hur cA a e of rri nnual e rs H ear eal or nit ngs sh P witc la hn S plaw n ittc yh pie n.g, Among WF oirgur ker -0. e 11 s 01* S **witching Hea -0.lt 0001 h Plan, by Plan T -0.01* yp *e ....................... 10 ages 65 and the oldegold sta r, as it m nig dard ht no fo t r ha priva ve rte e ce analysts a ived claimnd s pde aidcisi exc on lusmake ively b rs, y M gove edicranme re. Tnht is policy study m a ake lso rdr s, othe media, and pped HMO 72% 30% Diabetes 0.05 0.06* 0.02 0.02 y 3ounger, healthier, and less likely to have had someone in the family treated for the various health conditions; and Report Availability: This report is available on the internet at www.ebri.org This analysis used data from an employer that increased from four to 10 the number of health plan options available to sufficiently broaY dear po sp in pl ulaan tion that includes enough healthy p-e 0.o 003 ple to make the -0. h 005 ealth plan’s cos 0.t06* (an **d premiums) F P in red fe in rre gd spro vider organization. D ov ee yr o, R whe . A lm ., D ing. C ly . C cons heid rke in r, he ana dlt M h . A ins . C uria ol n. " ceA t doAT a p bte in tghe a C A G m lio ns icta o l C r om sLecorAN ond bid -im tyCE o Isn t dim exp fo or rt U ant se w wo itrh k I pC laD c-e9 -b CM ene Afd itm (iF nro istr ns attiin v ean d the Imp publi ac economic security and employee benefits t o c. f Demographics, Health Status, and Use of. Health Care Services on Carrier enrollees from the statistical analysis, since there was only one HMO to choose from even after the six new health-plan Congestive heart failure 0.12 0.03 0.04 used fewer heal Heta hl th ca Sre ta tu se srvices. 63% e Fm igur plo • 60 e y % e 7, Tehe sV t ar o lo ing s abl ho ee M w r awh n eans eem thpe lo r b y y ce eH e rt e a w al in T at s h h P d ee e nr E m lm a o on S p lle glo rap d yw ein h eit ic c Be his h s in an n e o g, frd it I he p n Re ri di ro she v e r a id u rc aua slt heh lIn o sp f stit la W hn, e u ital te h E tthe h (EBRI) m c le apl re so s y s lik w e ea rv e es ly -io c f o e nl hu s e y n are C d oer d o s v rh in e er e l a 1 a w te 9 ge as 7 d8 .to .......................... to Its p sla w mn it issio csh wp n it la cis hin ns to .g . 11 reasonable on a per-covered-individual basis, so it’s forced to terminate or modify the health plan or alter the bases on DatabS as w eist.c " h Jion ug rn , A al o mfo Cn lin gic E an l rEo plid leee m sio W loigty h E 45, m n po lo . 6 ( yee Ju -o ne n l1992) y Cov : 613 erag -9. e, by Type of Health Plan Helm an 2015) 20%. Workers also place a high value on health plan choice: 80 percent of workers think that it is extremely choices we Ar se thm ad a/d ce hr doni . A cf obs ter tap rucp tilvye pul ing m th onar esey di cri steas eria, e the an -0.al 01ytical datas-e 0. t 01 contained 20,-5 0.2 01 2 employees, -wh 0.02 ich were 4 Charlson comorbidity index 0.001 -0.02 0.02 Descriptive Statistics 60% contribute to, to encourage, and to enhance the development of sound employee benefit Health maintenance organization. The six new health plan options all used smaller networks of health care providers relative to the original plan options which individuals choose among the health plan options (Fronstin & Ross, 2009). or ve EBRI explo ry imD pepr ortes an st ion fro es the breadth of emplo r employers to offer a choice y oee ben f heal 0.t 02 h efits and related issues. plans (Frons 0.02 tin and Helma-n 0.004 2 016). HSA-Elig 0.001 ible Hypertension 0.02 0.001 -0.03 separated into two cohorts: 6,948 with employee-only coverage, and 13,574 with family coverage. Who we are Relationship of Demographicp sro , g H ra e m as lt ah nd S so ta un td u s pu a bli ncd p U olis ce y th of ro H uge ha olb tjec h C tiv a er re e w seai rc th h aP nd la en d S uca w tio it nc . hi EBRI ng is the only 50% a b c Figur • e 8, M oV re ar a iabl ctua e M l us eans e of o bfy fic H ee val istih P ts fo la r n S botw h itp crh im ina g, ry I n ca di re v id pua hys ls ic W ianitsh F and am sp ily e C ciao lis ve tsr age was ................................ linked to less plan sw ........ itching 13 . Wh 10 at % 2014 enrollees did for 2015: Overall, one-third of 2014 plan enrollees switched health plans in 2015 Enthoven, Alain C. "TThe Institute seeks to advance the public’ heory and Practice of Managed Competition in Health C s,are Finance." (Elsevier Science Publishers, B.V.) and did no Use o t pr fo Hv D ea id ysle t lip h o id C ut ea m- ria of e S -n er ev two ices rk benefits. -0. PP 004 O 0.02 EPO -0. H003 ealth Plan The study deEBRI scribed studie in this s the worl Issue Brd iefof health and retirement ben was conducted through the E efit BRI s — issue Center fosr such a Resears ch 40 on 1(k)s, HealtIRAs, retire h Benefits ment 5 T his Issue Brief examines the expe prriv ien ac te, e n oofn a p ro part fit, in co un la pr arti larg sane , W em ash plin oy ge to r, n ,an DC d -a bas se ud b s oe rg t ao nfiza itti s oe nm cp om lom ye ite ted s, w exic th lu siv res ep lye c tot to According to unpublished est imates from the Employee Benefit Research Institute based on data from the March Any hos Dpi iabet taliz es ations -0.003 0.01 0.01 0.04* 0.033 0.05 0.048 F Fo igr ur ee x am 9 p p D rle e em s , ean o nt g s re a m tphh p eil co e sy se tir mta htat ed is r e ola ffteio ring nship a w s id ofe d c eho mo icg era op f h he ics a,lt h h ep alla th n ss tm atauys ,f ind and t h pa rito o r fu fe sreing of on hee al t or h c m aor ree s ervices with (Figure 51988. ). Wincom o rkerse e ade nrolle quacy, d in the co H nsu SAm per-drive lan were n m benefits, ore likelySocia to sw l it Security, ch plans ttax treatment of both retireme han other workers. One-half of nt HS and health A-plan Not surprisingly, the trend has been toward more health plan choice. The percentage of employers offering health Innov ation (EBRI CRHBI), with thep f uund blic ing po liscup y p reo se rta rc of h the and f o ello duc w aing tion oo rn g aeniza cono tio mic ns:se A cm urit er yic a ann d Eexp mp re losyse,e A b oen neH fit e w issu itt,e B s.lue Methods the media’s and policymakers’ knowledge a rece 40 n% t increase in the number of health plans that employees could choose. In 2014, this employer offered Figure 9, Im0% pac Ctonges of D tiem ve hear ogr t f aph ailuriecs, Heal th Status, and Us-e of 0.06 Health Care S 0.06 ervices on Plan -0. S 06witching, Among Any emergency department visits -0.01 -0.02 -0.003 -0.005 2016 Curren Matl ePopulation Survey, about 60 percent of wor -0. ker 03* s* were employed -0.05* by firms with 100. 