The majority of employers with consumer-driven health plans rate their experience as good or excellent, but many have been unable to judge the return on investment on their health spending, according to a new poll jointly conducted by Employee Benefit News and Healthcentric Partners, a firm providing audits, research, consulting and communication planning for employee health.

Surveying HR/benefits professionals about their experiences with consumer-driven health plans, the results highlight health-care consumerism as "an important and growing trend," says Frank Hone, Healthcentric Partners founder.

The survey also shows an increasing movement toward "giving individuals more responsibility and more control over the decisions in regard to their own health," he adds.

The key findings from the survey include:

•  37% of respondents say their experience with consumer-driven health plans has been excellent, while 31% say it has been good, and 32% say it has been fair or poor.

•  63% offered a CDHP in 2008, and 17% report the CDHP was the only plan offered.

•  57% increased cost-shifting to employees, and 54% say they promoted greater responsibility for personal health among their workers.

Looking ahead, Hone predicts more employers will start leaning hard on their employees to do a better job of managing their own health.

Indeed, "the ones that will be more successful will be the ones that take an assertive stance with their workforce," he suggests.

He also predicts that there will be a gradual shift away from consumer-driven health and toward value-based health plan design.

About 20% of survey respondents say that value-based benefit design is an approach that they are considering for the future, and 41% indicate that they have partially or fully implemented a value-based benefit design.

Hone does not expect any growth in the percentage of employers offering a full-replacement CDHP as the only health plan option. "Employers are finding that they need to provide some kind of options for their workforce," he explains. Most employers feel that having some level of choice is what the employee would like."

However, Sander Domaszewicz, a senior consultant at Mercer, has noticed an increase in employers considering a full-replacement CDHP, especially among small firms.

Some companies do this because they want to use an account contribution as a wellness incentive, and that doesn't work well unless everyone has a health savings account or a health reimbursement arrangement. Prodded by the economic recession, the full replacement strategy "is going to be increasingly considered," Domaszewicz predicts.

Bill Sharon, a senior vice president at Aon Consulting, agrees: "We're seeing it with our own clients just in the last two months. We have gotten more calls from clients, more interest" in consumer-driven plans.

Hone stresses the need for more employee education about consumer-driven plans.

"CDHPs haven't been effectively promoted. Education hasn't been provided in as much depth as it could be," which leads to low enrollment numbers for the plan, Hone explains.

"The [benefits] industry is not where it should be, but each year there's been steady progress" in employees' understanding of CDHPs and how they work. Only 12% of survey respondents say their employees understand CDHPs better now than in previous years.

"There needs to be an increased emphasis on effective communication to the employee, not just about the benefit plan, but about behavior change," Hone asserts. "The benefit plan itself won't drive behavior change."

Measuring CDHP results a challenge for employers

Sometimes it can be difficult for employers to know how healthy (or unhealthy) their workforce is.

More employers should use health risk assessments and onsite biometric screenings to get a more accurate picture of the overall health of their workforce, Hone suggests.

"There's a lot more that can be done to directly evaluate the individual health of the workforce through primary means," he adds."They aren't doing as much as they might to help the employee by using primary data."

About 31% of survey respondents have used health risk assessments, and 16% have used biometric screenings. They seem more likely to rely on claims data analysis (79%) and prescription drug usage information (59%).

The survey reveals employers want to measure outcomes and return on investment for their health plans, but they "don't feel they have the full capacity to do that," Hone notes.

About 41% of respondents cite the ability to measure results as an important factor in their health strategy, but only 2% say they are fully capable of accurately measuring return on investment for their health care spending.

Frequently, employers roll out several different health and wellness initiatives at the same time, which makes it hard to pinpoint the exact cause of any savings that occur.

Small business owners speak out against HSAs

At a Congressional hearing on Feb. 4, several small business owners spoke out against health savings accounts, based on their experience.

"Virtually zero people want it," says Dave Ratner, owner of Dave's Soda & Pet City, a small business in Springfield, Mass. "We need to develop a consumer-friendly comparative cost and quality information. My customers know more about the pet products on my shelves than they do about the doctors or they health plans that they [use]."

Another small business owner, Janette Davis, president of Southeast American Financial Group in Pembroke Pines, Fla., chose an HSA for herself and her husband.

But she says HSAs are "a challenge for the employee who has a pre-existing condition. The families of small business owners bear the brunt of the inequalities in our health care system that is heavily skewed in favor of big business. When I worked for a larger business, I had a more affordable family policy, which also covered my husband."

Another concern is that "[HSAs] could keep people from going to the doctor when needed," says Michael Beene, senior health adviser for the National Association for the Self-Employed.

Public employers not buying into CDHPs

According to a new survey by the International Foundation of Employee Benefit Plans, only 17% of public employers offer a consumer-driven health plan to their workers.

"Although CDHPs have become common in the corporate environment, many public-sector plans do not see CDHPs as a good fit for their organization - perhaps because the greater out-of-pocket costs associated with CDHPs could result in employees delaying needed care," says Sally Natchek, senior director of research at the International Foundation of Employee Benefit Plans, a nonprofit organization and source of education and information on employee benefits topics.

"Instead, public employers are working to control costs by implementing wellness and disease management programs, and building a foundation for individual responsibility."

Public employers cited these main reasons for not offering a consumer-driven plan: poor fit for organization (35%); don't favor shifting costs to employees (20%); waiting until CDHPs are proven effective (18%); and expect low participation (18%).

In addition, 74% believe that there is a lack of good data about the cost-effectiveness of CDHPs, and 79% state that wide acceptance of CDHPs is unlikely until they become simpler to navigate, IFEBP reports.

Associate Editor Elizabeth Galentine contributed to this report.