Enrollment in consumer-driven health care stalls

When PPOs were first introduced to consumers, the idea was slow to catch on, though now they cover most consumers in private health plans. Now, the buzz surrounding consumer-driven health care is not always translating into its adoption -- though supporters point to what happened with PPOs to say that enrollment in health savings accounts may well take off.

When given a choice among various health plans, only 19% of employees choose consumer-driven health plans, according to a study released recently by the Center for Studying Health System Change. Another recent study, this one by the Commonwealth Fund, finds that enrollment in consumer-driven health plans is virtually unchanged in 2006.

Consumer-driven health refers to plans in which patients have a greater financial responsibility for care than they would in an HMO or PPO. High-deductible insurance with health savings accounts are part of consumer-driven health, and the term HSA is used to describe that pairing. However, a high-deductible plan does not necessarily have a savings account component.

While both studies suggest a lukewarm response to the new health plans, Jeremy Lazarus, MD, vice speaker of the AMA House of Delegates and a psychiatrist from Denver, said it may be too early to judge the long-term success of consumer-driven health plans, considering it took 10 to 15 years before PPOs overtook HMO membership. The AMA has come out in support of HSAs and consumer-driven health care as part of an overall effort to give individuals more choice in their health care decisions. It also supports adoption of a consumer-driven, market-based plan using tax credits and insurance market reforms as a means to cut the number of uninsured.

"The jury is still out," Dr. Lazarus said. "It remains to be seen whether it will improve. ... We saw this as one option in terms of choice. We don't see these consumer-driven health plans as the solution to the uninsured problem."

According to the Commonwealth Fund, 10% of consumer-driven plan enrollees were uninsured before being covered by their current plan, compared with 20% among high-deductible health plan enrollees and 24% among those with comprehensive coverage. Also, the majority of people with high-deductible health plans do not have a savings account, mainly because they can't afford to contribute to it. About one-third of adults in consumer-driven plans do not receive employer contributions to their accounts, and nearly one in five does not contribute his or her own money to the accounts.

Dr. Lazarus said physicians and their practices should be vigilant in educating themselves about how to deal with patients using high-deductible health plans because of concerns about the difficulty of determining co-pays and deductible levels when a patient shows up in a doctor's office.

But physicians aren't the only ones in need of more education about consumer-driven health plans. The Center for Studying Health System Change finds that health plans, employers and individuals aren't completely comfortable with their knowledge, or sharing their knowledge, about consumer-driven health.

"The plans don't sell themselves," said John Gabel, the center's vice president. "Because [they can be] complex, a lot of employees are deterred from enrolling in them. ... For these plans to really take off, employers are going to have to invest in communication and education."

Tom Hircik, national director of HSA product distribution with ACS Mellon HSA Solution, a nationwide HSA administrator with more than 150,000 accounts and 5,000 employer groups, said new insurance products are rarely adopted in dramatic spikes. The U.S. Dept. of the Treasury projects that there will be 14 million HSAs covering about 25 million to 30 million people by 2010.

"The principal driver is going to be the insurance companies pricing the plans accordingly," Hircik said. "Then employers and employees creating demand."

He said employers are drawn to HSAs because premiums are lower, even when the employer makes a cash contribution to the employee's account. Hircik also noted that companies that improved education have seen increases in the number of employees who signed up for the plans.