EBRI’s Consumer Engagement Survey

The Employee Benefit Research Institute (EBRI) has released its latest annual survey of people with Consumer Driven Health Plans.

This is a large online survey the organization has been conducting annually since 2005, so it has the ability to track trends rather than just look at a point-in-time. This one should be encouraging for people who believe in consumer empowerment.

First, let’s get one annoyance out of the way. The very first item on the very first page says −

The 2012 EBRI/MGA Consumer Engagement in Health Care Survey finds continued slow growth in consumer-driven health plans: 10 percent of the population was enrolled in a CDHP, up from 7 percent in 2011.

“Slow growth?” Enrollment grew from 7 percent of the population to 10 percent in one year, and that is “slow?” In what universe is a 43% rate of growth in a single year considered slow? Sounds pretty damned “explosive” to me. Keep in mind this is percent of the population, including people on Medicare and Medicaid and those that are uninsured. For the privately insured, EBRI says 15.4% ― almost one in every seven adults ― were enrolled in either a consumer directed health plan (CDHP) or a high deductible health plan (HDHP) eligible for a Health Savings Account.

Okay, now that we have that off our chest, let’s look at the rest of the findings. EBRI finds (to no one’s surprise) that –

• (A)dults in a CDHP and those in an HDHP were more likely than those in a traditional plan to exhibit a number of cost-conscious behaviors (and) CDHP enrollees were more likely to use cost information and to try to find information about their doctors’ costs and quality from sources other than the health plan.
• CDHP enrollees were more likely than traditional-plan enrollees to take advantage of various wellness programs, such as health-risk assessments, health-promotion programs, and biometric screenings.
• Adults in a CDHP were significantly more likely to report being in excellent or very good health. Adults in a CDHP and those in a HDHP were significantly less likely to smoke than were adults in a traditional plan, and they were significantly more likely to exercise. CDHP and HDHP enrollees were also more likely than traditional-plan enrollees to be highly educated.

This last point is important. It is the death knell of the old “healthy and wealthy” argument. To the extent they are healthier it is due to behaviors they control, and to the extent they are wealthier it is due to being better educated. Unfortunately the report doesn’t provide any further information about education levels.

It is also interesting that CD Health Plans are enrolling far more new people than any other approach. When it comes to longevity in a type of plan 49% of those in a traditional plan have been in it for 5 years or more, and only 11% for under a year, but of those in a CDHP, only 26% have been enrolled for five years or more, while 18% for less than one year. So the proportion of population with CDHP coverage should continue to grow.

But the most important take away by far is that people are doing exactly what we predicted they would do. They are paying more attention to the cost of the services they consume on every one of nine measures. For example, 53% of CDHP enrollees requested a generic drug instead of a name-brand, while only 41% of traditional plan enrollees did. Thirty-five percent of CDHP enrollees “talked to a doctor about treatment options and costs,” as oppose to 28% of traditional enrollees. Thirty-two percent “checked price of service before getting care,” compared to 23% of traditional. They are also more likely to participate in wellness programs, including health risk assessments, health promotion programs, and biometric screenings.

Finally, physicians come out looking great on this survey. EBRI reports –

Over 80 percent of plan participants, regardless of plan type, strongly or somewhat agreed that their doctor communicated with them so that they could really understand what the doctor was saying and reported that their doctor was informed and up-to-date on their medical history. Roughly 80 percent reported that their doctor was accessible for appointments when the respondents were sick. Roughly 70 percent reported that their doctor understands them as a person, including their work and personal life, and beliefs, and that their doctor coaches them on staying healthy rather than just treating their health problems. Just over one-half report that their doctor provides information on after-hours care, and 21–28 percent report that their doctor is accessible by email.

Overall this is one of the most encouraging reports I’ve seen in a while. Policy people have been striving for decades to get patients to become more informed and engaged in their own care. It looks like they key to achieving that has been found.

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