Consumer-driven health plans have bypassed health maintenance organizations to become the second most common plan design offered by U.S. employers, according to an Aon Hewitt survey.

CDHP designs are becoming increasingly popular among employers because they provide the framework needed for educating and motivating employees to actively engage in managing their health and wellbeing, according to Maureen Fay, senior vice president and head of Aon Hewitt's CDHP working group.

In 2011, 58% of employers offered a CDHP and 38% offered HMO plans, according to the survey of nearly 2,000 U.S. employers representing more than 20 million U.S. employees and their dependents.

PPOs continue to be the most popular plans, with 79% of employers offering them in 2011.

 “As employers struggle to address unsustainable increases in health care spend, they can no longer rely on traditional methods of tweaking plan designs like increasing copays and deductibles or increasing employee payroll contributions for medical coverage,” says Fay. “Employers are beginning to explore innovative solutions that focus on both the short-term need to manage health care costs and the longer-term requirement to change underlying behavior patterns, shifting the focus from ‘caring for the sick’ to ‘actively managing the health of their employees.’”

A growing number of employers are also considering using voluntary benefits, such as critical illness and accident insurance policies, to supplement CDHPs. More than a quarter (26%) can attribute an increase in CDHP enrollment to the availability of voluntary or supplemental medical benefits. While just 6% of employers use voluntary benefits today to complement the CDHP and encourage enrollment, 42% report they will consider this approach in the next few years. 

Among employers that offer CDHPs, health savings accounts outpace health reimbursement arrangements, 34% to 18%, respectively. However, the survey shows a higher number of employees enrolling in HRAs (43%) compared to HSAs (28%). HRA plan designs are popular among large employers embarking on full replacement CDHP strategies, as they offer more design flexibility to the employer than HSA designs.

Employers are using a variety of tactics to encourage employees to enroll in CDHPs, including subsidizing premiums at a higher level than other plan options (36%), covering preventive medications before the deductible (34%) and contributing employer funds to the HSA (30%) and HRA (22%).

Employees are willing to try CDHPs and their associated accounts, and will continue to choose them because they often come with a lower premium, according to a separate survey of 3,000 employees and their dependents by Aon Hewitt, The Futures Company and the National Business Group on Health.   However, employees find the plans challenging to understand and use.

“Employees want to choose the most cost-effective plan with the least hassle, but they often have very full lives and are not all that interested in digging into the details of CDHPs, HSAs and HRAs,” says Joann Hall Swenson, partner and health engagement best practice leader at Aon Hewitt. “Our research and experience tells us that simply giving employees lots of educational information about these plans and accounts is only helpful to the small minority of people who like all the details.”

To address this, she offers employers the following tips:

• Make sure the right people are in the right plan. Employers need to identify segments of their population most likely to value and take advantage of the unique features of the CDHP, and tailor the marketing to them. They also need to monitor employees’ day-to-day experience of using the plan to ensure it “re-sells” itself and engages consumers in the appropriate financial and health behaviors.

• Reinforce the plan’s actions and advantages. Employers should articulate what’s in it for employees; how they can benefit from the plan’s key features, and be very specific about the actions they need to take.

• Make it easy for employees and their families.  This includes removing barriers to care at the point of need through initiatives like value-based plan designs or fully-funding employer contributions to HSA/HRA accounts at the beginning of the year.

To be effective, employers must also provide tools and support throughout the year so more employees and their families can learn how to:

• Participate in activities to help them assess their health opportunities and risks such as health risk assessments and biometric screenings.

•  Navigate new tools to help them make smart choices in selecting appropriate treatments.

• Leverage behavioral and clinical resources like disease management nurses and health coaches to help set and make progress toward health improvement and maintenance goals.

• Follow preventive care guidelines to stay their healthiest.

• Manage chronic conditions by working closely with their physician and adhering to evidence-based treatment protocols.

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