Consumer-Directed Coverage Makes Market Inroads

Those who choose these plans tend to be more educated and dedicated to maintaining healthy lifestyles

Frank Diamond
Managing Editor

The Employee Benefit Research Institute recently went looking for what many hope to be one of the bulwarks of a new, cost-effective health care system — the “engaged consumer.” The institute found him in two relatively new benefit systems: consumer-directed health plans (CDHPs) and high-deductible health plans (HDHPs).

In its “Consumer Engagement in Health Care Survey, 2011,” the EBRI conducted an online poll of 4,703 privately insured adults, ages 21–64, to find out how well CDHPs and HDHPs were doing in the marketplace. It also weighed “the impact of these plans and consumer engagement more generally on the behavior and attitudes of adults with private health insurance coverage.”


Seven percent of the population was in a CDHP, up from 5 percent in 2010. That’s a 40 percent increase in one year. Enrollment in HDHPs grew from 14 percent to 16 percent. “Overall, 15.8 million adults ages 21–64 with private insurance, representing 13.1 percent of that market, were either in a CDHP or were in an HDHP that was eligible for an HSA....” the survey states. “When their children are counted, about 21 million individuals with private insurance, representing about 12 percent of the market, were either in a CDHP or an HSA-eligible plan.”

This is not only a slight shift in coverage, but in attitude as well. “It is clear that underlying characteristics of the populations enrolled in these plans are different....” For instance, those in CDHPs and HDHPs tend to be more highly educated. In addition, “Adults in CDHPs and HDHPs were significantly less likely to smoke than were adults in traditional plans, and they were significantly more likely to exercise.”

Wellness programs seem to matter more to those enrolled in a CDHP. “CDHP enrollees were more likely than traditional plan enrollees to report that they had the opportunity to fill out a health risk assessment and they were also more likely to report that they had access to a health promotion program.”

Members’ cost-conscious decision making by type of plan, 2011

Employer offers wellness program, 2011

Person participates in wellness program offered by employer, 2011

Though CDHPs and HDHPs are growing, market penetration remains relatively small. EBRI reports that “the amount of time individuals have been in these plans is shorter than the time others have been enrolled in traditional coverage.”

Number of years covered by current health plan, 2011

Of course, a lot of people still don’t know about CDHPs and HDHPs. In particular, someone enrolled in a traditional health plan is not likely to be aware of consumer-directed health plans.

Familiarity with consumer-directed health plans

One of the survey’s conclusions is that “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 will be better understood.”

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