When citizens have more financial skin in the health care game, do they behave more like consumers — looking for and finding value-based health care? And will that behavior lower health care costs?

According to 30 years of this social experiment, the jury is still out. But value-based plans may be emerging as a useful model to promote rational use of care that works, while increasing consumer satisfaction.
The Employee Benefit Research Institute (EBRI) held a forum to debate the track record of consumer-directed health plans in December 2008, Outlook for Consumer/Patient Engagement in Health Care—30 Years into the Experiment. EBRI’s latest Notes publication issued in March 2009 details the forum’s discussion.

Consumer-driven health plans (CDHPs) are framed in this discussion as plans that link high-deductible health insurance plans with tax-favored accounts.

The forum presented two sides of the argument: one from a health plan’s perspective, and one from the HR Policy Association. The plan’s view was optimistic; the HR Association’s, not-so-much.
From the plan’s perspective, CDHPs need 3 elements to succeed:

1. Protection from catastrophic illness
2. Easy-to-use tools to evaluate cost and quality
3. Personalized help for consumers to navigate the health system.

The HR Policy Association expressed skepticism about consumers’ access to the information they need, citing a lack of transparency among consumers about pricing that negotiated between providers and plans.
According to a 2003 forecast from Forrester Research (that gets quoted a lot), growth of CDHPs was expected to reach 25% market penetration in 2010. According to EBRI, about 3% of adults with private insurance were enrolled in CDHPs in 2008.
Paul Fronstin of EBRI presented data from the Institute’s November survey into consumer engagement in health care. The survey found that 63% of traditional plan participants were satisfied with their health plan compared with 49% of consumers in consumer-directed plans and 40% of those enrolled in high-deductible plans.


An emerging model of health plans that employee benefits consultants discussed are value-based health designs. The objectives of these plans, according to Towers Perrin, are to achieve “maximum value for both individuals and plan sponsors.” Each enrollee’s health behavior would be encouraged, through benefit design, to use health services most appropriate to their needs. Incentives link copayments to clinically demonstrated benefits.


This approach is currently used by some employers in the area of prescription drug benefits; for example, an employer may totally eliminate the copay for a specific class of drugs for diabetics to motivate those employees to stay on their therapeutic regimen.

Health Populi’s Hot Points: Some of the best and brightest lights from the health plan design scene convened at this EBRI forum. As bright as their lights are, there remain real questions about what’s working in health plans and how to motivate citizens to get engaged in their own health and health care. It is too early to judge whether value-based benefit design will be a panacea for both motivating positive health behaviors and lowering costs to payers (including consumers) over the longer run.