002 or more As a re 40 sult % , the employer had a concern about adverse selection. To mitigate against this, the employer provided comprehensiv benefits, e (highercost prem manage ium) plan ment s alo , worker a ngside les nd s cemploye ompreherns attitude ive (and s, lo policy reform p wer premium) rp opo lans sals, is no and p t fease ib nle sion if oasset nly s p enr lan olle sw eit sc s hing witc he ford w po lan rke s,r sc o wm itp h are emd EBRI’s p lo wit ye h e2 m -o 7 en m p ly e b e rc c ro sh ev n ip etr o ag inf ce E lu . P dRe O es e s ault n crro o sl ss la e-re se es c ,p ti2 ro e 4 ns p e ont e f r pe cee d nn sio fto o n r f a fu P nn P y dO s; p la e bnr n usin o sw lle ess itec esh, s; , a trad a nd s w e 1 a e 3 ss ll p oae csiatio rc beyn nttshe ;o f benefits that offer a choice of two or more health 1 plans has increased from 21.5 2percent 3in 1996, to 414 .4 percent in 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Cross Blue Shield Association, Boeing, Healthways, IBM, JP Morgan Chase, Kaiser Permanente, Mercer, and Pfizer. Asthma/chronic obstructive pulmonary disease -0.02 0.06** -0.02 employees a choice of four health plans? an HSA -eligible health plan, an EPO, a PPO, and an HMO ?all with the The purpo P s re im ar ofy t c his are phy stud sy ic w ian v as istio ts examine, for this part -0. ic 01* ular * employe -0. r,01* th*e variables as 0.001 sociated with -p 0.la 0001 n switching by Age -0.003*** -0.001 -0.003*** Enrollees With Employee-only Coverage, by Type of Plan Switch ............................................................ 14 employees in and 2015. fundi and under ng. There is wi standing of employee benefits and labor de unspread ions; heare lthcog care n p ition rovidthat if employee be ers and insurers; govern nm ee fits nt odata exist, EBRI kno rganizations; and servicew fir s m it. s. . "Consumer-Choice Health Plan (First of Two Parts)." The New England Journal of Medicine 298, no. 12 (March financial incentives to nudge people with various health risks to enroll in the new plans. The new plans had lower le tys pse he ofa p ltla hy n e sw mit pc lo h, y ew ehic s eh nrin olc l lud in tehse ins mt oarn ec c eo sm w phe rer hee n 1s )i v ee nr p ola lle ns es . switched the insurance carrier but not the type of HMO enrollees. 2010 (the year t D h epr e es Pat sii on ent Protection and Affordable Care A0. ct005 was enacted), an 0.03 d to 45.9 percen 0. t 02 in 2014 (Figure 1). 30% Specialist physician visits -0.01*** -0.01*** -0.0004 -0.001 Household size (individuals) same carrier. In 2015, it added six new health-plan choices?HSA-eligible plans, EPOs, and PPOs?from two additional employees und So eurrce the : Medi e cal xp Exa pendi ndte urd e Ps anel et S o urf v ey o .ptions, and to see whether additional plan options led to adverse selection. To 24% 1978a): 650-658. employee premiums, higher HSA contributions, and no cost sharing for primary care office visits and generic drugs. Use of Health Care Services health plan, 2) enrollees switched the type of health plan, but not the carrier, and 3) enrollees switched both the type And the trend has he their importance to our nation’ ld for all employer groups by size from s economy 2005 to 20. 14; the lowest percentage increase was among 6 Prescription drug fills 0.0000 0.0002 -0. 21% 0001 0.0001 Annual earnings -0.002 -0.0001 0.005 Figure 10, Impact of Demographics, Health Status, and Use of Health Care Services on Plan Switching, Among carriers. As a result, employees saw their plan choices increase from four to 10. ac O cn o m av per lisa h gte, his t,h te he p er ancal ey nstia sg fe irsotf fem la EBRI’s gg pe lo dy ter w ho o srk s o e f w f aer dho via n ng s cw ea s it c ckhe h no od iw c e lp ela do gns fe p b a la n en dt s we um ne d o n er rsta e 2014 tn hdain n an g d do o u f2015 belm ed p . lo N by et e ex ew t, een bit enfe ur f1 itt9 s he 9a 6 rn c d ala nth s ds eif 2 iri0 e 1 d4 , EBRI delivers a steady stream of invaluable research and analysis. There is evidenc Ae ny t hos hat pi a tal div ze atrions se selection does exist and can -0. im 002 pact the availab -0. ili03 ty of health plan 0.s01 in the employment- 20% 20% of health p Nla um n ber and of out the pat ca ient rri pr erov . T ider hes findings indicate tha 0.t001 demographic -0. s 001 and prior use 0. of001 health care se -0. rv 001 ices are Years in plan 15% -0.01*** -0.001 0.06*** the largest employers, which were already at a high percentage in 2005/6 (Figure 2). Table of Contents importance to the nation’s eco 13% nomy among policymakers, the news media, and the public. It EnrolleA eny s em Wier th F genc aym depar ily C tm o ent ver viage, sits by Type of Plan S -0.02 witch ................................ 0.01 ................................ -0.03* ......... 14 A bu lsto ,t h la e rg pe er r c een m p ta logye eEBRI rs of are wo rm kpublications er ore s o lik ffeer ly in ed tclu h an ade cshm in-de oal icle ep o m th f pplcove o layn esrs rage h ta os oin fof key issues a fc err ea a s ced ho ib ce y o ofn p lnd ylan 5tren 4 s. p Ier n d s 2014, c; en summ t. 82. arie 1 ps erof rese cent of arch e m p l oy.e "C eso w nsu ho m s er w-it Cc hhe oicde H pla ens alt ha P cc la on rd (S ing ec on to dt of he T na wto P urea ro tf s )." the Tir he s N wit ec wh. E n Sg ple ac nd ific Ja oll ur y,na the l o f Me stud dy ic c ine re a 298, ted n thor.e 13 ( e adM da itrio ch n al Despite the incentives to enroll in the new plan options, older workers were less likely to switch health plans than based groA uny p m out ar -of ke -t net . F woor r k e s xa erm vip ces le, ut Biluc izat hm ionueller and Fe0. ld F02 s igur tein e( 1 5997) 0. and 03 Buchmuelle -r 0. ( 018 1998) looked -a 0.t013 the effect of Health Status predictors of plan switching, but health status is not a strong predictor. does this by conducting and publishing policy research, analysis, and special reports on Primary care physician visits -0.001 -0.003* 7% -0.0003 T Fig his ur e exa s ................................................................................................ mination of 7% the data produced the fo7% llowing findings: ................................................................. 