In 2005, employers shifted costs to employees through increased cost-sharing at the time of service, rather than through higher premium contributions, according to Mercer. In Preferred Provider Organizations (PPOs), the most common type of medical plan, employees shouldered new or raised in-network deductibles, with over a third of small employers (those with 10-499 employees) requiring a deductible of $1,000 or more.
More PPOs sponsors used an office visit coinsurance requirement which allows patients to see the actual cost of the service provided and thus is seen as a consumerist strategy, according to a Mercer overview. When asked about cost management strategies for the next five years, relatively few employers said cost-shifting will be the primary strategy. Instead, employers plan to focus on consumerism (promoting informed and responsible spending by employees for health care) and care management (programs designed to improve employee health, including disease management), Mercer said.
The use of care management programs grew strongly in 2005, as did the use of incentives to encourage participation, and to measure return on investment.
Among employers with 20,000 or more employees, Consumer-Directed Health Plan (CDHP) offerings rose sharply, from 12% to 22%. Overall though, CDHPs saw only modest growth. Only 2% of all employers with 10 or more employees offered CDHPs in 2005, and only 5% of large employers – those with at least 500 employees – offered them. Nationally, just 1% of all covered employees are enrolled in CDHPs. Small employers are shying away from CDHPs, including Health Savings Account-based plans, with only 63% offering such plans in 2005, compared to 66% prior.
The survey report and tables can be purchased here .