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Optimizing enrollment in employer health programs: a comparison of enrollment strategies in the Diabetes Health Plan.

  • Author(s): Kimbro, Lindsay B;
  • Li, Jinnan;
  • Turk, Norman;
  • Ettner, Susan L;
  • Moin, Tannaz;
  • Mangione, Carol M;
  • Duru, O Kenrik
  • et al.


Many health programs struggle with low enrollment rates.


To compare the characteristics of populations enrolled in a new health plan when employer groups implement voluntary versus automatic enrollment approaches.

Study design

We analyzed enrollment rates resulting from 2 different strategies: voluntary and automatic enrollment. We used regression modeling to estimate the associations of patient characteristics with the probability of enrolling within each strategy. The subjects were 5014 eligible employees from 11 self-insured employers who had purchased the Diabetes Health Plan (DHP), which offers free or discounted copayments for diabetes related medications, testing supplies, and physician visits. Six employers used voluntary enrollment while 5 used automatic enrollment. The main outcome of interest was enrollment into the DHP. Predictors were gender, age, race/ethnicity, dependent status, household income, education level, number of comorbidities, and employer group.


Overall, the proportion of eligible members who were enrolled within the automatic enrollment strategy was 91%, compared with 35% for voluntary enrollment. Income was a significant predictor for voluntary enrollment but not for automatic enrollment. Within automatic enrollment, covered dependents, Hispanics, and persons with 1 nondiabetes comorbidity were more likely to enroll than other subgroups. Employer group was also a significant correlate of enrollment. Notably, all demographic groups had higher DHP enrollment rates under automatic enrollment than under voluntary enrollment.


For employer-based programs that struggle with low enrollment rates, especially among certain employee subgroups, an automatic enrollment strategy may not only increase the total number of enrollees but may also decrease some enrollment disparities.

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