4 What we do findings and policy developments; timely factsheets on hot topics; regular updates on legislative and employers with 1,000 or more employees offered at least two health-plan choices, compared with 17 percent among indica 10 to %rS s 1978b our foc r e: t) ho E : 709 m spl eoy w -720. ee B ho s eneef witcihe t Res d p ear lac ns h I :ns 5% atls itut o e anal switc yhe sisd bas caed on adm rrier, also ini s stw rat itiv ce c hed lai m ps la dat n ta. ype, and switched both carrier and younger workers, and the higher use of office visits for both primary care physicians and specialists, higher use of moving to a C har fixe lsd on c coom ntror ibbi ut diio tyn index at the UniversityH oefa Clt ah lif oP rnia lan 0. ( U S 02* C w )it . P crh ioin r g to 1994, - 0. U 03 C set its contribu0. tio 03 n equal to the EBRI’s mission is to contribute to, to employee benefit issues; holding educational briefings for EBRI members, congressional and 7 Specialist physician visits -0.003* -0.002 -0.002 Figure 11, Impact of Demographics, Health Status, and Use of Health Care Services on Carrier Switching, Among regulatory developments; comprehen Fsi igur ve e refere 1 nce resources on benefit pro 0% grams 0% and workforce Bhargava, Loewenstein and Sydnor (2015) examined plan choices among employees working for an employer Notes: Statistical significance denoted as follow s: *** p<0.01; ** p<0.05; * p<0.10. employers wi Hytper h lte ens ss ion than 10 employees (Figure 2). And beca -0. us 06* e * larger employe0. rs06* employ a larger p 0. e06 rcentage of the I pnt lar n od tyuc pe tio . F nina ................................................................................................ lly, since most plan switching that occurred was for carrier only .......................................................... (not plan type), the study also created 5 emergency depart Pres m ce ript nt ion dr s, an ug f d ia llshig fh ed eer ran l u am geb ne cr y o sta f ff ou , a tp nd a tth ieen 0. n t e 0002 p w rs ov mid ed eiras; we andr e sp a o 0. n ll0000 so co rin rrg e lpa utb eli dc wi optin hi 0. o le 0001 ns su s p rvla ey n s s ow n it ec m hing ploy. ee c Oovsetr o all, f 0% t he ge nd hee arlt ha h p dla vn erw y itlit h tlte he re la lartg io ens st hm ipe m tob p ela rsn hip sw , it bc ut hi ng in .1 9 T9 h4 is U st Cu d re yd o uc be se dr v the ed e tha mp t lo m ye en r p wre erm e iu lem ss clik ont ely rib tut haio n n w to om the en 100% • One-third of health plan participants enrolled in both 2014 and 2015 switched c health plans between 2014 and a b d 5 issue encour s; and age major survey , and to enhance the development s of public attitudes. Enrollees P W erit cen h Etm ag plo e o yefe P -o rnl ivy at C eo -sect verage, or E bst y T ab yplie of shm Hen eal ts O th Pfla fer n ................................ ing Health Insuran ............................ ce 15 that in 0% creased plan choices from nine to 48. They found that the majority of employees made objectively worse Enthoven, AD la yis n, lip a idn ed m T R ia otial chard Kronick. "AH C SA o Pl ns aum n er-Choice HealEPO -t0. h P 02lan for the 1990s -0. (F PPO 02 irst of Two Parts)." -0.H 02 T MO he New England Number of outpatient prov be ider nef sit issues. EBRI’s Educ -0. a tio 003* n *and Research- 0. F002 und (EBRI-ERF) -0. p01* erfo **rms the charitable, work force, about two-thirds of workers had a choice of two or more plans in 2014 (Figure 3). three flags that segmented these employees by their baseline plan type. These dichotomous groups were then amount charged by the least costly plan available statewide. This policy led to a high degree of plan switching by UC to switch their type of health plan, but overall there was no statistical correlation. In contrast, regardless of the type of Data and M 19 e96 t h od 19 o97 loEBRI gy 19 ................................................................................................ 98 19meetings 99 20 present an 00 2001 20d 02explore i 2003 20s 04 sues 2005 with 2006 thou 20ght 07 20 leade 08 20 rs 09from all se 20........................................... 10 2011ctors. 2012 2013 2014 7 2015. That Offer Two or More Health Insurance Plans, 1996?2014 Diabet Aes ny out-of-netw ork serv eid ces uc ut atiilo izn at ailon , and scientific fun0. 0. cti 01 05 ons of the Institu-te. 0.03 0. EBRI 03 -ERF is a tax -0.01 -e-x 0. e08 mpt organization choices tJh oa ur nna th l o ey f M co ed uilcd in h e a320, ve, n wo it.h 1 t ( hJe a nauvae rr ya 1989 ge ea m ):p 29 lF oiy gur -37. ee e 10 opting into a plan costing them $373 more per year Changed plan in 2015 Did not change plan of sound employee benefit pr ograms and analyz 90 e% d. Source: Employee Beneefit Research Institute analysis based on adm inistrative claim s data. 87% e he mapltlo h yp ela es n , s aw nd it cth, he o sld weitrc w hin org k e crosnt w rib eru et e leds st olik se ig ly nif to ic a snt wi ta cd h vhe ers ae lt h sep le la cn tis o n th , a dn riv ying oung one er w pla orn ke orut s. o Hfig the he rU -in Cc in om tee r na wo l rkers EBRI regularly provides congressional testimony, and briefs policymakers, member organizations, Figure 12, Impac Sourt c of e: E m D pl e oy m ee B ogr eneef aphiitc R s es , H ear ea ch I ltns h tS itut ta e anal tus,y a sis n bas d U ed on adm se of Hini ea stl rt at hiv C e c ar laie msS dat era. vices on Carrier Switching, Among 50% Congestive heart failure supported by contributions and0. g01 rants. 0.32 a Study So Su a H rce m eal :p tM h s ledi eav ................................................................................................ I c im ngs al Ep x ac pendi acc ount t o tur .f e D Panel em So urg vey ra . phics, Health Status, and Use of Health Car.................................................... e Services on Plan 8 compared with choosing an otherwise equivalent plan with a higher deductible. This is equivalent to 2 percent of b Notes and : Stat the medi istical signia ficon employe ance denoted asr f benefits. ollow s: *** p<0.01; ** p<0.05; * p<0.10. marke • t a W nd oErk xc le le ua srs id ve ing e prnr ov io t der he lle or dhig gani in zh at t-he ion. op tH io Sn A-pp la la n n to in r2014 aise pw re em reiu m F m io gur sr e 4 e 9 lik 3 peely rc teont s w in it1 ch 99p6la . ns than other workers. 45.9% were more A lik se thm ly a/ th ca hr sound public policy thr n oni lo cwe obs r-tirn uc co tivm e pul e w m o onar rker ys di ts oeas sough objective w eitch carriers -0.. 