Asparity Decision Solutions found that employees who used decision support during the 2007 enrollment season made different and more cost-effective health care choices that better met their needs than employees who did not use decision support (nonusers). Asparity quantified consumer behavior in health care benefits and found the following results from the 2007 enrollment season:

• Decision support users enrolled in High Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs) at a higher rate.
• Decision support users enrolled in Flexible Spending Accounts (FSAs) yielding tax savings for themselves and the employer with lower Social Security payroll taxes.
• Decision support users experienced cost savings by enrolling in medical plans that cost two percent less in total health care costs.
• Given the total cost of health care, annual income determined employees' health plan selection.
• Total employer health care costs were generated by a small population of employees.
• Health plans varied significantly in how well they performed in meeting employee personal needs and financial circumstances.

HDHP Enrollment. Decision support users enrolled in High Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs) three times more than nonusers. Asparity found that seven percent of decision support users enrolled in a HDHP while only two percent of nonusers enrolled.

Tax Savings. Decision support users enrolled in Flexible Spending Accounts (FSAs) two times more than nonusers and contributed two times more to their FSAs. Asparity found that the behavior was even more pronounced by those decision support users who used Asparity's Savings Account Estimator, an FSA/HSA Calculator. Average employee contributions and tax savings for employees and employers across all decision support users, nonusers, and Savings Account Estimator (SAE) users were as follows:

• Users contributed an average of $506 to an FSA, yielding a tax savings of $192 for themselves and $27 for the employer.
• Nonusers contributed an average of $209 to an FSA, yielding a tax savings of $84 for themselves and $11 for the employer.
• Savings Account Estimator users contributed an average of $989 to an FSA, yielding a tax savings of $382 for themselves and $56 for the employer.

Cost Savings. Decision support users enrolled in plans that cost two percent less in total health care costs (employee contributions plus out-of-pocket expenses) than nonusers. Asparity found that decision support users estimated an average of $3,143 in total health care costs and spent an average of $68 less than nonusers given their enrollment behavior.

Income Analysis. Looking at the total cost of health care, employees making $30,000 or less spend 10 percent or more of their income (on average) for health care, while higher-income employees making $100,000 or more spend three percent or less. As a result, lower-income employees were essentially limited to the lowest-cost plan, making it even more important that they understand the total cost of their health care when choosing a plan. Higher-income employees were more likely to choose a plan based on personal needs, such as open access, chiropractic coverage, or satisfaction measures.

High-Cost Utilizers. Asparity found that 18 percent of Medical Cost Calculator users accounted for 75 percent of total health care costs (as estimated in the calculator). The results were based on users' projected health care utilization not historical claims data and were consistent with current research about high-cost utilizers of health care services. Employers can be confident that employees are doing a good job of estimating their demand for medical care, said Colleen Murphy, Asparity's President and CEO.

Plan Performance. Health plans HDHPs, HMOs, PPOs, etc. varied significantly in how well they performed in meeting different types of consumers' personal needs and financial circumstances. Asparity's Health Plan Scorecards provide employers with a summary of each health plan's performance in Asparity's decision support.

"Employees continue to use our decision support to become better health care consumers," said Murphy. "By quantifying their employees' buying behavior and health plans' performance, our goal is to help employers become better health care suppliers."

The findings are based on the 2007 annual enrollment season across Asparity's private and public-sector customer base.