Health care consumerism continues to grow – through both consumer-directed health plans and tools that provide all health care consumers with more information about their health care choices and costs.

Here are some examples of their growth:

• The number of employers with 500 or more employees offering CDHPs increased from 14 percent in 2007 to 20 percent in 2008.¹
• Thirty-one percent of new coverage issued in the Small Group market was for HSA/HDHPs.²
• Companies that offered an HSA for 3 years saw significant growth each year, reaching 29 percent in the third year.³
• In 2008, enrollment in CDHPs reached 7 percent of all covered employees, up from 5 percent the previous year.¹
• In companies that offer CDHPs, employee enrollment also continues to rise – from 8 percent in 2006, to 10 percent in 2007 and 15 percent in 2008.⁴

The top two reasons that plan sponsors give for offering a consumer-directed health plan (CDHP) are lowering benefits costs and promoting consumerism.³ Both of these reasons are likely to become even more important as plan sponsors deal with the current economic situation.

During a recession, health care use tends to increase. Consumers get care they might otherwise delay because they’re concerned about losing their employer-provided health coverage. People paying for coverage under COBRA also tend to have higher usage than active employees. And there is a higher incidence of stress-related medical and behavioral health conditions.¹

Aetna was the first national, full-service health insurer to introduce a consumer-directed product in September 2001. We offer a wide range of CDHPs, including Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs) through the Aetna HealthFund^® family of products. We have a plan for all your clients – no matter what size or funding arrangement they prefer.

Click here for more information on the Aetna HealthFund plans.

How CDHPs can help plan sponsors with benefits costs

CDHPs save money. According to one survey, companies with at least half of their workforce enrolled in a CDHP had a 2-year median cost trend, almost half that of companies without a CDHP.⁴ Another study found that CDHPs cost 4.8 percent less than PPOs and HMOs.⁵ One explanation for this cost difference is the fact that CDHPs have higher deductibles than other medical plans. But they still cost more than $400 less per employee when compared to PPOs with $1,000 or higher deductibles.¹

High deductibles are a growing trend among non-CDHPs. Over the last 2 years, the percentage of covered workers in a plan with at least $1,000 for single coverage grew from 10 percent to 18 percent. The jump was even greater for smaller companies – 16 percent to 35 percent.⁶ Plus, a recent Mercer study found that the median deductible for more traditional health plans is also rising, from $500 in 2007 to $1,000 in 2008, possibly due to the influence of CDHPs.¹ The minimum deductible for an HSA-qualifying high-deductible health plan (HDHP) is $1,150 in 2009.

Higher deductibles are just one way plan sponsors are cutting costs. In the next year, 40 percent of companies report that they’re likely to increase employee premium contribution amounts, 45 percent are likely to increase office visit cost sharing, and 41 percent are likely to increase the amount employees pay for prescription drugs.⁶

Healthier employees also reduce costs

The increase of CDHPs is also tied to a more general increase in health care consumerism. A survey by the Employee Benefit Research Institute found that CDHP participants make better-informed health care decisions and are generally healthier.⁷ That’s because employers who offer CDHPs also provide more and better health information tools to their employees.³ In most cases, these companies promote healthy lifestyles to all their employees, not just those participating in CDHPs.⁵

Of course, health management and wellness programs are an important part of consumerism – one that encompasses the entire health benefits industry, not just CDHPs.

Aetna offers a wide variety of tools to help employees make decisions about their health care benefits, such as:

• Plan Selection and Cost Estimator — Helps employees estimate out-of-pocket health care costs, compare plan offerings and determine which plan best meets their families’ needs.
• HSA Savings Calculator — Lets employees review their potential account balance over time, estimate tax savings, compare the performance of several different savings scenarios and more.
• HSA Maximum Contribution Tool — Helps employees determine their annual contribution limits. Employees may also factor in any employer contributions or catch-up contribution amounts, if applicable.
• HSA and HRA tutorials — Online courses help employees understand why health plans are changing, what health care consumerism means, and how HRAs and HSAs can offer important benefits.
• Online videos — Explain how the HRA or HSA plan works in a simple, conversational, personal style. Modules make it easy for members to review the information that matters most to them.

The Aetna Navigator^® member website gives members secure online access to their personal benefits information with self-service features, such as reviewing fund/account or deductible balances and checking the status of a claim. They also have access to other features, including:

• Health care transparency tools – see the article in this issue.
• Healthwise^® Knowledgebase – research clinical information on thousands of health topics and medications.
• Aetna InteliHealth^® – allows members to search from credible health and wellness information and helpful interactive features.
• DocFind – provides access to up-to-date information in our directory of preferred health care professionals, as well as survey results to see what other members are saying.
• Personal Health Record – provides individuals with easy online access to their personal health information.
• Simple Steps To A Healthier Life^® – interactive online tool that uses a health assessment to help members turn knowledge about their health into action for making positive health changes.

We also offer a wealth of wellness programs. See the article on how to build an effective wellness strategy elsewhere in this issue of Aetna INsider.

CDHPs are here to stay

As more plan sponsors of all sizes adopt consumer-directed health plans, their impact on the entire health benefits industry will continue to grow. In fact, current economic pressures are likely to accelerate the growth of CDHPs.

HSAs accounted for most of the CDHPs added in 2008. Unlike HRAs, HSAs don't require an employer contribution. In fact, 29 percent of large HSA sponsors do not contribute.¹ This makes these plans particularly attractive to plan sponsors struggling to offer health benefits to their employees. They also provide attractive tax incentives.