01 And the longer a0. n 07 employee was enr -0.o 11 lled in his or her Enrollees With Family Co verage, by Type of Health Plan ......................................................................... 16 . "A c ConsumerS -C whioi tcch ei n Hg e,a A lth m P ola nn g f E or n t ro he ll 1 ee 9s 9 W 0s (S ithe F con am d of ily T Cw oo P veraarg tse )." , b Tyh T e N ypee w o Efng Plla and n S Jw our itc na hl of Medicine 320, a Preferred provider organization. Th mea e e nxp an lan na ua to l rin y cvoam ria e ba le nsd b 4 e2 lie p ver edc en to tb o e fa tsh se oca ia vter ed a g we ith em plp an lo y cee hoip ce o ratnd ion s o wfit tch hing e pr e we mrie u m de . rived from 2014 eligibility Me80 th% ods ................................................................................................ Preferred provider organization. ............................................................ 8 EBRP I er issu cen es tag pre e o ss frele Priv as at ee s- sect on ne or wsworthy Employees developm Workients, ng inand i Estab s a limong shmen the mo ts st widely quoted d Depression 0.002 0.03 76% 0.43. 053% health pla 45n, H % eal the th m le aint s enanc s like or ely gani th ze aty ion. weEBRI re to s Is w sue itc h Brie pla fs ns is . O a v se erial ral l, w fitohr in ev -d eery pth y e ev ar alu th ati ao t na op f e erm so plo n y w ee as b e enn ero fitl lis ed su e in s a a nh d e tren alth ds, plan, 42.5% 42.6% b no. 2 (January 1989b): 94-101. research and education. Any Sw itch 73%Sw itch Carrier Sw itch Plan Type Sw itch Both While numerou E s xs ct lus ud ivie e pr s h ovav ider e or exa gani m zine ation. d questions related to health-plan choice, very 41. fe4% w have examined research and claims data. D sou em ro ces grao phi n O c e f fm c er hployee a in ra gc t T ew ris be ot ic o ns r e fits inc Molud r by all media. e eH deal agte h , g In esu nde ran r, ho ce us Pe lan hold s, s 1996?2014 ize, income, and the number of years Use of Health Care Services Sim Sila tatris lyt,ic C aut l oA le nrO a a ly ne nd sis - ha Re ................................................................................................ lfb o efr H (1998) SA pla ae n s xw e anr m ellio n a lle e s de c rit s c h ica san wl it g a ce n he s a lt y dh se a pstla o tns o f o e,k m c p p olo lm ay c p ee a e rat b ee d n H e w a fit rv it h p ard o2 li7 c U ies pn e ir a vc n e e d rs nt ............................................. pit ro y a. p m o In o sa ng ls. 19 E 9 EBRI P 5O , H e a nr No rvoard tes lle e is m s ,se o24 v rial ed to 9 8 Our they were 5 pe c rcentage points less likely to switch plans. Demographics 7 CHECK OUT EBRI’S WEBSITE! 39.5% In June 2007H , eal thte h sE av RiI ngs SA ac Ic nount dus .try Committee (ERIC), a membership organization representing the employee 70% 67% questions re Alny a t e hos d EBRI tpi ot al ain zat direct eim ons plos ye membe r expand rs ing and the other constit number of uen he -0.a 02 cie lth-s p la to n the informatio cho38. ice 7% s for em n pthey need an loyees and t 0. he 18 d irunde depertakes ndentsnew . an employee was enrolled in his orp ro he vrid ciu ng rre cu nrre t p nlt an in. fo Trm hea ti lat ont eor nw aas va c riet onys io dfe re emd p lo im yp ee o rt be ann etf,it s tinc opics e ine . EBRI rtia e of r is st iac k we ine ek ss ly has a V efr ixe y fd e w co 40 o nt % f rth ibe ut p H io eS rn c Ae f-o nt prla he an ma eolnr tng h o b lle PeP e ne O s fw e itnr s ho . oC lle so w n eit tsrc ,i he bau nd d ti o p1 nla 3 sns we pe a rrc le se os nt e s tw a a m ittc o h 8ng e 5d p H teo M r ca O en de tif nr o fe fo rt lle ehnt e e slte .y a pset -o cfo s he tly alt ph olp icla y n. fo r F ie vm e p ple orye cee nst 80% Findings ................................................................................................ Male -0.01 -0.01................................................................ -0.002 0.001 9 Ericson, Keith M. Marzilli. "Consumer Inertia and Firm Pricing in the Medicare Part D Prescription Drug Insurance Exchange." benefit plan As nyo em f tresea er he genc lar ryg ch depar est on a cto m rn ent po ongoi ro v ra iu st n iio td su ng nps o in ba f EBRI tsis. he Ure nit seead rc S h ta an -t0. d e s, 01 in sig rele hts, ase as d w ites llp ao s 0. sit 02 up io dn ates pa o pne r su , rv en et yit s, -le 0. stu d 04 d “ies A N , e liw tig aB tie on ne , fit There public are severaat l quions estions that research can address. For example, which workers switch plans when more choices been reported in the context of health plan choice (Strombom, Buchmueller and Feldstein 2002) (Ericson 2012) (Handel e s Dw a erisn tp cin h itg e ed b t he t e A o lge o t fw ind h e$45, ing PPO, s 000 in EP ta he O y or e baiv rH ,a MO r 80 iat e p w ea it rna c h etn lhe yts ifo ss,a r h m eem e a lt p ch la orr y s-e t i0. e a ert 004* s ,u w s e a hile *ha *rnd in 7 a g 35. p ne be 2% erg tcw -lig e 0.e nt 004* ib e n le s w *$45, *rit ec la he 000 tio dns to a hi n -a 0. p d 001* d t$70, o if fp e *la r000 en nts w he a ity a ce lhi -ta 0. h ng r0004* ,p a la . nO n dv t75 e yrpaep ll, e w r tit he ce h n t Health-plan choice has existed for many years. For example, the federal government as an employer has been offering NBER WorkEBRI has earned widespr ing Paper 18359 leg (N islatio ationn a l B an udr ea re uead r g o ulatio f Eco negar no am ffeid as c c R tinesea g em rc ph lo ), y S eeept be em neb fit er 2 plan 01s 2. . The EBRI Databook on 60% Primary care physician visits -0.002 0.003 -0.02** EBRI maintains and analyzes the mo 33.st 8%comprehensive database of 401(k)-type programs in the PlaD tfeosrcr m ipfti ov re L S ifta e ti Sseticcs ur ................................................................................................ ity.” In it, ERIC outlines a proposed structure that employers c.......................................... ould use as an alternative t o 9 a re ad • de W d 35 hile H ? % ous D oH ehol eS sA d s an pila zinc e ( n ir ndi eena v rso idual ing llee s m s ) e w nu ereo fm p ola re n lik op etly io ns to s r0. e ws 02* iult tc*h *in pla ans dv,e r th se o0. sse 02* e le wh *c *to io d ni?d A srwi e tt -c 0. he h 0001 rwe e w re a y m s ots ot m lik -it 0. eig 0002 lya tto e s aw ga itin ch stt o 2013) EBRI’s website is easy to use and packe . d with useful information! Look for 32.6% foonr ee o m f p tlh oey e ne esw ec arn arriin eg rs m . 