Would it surprise you to know that Rhode Islanders are not taking advantage of an effective tool in making healthcare costs more manageable?

Most Rhode Islanders still rely on health coverage that leaves healthcare decision-making in the hands of payers and providers. They know very little about the cost of their care, or the difference between low -value and high-value care.

Consumer-driven health plans (CDHPs) typically feature lower premiums and high deductibles, but they can be paired with a tax-advantaged account such as a health savings account (HSA). CDHPs with HSAs provide consumers with a kind of 401 (k) investment vehicle for future healthcare costs. Unused funds in HSAs stay with the member forever and give employees a way to cover high deductibles while having a lower monthly premium. They also enjoy the triple tax advantages of an HSA: contributions are pre-tax, interest earned is tax free, and withdrawals for qualified medical expenses are tax free.

But most important, since employees in CDHPs have an increased financial stake in how their healthcare is provided and paid for, they become more involved in the management of their care.

Despite these advantages, fewer than 15% of Rhode Islanders are enrolled in these sorts of plans, compared to nearly 25% nationally. Not surprisingly, local monthly premiums are significantly higher than the national average ($452 in R.I. vs. $386 national).

Blue Cross & Blue Shield of Rhode Island (BCBSRI) believes that putting more healthcare decision-making in the hands of Rhode Islanders is just one tool we can use to close the affordability gap. 

Our story
Recognizing that the CDHP model differs from what local businesses and their employees are used to, BCBSRI began to shift to CDHPs for its own employees several years ago. We thought our own experience could provide strong evidence that higher deductible plans paired with HSAs and a model that encouraged primary care providers to serve as a kind of care quarterback positioned employees to be more engaged consumers of high-value healthcare – the right care delivered at the right time, in the right place

To increase adoption of CDHPs, we teamed up with Virgin Pulse to offer our employees an interactive technology platform so they could have fun making healthy choices, and we put money into employee HSAs when they met fitness, wellness, and activity milestones. We believed that our employees would see better healthcare results with these new incentives and our experience has proven that to be true:

• Adoption of CDHPs among our employees has grown from 41% in 2012 to 89% today.
• Preventive screenings have increased, medication adherence has improved, and our employees are tracking and engaging in more physical activities (91% of employees who track physical activity walk more than 7,000 steps daily).
• From 2013 to 2016, our employees took significant costs out of the system by reducing their use of low value care – approximately $3,300 per employee.

By taking simple steps, such as choosing generic drugs (13% more than employees in traditional plans) and using the emergency department less (52% less than employees in traditional plans), employees are making smart choices about how they receive care. Equally important, they put money in their own pockets: approximately $1.07 million in 2017 (up from $485,000 in 2012). BCBSRI employees are proud of the difference they are making in creating more affordable, consumer-driven healthcare – and in taking more control of their own care.

What’s next?
There are clearly many opportunities for employers to motivate employees to be more involved in important healthcare decisions.

We recognize that not every employer and business is ready to make dramatic changes, but even incremental changes can lead to savings and improved employee health and well-being. BCBSRI acknowledges its responsibility to make healthcare affordable and simple for Rhode Islanders. And we’re ready to help employers chart a new course toward building a workforce of employees truly invested in their own healthcare and well-being.

Visael “Bobby" Rodriguez, is the vice president of Human Resources at Blue Cross & Blue Shield of Rhode Island.