Risk selection into consumer-directed health plans: An analysis of family choices within large employers

Roland D. McDevitt, Amelia M. Haviland, Ryan Lore, Laura Laudenberger, Matthew Eisenberg, Neeraj Sood

Research output: Contribution to journalArticle

Abstract

Objective To identify the degree of selection into consumer-directed health plans (CDHPs) versus traditional plans over time, and factors that influence choice and temper risk selection. Data Sources/Study Setting Sixteen large employers offering both CDHP and traditional plans during the 2004-2007 period, more than 200,000 families. Study Design We model CDHP choice with logistic regression; predictors include risk scores, in addition to family, choice setting, and plan characteristics. Additional models stratify by account type or single enrollee versus family. Data Collection/Extraction Methods Risk scores, family characteristics, and enrollment decisions are derived from medical claims and enrollment files. Interviews with human resources executives provide additional data. Principal Findings CDHP risk scores were 74 percent of traditional plan scores in the first year, and this difference declined over time. Employer contributions to accounts and employee premium savings fostered CDHP enrollment and reduced risk selection. Having to make an active choice of plan increased CDHP enrollment but also increased risk selection. Risk selection was greater for singles than families and did not differ between HRA and HSA-based CDHPs. Conclusions Risk selection was not severe and it was well managed. Employers have effective methods to encourage CDHP enrollment and temper selection against traditional plans.

Original languageEnglish (US)
Pages (from-to)609-627
Number of pages19
JournalHealth services research
Volume49
Issue number2
DOIs
StatePublished - Apr 2014
Externally publishedYes

Keywords

  • Selection
  • account-based plans
  • consumer-directed

ASJC Scopus subject areas

  • Health Policy

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