A recent article in Kaiser Health News, picked up by media outlets, provocatively announced that “High Deductible Health Plans Fall from Grace in Employer-based Coverage”. Citing a recent survey of large employers showing a steep drop in respondents offering only an HDHP, the article noted that “Companies have slowed enrollment in such coverage”. Have they?
Let’s take a breath. Mercer’s just-released 2018 National Survey of Employer-Sponsored Health Plans reports continued growth of both offerings of these plans and enrollment in them among midsize and large employers, though at a slower rate than in most recent years. Today, over two-thirds of these employers offer a consumer-directed health plan (a plan with either a health savings account or health reimbursement account), and fully 37% of enrolled employees have chosen an CDHP. More HSA-plan sponsors than ever—82% —are now contributing to the underlying HSA, with that amount rising over 6% to nearly $700 for an individual employee. CDHPs are here to stay.
The ACA’s Excise Tax drove many employers to speed up offering CDHPs; its delay, and a slowing of health trend, has let employers regroup on how to optimize these plans. Instead of pulling back on CDHPs that may have been rushed to market, employers are more likely retrenching, moving to improve the tools the consumers need to use to work CDHPs properly, not abandoning the model. Today, new technologies and “point solution” vendors are filling the market with approaches to optimizing the employee experience and employees’ comfort level with even high-deductible plans.
It’s like HMOs—they didn’t work well in the 70s and 80s because, in part, the structure and technology weren’t there to effectively measure results, pay per capita rates, but then pay out from withhold pools based on performance. Now we have episode-based care, ACOs and payments based on case rates and integrated models, i.e. the technology that HMOs needed back then. Point: it’s not necessarily the model that fails—it can be the tools aren’t there to enable it to do what it’s supposed to do.
CDHPs are a good financial option for many, especially as payroll contributions are usually much lower than for a traditional plan, but typically not for everyone in an employer population. They require behavior change and an understanding of how one needs, uses and accesses care. Employee diversity is seldom as clear as when we consider health and affordability. Mercer’s 2018 survey shows that, by far, midsize and large employers continue to offer choice: 68% offer an CDHP, but nearly four out of five of them offer a more traditional option, too. Rather than walk away from CDHPs, employers will likely continue to offer options while improving the communication, tools and programs that can make CDHPs work best for many of their employees.