32. B oy 4% re c t om han pa $ ri7 s0 on ,0, 0E 0P a Oy a end ar. PN Pon O -eunio nrolle n e es m w plo ho y ese w sit e cxp hee dr ie wnc ere e dm tuc heh cm haong ree lik in ely 19 t9 o5 67. s , w w 0% ithile ch tuni heio r n a Cha wirdls eo ran n C 70 g oe % m o ofr b he ida itlt yh I-nd pla en x c w ho asic n eo st tre o leat mepdlo ty oe p ela s n and sw ritecthing irees. s Em incpelo tye hee 1 s 9w 6i0 th s t hh ig ro h ug blo h otd he p r Fe esdse ur ra el w Em erp elo le ys es e slik H ee ly a lt tha h n Employee Benefits is a statistical reference work o 66. n5% employee benefit programs and work Specialist physician visits -0.01** -0.003 -0. 66. 01* 0%* world. Its computer simulation analyses on Social Security reform 65. 6% and retireme 65.5% nt income adequacy 65.3% 64.8% 51% the curren Atnnual way ear in ni w ngs hich they provide both health -a 0. n 003* d re **tirement -b 0.e 003* nef*its. The p -0. ro 002* pos **al used a-n 0. 002* exc*h *ange Relationship of Van or ariableganization that “tells it like it is s With Switching/Non-Switching ...................................................................................... ,” 10 the same plan type with a differe 30.n 3% t c30. ar3% rier. adverse selection? Do workers choose the best plan for themselves in a choice environment? How is the best plan force-relat 49% ed issues. 29.7% e t ty ho m pp e se these special features: lo o y w f ehe iteho sa P w lt ut rh es e re ip t c la r tin o pt n. o is on dr t w Taf hir itfc ug f eh tc ette e ihe ln ld s p u te y nr p tcie le 1 nt o9 f 9 o he 6 f ,a E w lt Ph O hi c p eh la nr n al olo lle orw eb e so d a t h nd thte he 7re 0. p he 001* seera arc clt eh nt he p o rs la f n P to P ty O lp o e o e k nr a 0. nd at o001 lle a ce a ts re r rs iat e w rm . itc A ehe nd ntd g e tro m o u 0. p a p lo 0002 d ( yitffe ehees r e 1 w n 9t it 9 h t5y p ne o n o-f Ben Frons eftiitn, s P Pr ao ul g.r " aF m e a(tF ur EH esBP) of E . A mt pp lory em s 29. e en 1% nt t,- B pas are tic d H ipa en alttsh P ha lan ves a ."n Ea Bv ReI Is ra 61. gs 4% e u eo B f ri ab efo,ut no 2 . 2 0 0 he 1 a (E ltm h pl pla oyns ee B toen cho efio t R sees fr ea om rc hin any 50% are unique. Years in plan -0.04*** -0.04*** -0.004*** -0.001 30% 59.7% (“benefit admini28. st1% rator”) combined with a fixed contribution from participating employers. Furthermore, in A course of health status measures was also examined. Using ICD-9CM diagnosis codes on medical claims, flags for six 58.6% determined? Is there plan churn or enrollment “stickiness” over time? How many health plans are too many to choose Re lationsN hip um ber of of De out mo pat gria ent phic prov s, ider Hesalth Status and Use of H 0.e 0004 alth Care with Pla -n 0.003 Switching ...................................... 0.003 12 57.6% unio healtn h w po larn ke w rsit)h atnd hebased on the f ao rcig ont in 57.a r 2% o l lc g ar ro rie up r, (wh tacts he il e 1. A 9 29 46 57. s the Bylaws state: p unio 2% ercen ntw oofr E ke PrO s )a . n d 21 percent of PPO enrollees switched the type of g diyvselip n id ye ear. I m n 60 ia st % itw ue te) re, S leespt s em likeber ly t 1 o 9s9w 8it . ch carriers than those wit 30. ho 5%ut it. Employees with diabetes were more likely to Health Status 56.2% 56.3% 56.3% • EBRI’s entire library of re o About 88 percent of HSA search publications starts at plan enrollees in 2014 who did the m switch ain W plans efb page. Click on or 2015 chose an HEBRI SA-plan with a c Ohcro tonbic er c o 2n 0d 0i7 ti,o n th se wC eo re m c m reitat tee ed:f o hig r Eh co bn looom d ip c rD esev sur eleo,p d m ys en liptid (e Cm ED ia) ,( e aln ev o artg ed a ncih zo alte io sn te r oofl )b, udsiianbes ets e slea , cd on er gse s atn ivd e heart Any out-of-netw ork services Co ut nitac lizat t ion EBRI Publications, -0. (2 0001 02) 659-0670; fax 0. p03 ublication orders 0. to09* (2*02) 775-6312. from? Charlson comorbidity index -0.01 -0.01 -0.004 -0.01 Carri 40e %r Switching 52. by 1% Type of Health Plan ............................................................................................................15 h sw eal itc tEBRI make h h p ca lan rrie an rsd t h m as information freel o n vteho d s to e a wit nho ewut c arr it. iW er. hile y av all ailable to al these relations l.hip s were statistically significant, none was significant at 25% “In all its activities, the Institute shall Source: d E iff m epl re oy nee B t car eneef rier.i t Res Suear bsc crip h Ins tiotn its utto e anal EBRI ysis Iss bas ue ed on adm Briefs arei ni in sc trlu atd ivee c d alai s m pa srt dat of a. EBRI membership, or as part of a educatorIssue Briefs s, released its and recEBRI Notes ommendation for our in-depth and s for replacing employm nonpartisan pe ent-based heariodicals. lth benefits with a system of failure (CHF), asthma/chronic obstructive pulmonary disease (COPD), and depression. Additionally, the Charlson Hypertens 33% ion -0.003 -0.005 0.002 0.0001 The study found evidence of adverse selection: Younger employees were more likely to switch to less-costly plans than A ls o, M O . e "P drders riicva art EBRI e e H Ad ea v /a lassume tn ht I an gsu e rh a s a nsa publi c e E bee xn ch in c a n service re e ge xis s a tennc d D e spo ef in in sed o nm si C e bility o fnotrrm ibu to stmake iin oc ne H th ea its finding elt h 1980 Plan ss: ? s M Isco e It di mpletely c Da éj re à A Vdv u A a acce ll O ntavge e ssi r A is ble g ia ts in e at ?lf" www.ebri.org a En B R oIpt Issu ion e the p<0.01 50% level. The presence of congestive heart failure, asthma/COPD, or depression was not related to plan Implications for Plan Sponsors and Public Policy .................................................................................................... 16 Notes: Statistical significance denot $199 ed as annua f l ol su low bsc sri : * p*ti * p< on 0. to 01; EB ** R p< I No 0.05; tes * a p< nd0. EB 10.RI Issue Briefs. Change of Address: EBRI, Dyslipidemia 0.001 0.0004 -0.003 -0.003 The case study examined in this Issue Brief addresses one set of questions: Which workers switch health plans when Co indm ep orb enid die ty n tI n re dg eixo w na as l ein xc clh ua dn eg de as s f r a og m e n w eh ral ic h s cio nre di void f u he alaslt , h wshto a tw uso ( uCh ld arl bes o gn iv , een t al a .f i1 x9 e8 d7 co ) (n Dte ry ib ou , tC io he n,r k co in uald nd p u Cr io clh ase 30% function strictly in an objective and o Re lde la r teim on p as loh yi— ep e of sso that all deci . T V his ar ria esb ult leesd W s in io ith a ns 1 6 S that w pe it r relate to emp c ce hi ntn p gr/ eN mon ium - lS oyee inc 27% wrie tc aben s hei ng in efits, the hig wheth h-co er st m plade an in in Cong 1996. N ress on-ran or bo dom ard rooms or to “traditB io rn iea f n l” o M . 