CDHP Savings Due to Younger, Healthier Enrollees

The Employee Benefit Research Institute (EBRI) gathered studies about consumer-driven health plans, and one found premium savings from CDHPs ranged from a high of 15.5% to a low of –4.7%, with average savings of 4.8%. However, the study found that most of the savings was due to younger, healthier workers choosing CDHPs and concluded that once typical risk- and benefit-adjustment factors were taken into account, CDHPs saved only 1.5%.   

In its August 2010 Issue Brief, EBRI said studies show that initially, CDHP enrollees are healthier than non-CDHP enrollees, but over time the CDHP population has a significantly higher illness burden.  

Surveys show that employers offering a CDHP increased from less than 5% in 2005 to between 12% − 15% by 2009. Growth in offer rates can be seen across all firm sizes, but recently, the percentage of small firms offering a CDHP has declined, while larger firms have continued to add a CDHP as an option.  

Overall, 19.1 million, or 11% of individuals with private health insurance, were enrolled in a CDHP in 2009.  

EBRI said most of the research to date has focused on individuals in health reimbursement account (HRA)-based plans, and little systematic research has been conducted on health savings account (HSA)-eligible enrollees. While HRAs and HSA-eligible plans look a lot alike, the differences are significant enough to warrant separate analyses of the impact of the plans, EBRI contends.   

The Institute also noted that most of the research to date has focused on plan design and has ignored the impact of the consumer-driven account on use of health care services and overall spending.  

However, the studies out there agree that use of preventive services did not change (upward or downward) as a result of the CDHP. There is evidence that emergency room use declined when plan enrollees were subject to higher deductibles, though the research should not be generalized to a CDHP setting, and there is also evidence that CDHP enrollees received higher quality care than members of other types of plans in areas related to low-back pain, eye exams, and nephropathy screening for diabetes.  

Concerning how CDHPs affect prescription drug use, studies found that overall use of brand-name prescription drugs fell and there was some offset from increased use of generic drugs, although some enrollees stopped their use of prescription drugs. CDHP enrollees increased their use of the mail-order pharmacy option. Overall use of prescription drugs among CDHP enrollees with certain chronic conditions fell, or did not increase when enrollees met their deductible.   

Finally, EBRI said that one study found that the financial incentives of the plan are not sufficient in driving behavior and that educational outreach also matters.