Has the CDHP movement peaked?

The latest data shows that while there has been some growth in the two types of consumer-directed health plans, it is not ‘statistically significant’ (3.8% of covered workers are enrolled in these plans in 2007, up from 2.7% in 2006).
Put another way, it looks like the CDHP movement is running out of steam.
That’s too bad.

One of the key components of any successful health care reform program will be engaging consumers more directly in decisions about the use of health care resources, individually as well as globally.
To date, the CDHP movement has been more about transferring costs to employees than coming up with a thoughtful and effective long-term role for consumerism. There’s no question they save money – employer contributions to CDHPs are over a thousand dollars less than for other health plans. Some employers put some or all of that saving into funding for the deductible; most don’t (over half of employers don’t help employees fund the deductible account).
One reason for the plateauing of CDHP growth may be employers hearing horror stories from employees about the myriad issues with CDHP plans – no money in the deductible kitty, providers refusing to discuss price or negotiate post-treatment, health plans refusing to require providers accept negotiated contract rates. Or they may think CDHPs don’t effectively control costs (4% of larger employers think CDHPs are ‘very effective’ at controlling costs, 15% of small ones).
Most CDHP programs are pretty lousy, including the one I’m in (Golden Rule).
But the idea has merit. It remains to be seen if CDHP sponsors can evolve their products quickly enough to make them meaningful. That will involve a radically-restructured cost share mechanism, elimination of the deductible and replacement with copays, with low copays for preventive care and maintenance medications.