373 edic a (r Eem cpolo vy ee ra e B geen ?ef an itd Ra es dd ea itrio ch n I an l st op ittu io te) ns, J au ro lyund 201 c 2ho . ice for supplemental insurance and prescription 1100 13th St. NW, Suite 878, Washington, DC, 20005-4051, (202) 659-0670; fax number, switching 20 . P % referred provider organization. Diabet o 21. es S 5% ixty-three percent of EPO enrollees in 0. 2014 03** who did sw 0.03* itch * pla 24% ns for 2015 0.00 switched to0. an 01 EPO with a • Visit EBRI’s blog. Subscriptions Conclusion b .......................................................................................................................................................... 18 an he aelm thp iln os yu er r a families’ in ntce ro d fr uo cm eho s a m m m oe o re s, n g care hco oim cbased ep s? etDo in g e on the highe sp r th ivea tint e rhoedauc st lth tqualit io pn lao nfs y, m . Se most depe ore e choicesnda cont blre ibu informatio te to adve n. rsEBRI’s Web e selection? site posts 1992) (Quan, et al. 2005). (202) 775-6312; e-mail: subscriptions@ebri.org Membership Information: Inquiries d Sis am enr plo ellm me E ean n xt c s lc us o are int ve pr i nue sho ovd w ider . n W or in itgani hin Figur ztat hr eion. e7e fy oe r aind rs,iv the idu a hig ls h w -it co h se t m plp alo n y wa ees - onnoly l o cn og ve err ag ofe fe . rS ee dp b ara eca te u s se tat oifs taid cs v e arre se psre els ee cn titoend. b y drugs accelerated with the passage of the Medicare Modernization Act (MMA) in 2003. Congestive hear unbiased manner and not as an advocate t failure -0.02 -0.02 0.01 0.004 40% 43.5% different carrier, and 72 percent of PPO enrollees switched to a PPO with a different carrier. c 20% all research findings, publications, and news alerts. EBRI also extends its education and public service Health savings account. regarding EBRI membership and/or contributions to EBRI-ERF should be directed to EBRI ht Fro tp n: s/ ti/nw , P wa w u.l,e r ain cd M .org u/rfro ar ym Ns./ R up oss. loa "d AFddr iles es /b si86a ng H 0ea 00lt00 h C 00 ar9. e M file arna kem t R eef .EoR rm IC T _Ne hrow ugh _B a ene n If nisu t_P rala nt cfe E orm xc_ hF aL n06 ge:06 Es 0. sen pdtfia a l n Pd ol icy whether 15 an %individual switched health plans, and if they did, the nature of the health plan switching in terms of I Rn efceorn etnrc ae sA s t s ................................................................................................ tto hm ta/ he c hr poni res ce obs nce tr uc of ti vse pul pecm ifonar ic dis y di ea ss eas ese and/or -he 0.01 alth condition -0. s, 001 the .......................................................... higher us-e 0. 01 of office visits -0. f004 or both prima r19 y • EBRI’s reliable health and retirement surveys are just a click away through the topic boxes at 13% role to improving Ameri Presid can ens’ t Ha finan rry Co cial naw kn ay owle at thdge e abothro ve ad ugh dressits a , (20w 2) ard 659--win 067ning 0; e-mp aubli il: co cn a se wa rvice y@ebcam ri.orgpaign Finally, several meaor opponent of any position.” sures for use of health care services were also studied. These were all measured in 2014 to control The same dynamic could occur in the public marketplace?or in any other health plan choice situation?where the A http lso ss:i// ncw C ew D otepr m h we po .es c1e n s 9d en i8 on .0 o ts s, r,g t /p m he o d P re f/Q u p blu ri ic a v P lat ity la en - -Af s O efc pt o to rio d r n a e ,b a m le n p- d lo HO y ee ta h rls er t hha I -Ca 0. ssu v02* ere es b-e t fo e on r C -Al int on l.rsi p od d der fuc 0. ." 02 ing EB he RI I alt ssu h-e p B larn 0. ief c 01 ho noic . 3 e 3 to 0 ( th Em eir pl 0. e o01 m yep e B loyen ee ef s,it via c ca ha re ng ping hys io cfian the s an typ de s p oe f c he ialais ltt®h s p wa las n, r e th la et e cd a rri toe le r, sor s pbla ot n hs . w W ithe ching n it. cB aut m eo tthe o o r vte yrpaell s pola f n he sa wltithc-hing serv,i cte he urseag wea? s u no se of 30%o Because only one HMO was offered in 2014 and 2015, 100 percent of the HMO enrollees who switched Endnotesthe top of the page. ................................................................................................ ChoosetoSave and the companion site www.choosetosave.o ............................................................ rg 20 10% Data and Methodology for the im Use o pact f H oea f p ltrh io C r aus re S e er of vs ic ees rvices on plan switching. They included 1) any hospitalizations, 2) any emergency m In oc re on -he traa 10 slt t% hy to p the eo pEle P O e it find herin dg ro s,p e cnr ov oe lle rag ese in or the mi g PrP at Oe w to itw h ard hig h leb ss lo -o ed xp p erns esiv sur e e a nd we lreess le -c so s m lik pe re lyhe tons siv we it cph latn os ,a no leatv he ing r PPO cafeteria Rpesea lansr c ah nd In fst leitxib ute) le, J sp ue nnd e 2 ing 00 9a.r rangements, as part of the shift from more paternalistic benefit approaches to difference by gender, but the study did find that individuals who switched plans were younger than individuals who did inpat Eie din totri s ae l rv Boia cre ds : H an ard ry e Cm one arg wae y,n pcuy b ld ish ee prart ; Stm eph een nt B s, lanu kelm y, b ede itro ro . f A p ny re vs iecw rip s etxio prn esse drdug in tfhills is p , unu blicm atb ioe nr a n odf td ho ifse fe o rfe tnt he a ouut thp ora s sh tieont ul d not 9 chose a different plan type with a different carrier. Any hospitalizations -0.01 -0.01 -0.01 -0.01 d e Se paer tE m netn hto v vis en it s(,1 3 97 ) nu 8am ), bE ent r o ho f p ve rim n a (1 ry978 carb e) ,p E hy ns th ico iavn en vi s (it 198 s, 4 8) ) ,nu Em ntb he orv o efn s a pn ed cia Klirsotn pick hy s(i19 cia89 n v ais ),it s a,n 5) d E nn utm ho bv ee r n o f and m Thoere b d eat an ascri a d fm o ber d ot re th oi s to h e s f to tu he ffd ic y ele rc s, s os tm r uhe e st efa ero s, lthy m me mb a in le arg th rs, ee o rm e oo m three p r lsp o co y om e nr so pt rrh s eat o he f trns he e civ E emp e n tp l ly ola y iens n e c B re w ena it es fh ie t d hig R ee se he m arp c r lho p Iy r ne e stm e it uium c th e,o th isc e . e E o BfR h I e Ed al ut ch at ip on lan ans d. R Feo se r at rh che t pha ron gre anr mo s lle me as k ing wit ho em ut p lo hy igeh es b lo mo od re p a re cs cs our un et,a w ble hic vh iais c o cs otns sha iste ring nt w (w ith ith exp dee fine ctad tio , ns fla. t-O dtohlle arrw eis m ep , lo no ye o r tc he ont r he riba ut ltio h ns sta ) ta und s p no ro t vsid we itrs ch up se lad ns , an . Td h e the av us era eg o ef aogut e -wa of-s n e 4t2 w .2 o rk ye s ae rrv s a icm es o? ng we thro ese no w t ho rel astw ed it cthe o p dla pn las ns w it acnd hing 46 . . 