That was one conclusion of a new study of the American Postal Workers Union (APWU) CDHP by the Government Accountability Office (GAO).
According to the GAO, some observers have expressed concern that CDHPs may attract younger and healthier workers, leaving older, less healthy enrollees to drive up costs in traditional plans. They also questioned whether enrollees are satisfied with the plans and have sufficient access to health care providers and discounts on health care services, according to the GAO report of the study .
Enrollee satisfaction with the APWU CDHP was mixed compared to enrollee satisfaction with other Federal Employees Health Benefits Program (FEHBP) plans. For the measure of overall plan performance, APWU CDHP enrollees were more satisfied than other new plan enrollees, but less satisfied than national PPO plan enrollees.
For four of five specific plan performance measures – access to health care, timeliness of health care, provider communication, and claims processing – APWU CDHP enrollees were generally as satisfied as other enrollees. With regard to the fifth measure – customer service – APWU CDHP enrollees were more satisfied than other new plan enrollees, but less satisfied than national PPO plan enrollees, the GAO said.
Relating to customer service, a smaller proportion of APWU CDHP enrollees reported being satisfied with their ability to find or understand written or online plan information, with the help provided by customer service, and with the amount of paperwork required by the plan, compared to national PPO plan enrollees, the GAO said.
Further evidence of enrollee difficulty finding or understanding plan information was revealed by the appeals filed with federal Office of Personnel Management (OPM) against the APWU CDHP in 2003 and 2004, GAO researchers found. Over half of the appeals related to enrollees’ understanding of the plan features, such as their ability to track their account expenditures or their progress toward meeting their deductibles, in contrast to appeals filed against other FEHBP plans, which tended to be distributed among a wider variety of issues. In fact OPM officials said a higher rate of enrollee dissatisfaction and confusion are traits typically observed among new plans, reflecting transitional issues as enrollees learn the features of new plans.
Enrollment in the APWU CDHP more than doubled, from 4,500 when it was launched in 2003, to over 9,500 in 2005. Including dependents, total covered lives increased from an estimated 10,000 to 21,000 during the same period. Over half of these enrollees migrated from existing national PPO plans, and about a quarter from existing HMO plans participating in the FEHBP.
The GAO said members of the APWU consumer plan were on average younger than national PPO plan enrollees, and healthier, better educated, and more likely to select individual rather than family plans than enrollees in other new plans and the national PPO plans.
The GAO report said that a larger share of nonelderly enrollees reported being in “excellent” or “very good” health status in the APWU CDHP compared to enrollees in the other new plans and the national PPO plans – 73% versus 64% and 58%, respectively.
Similarly, a larger share of nonelderly enrollees in the APWU CDHP reported having a four-year or higher college degree compared to enrollees in other new plans and the national PPO plans – 49% versus 42% and 36%, respectively.
Finally, excluding retirees and the elderly, fewer APWU CDHP enrollees selected family plans as compared to enrollees in other new plans and the national PPO plans – 55%, versus 66% and 65%, respectively.
APWU CDHP enrollees generally had access to comparable provider networks and discounts as enrollees in large national PPO plans participating in the FEHBP. In 21 states, the APWU CDHP used the same provider networks as used by other national PPO plans.