To identify the degree of selection into consumer‐directed health plans (s) versus traditional plans over time, and factors that influence choice and temper risk selection.
Data Sources/Study Setting
Sixteen large employers offering both and traditional plans during the 2004–2007 period, more than 200,000 families.
We model 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.
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 enrollment and reduced risk selection. Having to make an active choice of plan increased enrollment but also increased risk selection. Risk selection was greater for singles than families and did not differ between and ‐based s.
Risk selection was not severe and it was well managed. Employers have effective methods to encourage enrollment and temper selection against traditional plans.