5 years among those who • Need a number? Check out the EBRI Databook on Employee Benefits. Any emergency department visits -0.02** -0.03*** 0.005 0.001 EBRI is sup 0% 20% ported by organizations from all industries and sectors that appreciate the value of Fund, or their staffs. Nothing herein is to be construed as an attempt to aid or hinder the adoption of any pending legislation, regulation, or F Krro ons nitcin, k P (19 5% aul 89 , a bnd ). Ruth Helman. "Views on Employment-based Hea blth Benefits: Findings f c rom the 2015 Health dand Voluntary prescription drug fills (days’ supply adjusted), a 6) number of unique outpatient providers, and 7) any out-of-network 2014 benefit year, this employer offered employees a choice between a preferred provider organization (PPO), an indicators were related to plan switching among PPO and EPO enrollees, and no health status indicators were related to choice. Interest by Te otm alployers in provid HSA ing Pl w anorkers with more EPO plan choices continue PPO d to be evident lea Hd MO ing up to the Primary care physician visits -0.002** -0.002* -0.0003 0.0003 did no • t s Vw erityc h. fe w AlH so S,A p -la pla n n sw enr itco he llere ss ha wd ho b e sw en itc in he the d p p lala ns n s fo writ le che ss dt im toe a ( 2 d.iffe 7 yre ea nt rs t )y tp ha e n ofno he na -lt sw h it pcla hn e. rs (3.6 years). In unbiased, reliable information on emplo interpretative rule, or as legal, accounting, actuarial, or other suchy pee b rofessienefits. onal advice. Vis www it .ewww.e bri.org bri.org/about/join/ for more. 8 This study examined data from an employer that increased from four to 10 the number of health plan options available health seW rvoic rk epl s a ucte B iliza en tio ef n. its S urvey." EBRI Notes (Employee Benefit Research Institute) 37, no. 3 (March 2016). exclusive p Sr po ec via id lis etr p o hr yg sa icn iaiza n vt isio its n (EPO), a health maint-e 0. n003* anc*e * organiza -t 0. io 002* n (*H *MO) and- 0. an 001* HS *A-eligible- 0. he 001* alth * plan (HSA p AC Fila gA n urd s ew e 10 b ita cte hing pr e as n e d an m itts so ng t201 he H e 0 S sA e tina m pla c attn e m d e e nr e nt fo f.e lle c An te ss o d . f m de om st org erca ep nt hic ly,s ,s o he maelt h em stp alo tus ye,r s a nd ha v pe rio shif r us teed otfhe he he altah lth cap re la n seo rv pic tio es ns o n the plya n • Instantly get e-mail noti?cations of the latest EB RI data, surveys, publications, and meetings Source: Em ployee Beneefit Research Institute analysis based on adm inistrative claim s data. addit ion, plan switchers earned more ($95,697) than non-switchers ($92,083). 0% 10% a to emplo Hy eal ee th s s. av T ings o m acit count iga .te against excessive concentrations of the less healthy individuals in the older plan options, the Prescription drug fills -0.0002 -0.0002 -0.0001 0.0000 EBRI Issue Brief is registered in the U.S. Patent and Trademark Office. ISSN: 0887 ?137X/90 0887 ?137X/90 $ .50+.50 plan). The inos uran Amc oe ng c aw rro ie rk r efr osr s tw he it c Phing PO, E he PO alt an h p dla Hns SA , 5 p la pe ns rc w en as t otfh e th s eam HS eA . plan enrollees in 2014 who switched plans switching for workers with family coverage. The health-status variables measure whether anyone in the family has the offer thbeir emp 19 lo 96 yee 19s97 int19 o 98 priv 19 at 99 e e 20 xc 00han 20g 01 es 20 or 02hav 20e 03 ad 20 d04 ed 20 pri 05vat 20 e06 exc 20h 07 ang 20 e08 s as 20 a 09w20 ay 10 to 20 o11 ffer 20 m 12ore 20 o 13pti20 on 14s (Fronstin and seminars by clicking on the “Notify Me” or “RSS” buttons at the top of our home page. Exclusive provider organization. . "VN iew umber s o of n t out he V pataient lue o prov f V ider olunt s ary Workplace Bene -0.fi 004* ts: F ** indings fro -0. m 01* the ** 2015 Hea0. lt0004 h and Voluntar-y0. W 0003 orkplace As previ cously noted, employees with individual coverage were analyzed separately from those with family coverage. W em he plo n y ee xa Pr r ef p m er rini o red vng id prov e d p ider la f or ina n gani sn w c zit at iac ion. l hi inc nge nt am ivo eng s in ind the iv id fo ua rm ls o w f it lo h w fa em r e ily m p co lovyeere a g per,e m it ium wass ,a g hig ain hefr o und HSA tc ha ont t he riba ut ltio h n ss ta , ta us nd h no ad c ao n st Concerning heafo lth r 2015 statusc,h p aln ag n esdw tit oc he a PPO rs w,e E re PO g eone r H ra M lly O h w eit ah lthie ther o tha rign inno al n ca -sw rrie itrcshe , arnd s. A 7m po eng rce p nla t n cha sw ng itc ehe d b rs o,t h thtehe ir d 2012) iseas. e or health condition. Similarly, the use of health-care-services variables measure whether anyone in the family d Health m aintenance organization. Any out-of-netw ork services utilization 0.01 0.003 0.004 0.002 0% Since polic Ben ySo ho ef uild rce ts S e : M rs edi u rm c v al eus E yx. pendi t " c EB o tn ur Rs e Iid N Panel e ort S e tur he s v( ey ir E .m epl ntoir ye e e B fam en ily ef ’sit R ins es ur ea an rcch e I ne nst eid tu st,e) the 36 he , na olt . 1 h- 1st (a Nto uvs em anbder se 2r0v1ic 5e ):s 2 -us -12. e v ariables s Fha or r201 ing 5 fo , rt he pr im pla an ry scpaorns e o ofrf ic sie g nif visic ita snt alnd y e g xp ene and ric e d d rit ug s he s, h alt oh ping pla n too e ffnc ero ing ura s.g e It le ad ss d e he d a tw lthy o n ind ewiv cid arri uae ls rs to , e s ac wh itc ohf to whi th ch e impact on plan switching among EPO enrollees (Figure 12). In this case, individuals who were in families where plan type and carrier. us coe mdo r the bid it he y aind lth 19 e © cx 96 a 2fr0 o e1 19 r 7 sp 97 e , la E rv m n 19 icp s 98 elo w , y a it 19 end ce 99 he B tr ehe s 20 n e 00 w fit ta os t Re 20 a 0. l 01 snum e 18 a20 r,c 02 w h b e hile Institu r 20 o 03 ff o ste e r 20 rno ? 