In January of 2003, Whole Foods became one of the first large U.S. employers to switch to an exclusively high-deductible health plan. The company's CEO John Mackey had decided that choosing the new plan was the best way to handle the company's growing health care costs and to help employees to be mindful cost-conscious health care consumers.

However, employees at Whole Foods who were used to a democratic culture in which employees regularly vote on company policy, felt betrayed by the sudden change without their input.

Analysts say that large employers have learned from the experiences of those who were the first implementers of the high-deductible plans and are taking longer between when they decide to drop their other health care plans and when they implement the change. Employers hope the longer time frame will give their employees time to adjust from being passive consumers of medicine to being active consumers of health care.

Enrollment in high-deductible plans is growing rapidly. UnitedHealth Group says that it experienced an 80% year-over-year increase in the number of businesses offering consumer-directed health care plans in 2006. Many large employers are opting to give their employees a year of education before they make the switch.

Deere & Co. chose to give its 13,500 non-unionized employees 18-months to plan for the change to a consumer-driven health care plan. Surveys are showing that the majority of employees say they are less satisfied with the new high-deductible plans, while employers rave about the savings they've made by making the switch. To help to bridge the divide, many large companies making the switch are instituting or bringing back wellness and preventative programs that may have failed in the past but are taking on new importance as employees realize they will be rewarded for healthy behavior.

Deere's new program will offer 100% coverage for all preventive care including screening for common cancer, heart and vascular disease, drug abuse, and diabetes, and other diseases that are less costly to prevent than treat. Deere would also like to transition its 8,700 unionized employees to the high-deductible plan when their contracts are up for renewal in 2009. The change would be dramatic for union workers who currently have a plan with no premium and a small co-pay for doctors and prescriptions

At Whole Foods, after the dramatic change was met with unrest, the company called for a referendum on their entire benefits package. Company executives carefully explained the rationale behind the plan. Because Whole Foods' workforce is mainly young, four out of ten employees did not opt for coverage at all. That meant that those who regularly use health care, older employees and those with families, signed up. The result was that the healthy contributed little to the costs and the sick spent. With costs rising dramatically, the company's other benefits were at risk. With this new information, employees voted in October of 2003 to pass the referendum to continue the consumer-directed health care plan. That year, medical claims dropped 13% and 90% of employees had money left over in their medical reimbursement accounts. The company's employees recently voted again to keep the plan and will vote again in 2009.