ABSTRACT

U.S. employers have increasingly provided high-deductible health plans (HDHPs) to their employees to reduce health care spending. Prior studies on employees’ choice of HDHPs were based on one or two years of data. This limits the ability to study the dynamic change in employees’ HDHP choices. This study used group-based trajectory models to classify employees based on their longitudinal patterns of HDHP choices. We also identified employee characteristics associated with HDHP choice, evaluated risk segmentation between HDHP and preferred provider plan (PPO) enrollees and assessed the impact of plan benefit change on healthcare utilization. The analyses were based on five years of medical claims, pharmacy claims and eligibility information obtained from a large employer. We identified four groups of employees based on their longitudinal patterns of HDHPs choices: early HDHP adopters, late HDHP adopters, HDHP non-adopters and HDHP abandoners. We found that employees’ job type, family type, and health condition were associated with their longitudinal patterns of HDHP choices. We also found increased risk segmentation between HDHP and PPO enrollees over the five-year period. These findings on how employees respond to health plan changes over time could help employers with health plan benefit design.