04 vEd icne 20 - u s sw 05 c us atio ite 20 cd h n 06 ,e a rw ns 20 d he i 07 t R rw eese a 20 a s a 08 p r0. p ch lic 23 20 Fu a 09 . bn A le d l 20 s .. o, 10 All Sim p20 r la ila ig 11 n h r ts re st20 w o 12 it the s ce he r 20 v fr 13 ind esd .w ing 20 e14 re s fle os r s likely Source: Employee Beneefit Research Institute analysis based on administrative claims data. There’s lots more! w ere all constructed at the househo ld level. Specifically, t thhe chronic condition flags represent whether any member of offered a PPO, EPO, and HSA plan. Thus, for 2015, employees and their dependents had 10 health-plan options for s ne om we p ola ne ns in , atshe the fa m ne ily w ha pla dn eo itp he tio r ns dia abll eu te ss e d o rs m asa th lle m r ane /CtO wP oD rk w s e fo re r he mo arlteh lik ca erly e t por osv w id ite crh s ta ond ano did the no r tE P pO ro v tha iden oind ut-iv of id -uals In the individual and small group markets, health-plan choice expanded in 2014 with the introduction of the ACA public Notes: Statistical significance denoted as follow s: **1100 13 * p<0.01; * St * p< reet 0.05; NW · Suite 878 * p<0.10. to have been treated for high blood pressure and dyslipidemia than non-switchers, and they were about as likely to individuals with employee-only coverage, health status was not related to plan switching, but prior use of health care the household had each disease; the Charlson Comor Washington, DC bidity Index is 20005 the maximum individual score yielded in the family Source: Medical Expenditure Panel Survey. ne 2015, two rukp b fr eo ne mf it fo s,u w r o hic pth ios no sm fo er m 20 ig14. ht v Visit EBRI online today: iew as less comprehensive cowww.ebri.org verage. in exc fa ha mng ilie ess w (a he nd re t he no ro ene lat e ha d d ins eit ur he anc r o ef m the arske e tc o re nd foit rm ion s sa.n d subsidies). h se arvveic b ee s ew na tsr era etla etde d fo . rI n dia fa bcett,e tshis , c o rn ela ge tio stns ivehip he w ara t sf a sitlr uorng e, e ars ta hm moang /CO eP m D p,lo ay nd ee s d e w pit re h sfsa io m n. ily coverage than they were for (202) 659-0670 www.ebri.org www.choosetosave.org ebr ebr ebr ebr ebr ebr ebr ebr ebr A ebr ebr ebr ebr ebr ebr ebr ebr res iiiiiiiiiiiiiiiii.................or or or or or or or or or or or or or or or or or ebri.org ebri.org ear g g g g g g g g g g g g g g g g g IIIIIIIIIIIIIIIIIc s s s s s s s s s s s s s s s s sh r s s s s s s s s s s s s s s s s sue ue ue ue ue ue ue ue ue ue ue ue ue ue ue ue ue epor Issue Issue B B B B B B B B B B B B B B B B Br r r r r r r r r r r r r r r r riiiiiiiiiiiiiiiiitef ef ef ef ef ef ef ef ef ef ef ef ef ef ef ef ef fr Brief Brief o• • • • • • • • • • • • • • • • • mM M M M M M M M M M M M M M M M M the ar ar ar ar ar ar ar ar ar ar ar ar ar ar ar ar ar • • c c c c c c c c c c c c c c c c cE h 2 h 2 h 2 h 2 h 2 h 2 h 2 h 2 h 2 h 2 h 2 h 2 h 2 h 2 h 2 h 2 h 2 March March BR 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3I,,,,,,,,,,,,,,,,, 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 E017 017 017 017 017 017 017 017 017 017 017 017 017 017 017 017 017 23, 23, duc 2017 2017 at • • • • • • • • • • • • • • • • • ion and N N N N N N N N N N N N N N N N No. o. o. o. o. o. o. o. o. o. o. o. o. o. o. o. o.• • 43 43 43 43 43 43 43 43 43 43 43 43 43 43 43 43 43 No. No. 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 R es 432 432 ear ch Fund © 2017 E mployee B enefit R esearch In stitute 19 6 18 17 9 14 4 12 2 8 15 5 10 20 7 16 3 11 13 Figure 7 Figure 8 Variable Means by Health Plan Switching, Individuals With Employee-Only Coverage Variable Means by Health Plan Switching, Individuals With Family Coverage Health Plan Switching Health Plan Switching Nature of Health Plan Switching Nature of Health Plan Switching Did Not Change Did Not Change Changed Both Changed Both Full Sample Full Sample Changed Plan in Changed Plan in Plan in 2015 Plan in 2015 Changed Carrier Changed Carrier Changed Plan Type Changed Plan Type Carrier and Plan Carrier and Plan (n=13,574) (n=6,948) 2015 (n=2,524) 2015 (n=2,524) (n=9,160) (n=9,160) Only (n=3,555) Only (n=3,555) Only (n=181) Only (n=312) Type (n=402) Type (n=547) Demographics Demographics Male Male 45% 72% 45% 69% 45% 73% 46% 70% 35% 66% 45% 70% Age Age 45.0 49.0 42.2 47.2 46.5 49.8 42.3 47.1 43.1 47.4 41.2 47.3 Household size (individuals) Household size (individuals) 1.0 3.3 1.0 3.3 1.0 3.2 1.0 3.3 1.0 3.2 1.0 3.3 Annual earnings Annual earnings $111,932 $94,384 $113,824 $95,697 $108,005 $92,083 $108,647 $92,374 $106,210 $89,575 $104,860 $91,807 Years in plan Years in plan 3.3 3.4 2.7 2.9 3.6 3.6 2.7 2.8 2.7 2.7 3.0 3.2 Health Status Health Status Charlson comorbidity index Charlson comorbidity index 0.21 0.19 0.18 0.16 0.23 0.21 0.18 0.16 0.19 0.19 0.17 0.14 Hypertension Hypertension 14% 26% 11% 22% 16% 28% 12% 22% 13% 25% 23% 8% Dyslipidemia Dyslipidemia 20% 35% 16% 31% 22% 37% 15% 31% 25% 33% 13% 30% Diabetes Diabetes 11% 6% 10% 5% 12% 6% 10% 5% 11% 4% 10% 6% Congestive heart failure Congestive heart failure 0.3% 1% 0.3% 0.3% 0.2% 1% 0.3% 0.3% 1% 1% 0.4% 0% Asthma/chronic obstructive pulmonary disease Asthma/chronic obstructive pulmonary disease 12% 4% 11% 4% 12% 4% 11% 4% 10% 4% 10% 3% Depression Depression 19% 9% 18% 8% 20% 9% 18% 9% 21% 9% 20% 8% Use of Health Care Services Use of Health Care Services Any hospitalizations Any hospitalizations 1% 5% 0.4% 4% 1% 5% 0.4% 4% 1% 5% 1% 4% Inpatient hospital stays (per 1,000 individuals) Inpatient hospital stays (per 1,000 individuals) 64.7 6.2 59.6 4.4 67.1 7.2 58.2 3.6 73.7 5.5 60.3 7.5 Inpatient hospital days (per 1,000 individuals) Inpatient hospital days (per 1,000 individuals) 385.4 21.7 313.3 10.7 420.2 28.0 303.5 10.3 464.7 5.5 290.7 14.9 Any emergency department visits Any emergency department visits 29% 9% 26% 8% 31% 9% 25% 8% 12% 33% 28% 6% Emergency department visits (per 1,000 individuals) Emergency department visits (per 1,000 individuals) 108.2 466.9 389.4 94.7 116.0 504.3 371.6 94.8 138.1 496.8 444.2 74.6 Primary care physician visits Primary care physician visits 2.3 7.2 2.1 6.8 2.4 7.3 2.1 6.8 2.8 6.9 2.0 7.1 Specialist physician visits Specialist physician visits 1.9 4.8 1.6 4.1 2.1 5.2 1.6 4.1 2.5 4.8 1.5 3.9 Prescription drug fills Prescription drug fills 38.0 17.2 14.8 32.4 18.6 40.7 14.7 32.1 16.9 34.1 14.2 33.2 Number of outpatient providers Number of outpatient providers 3.9 8.0 3.6 7.2 4.1 8.4 3.5 7.1 4.8 8.5 3.3 7.3 Any out-of-network services utilization Any out-of-network services utilization 22% 10% 10% 20% 10% 23% 11% 19% 11% 24% 20% 7% Source: EBRI analysis based on administrative claims data. Source: EBRI analysis based on administrative claims data.