But the recent introduction of national insurance companies may change that. Big dogs like UnitedHealthcare and WellPoint (sold here through Anthem Blue Cross Blue Shield) say they are pushing CDHPs and are encouraged by the initial results.

Consumer-driven products may include, for example, Health Savings Accounts (HSAs) and high-deductible plans. Monthly premiums are lower, but individuals are expected to pay "out-of-pocket" for doctor's visits and surgeries, up to a certain point. That out-of-pocket money comes from the plan's bank account, the HSA, which is funded by employers and employees.

The plans are supposed to save money by making consumers more selective about spending (shopping for prices, self-treating a cold), and in return they can expect to grow a nest egg for medical costs in old age.

UnitedHealth - which is poised to become the valley's largest health insurer pending a takeover of Sierra Health Services - reports a 109 percent increase in CDHP membership from 2006 to 2007. Granted, the numbers are comparatively low: UnitedHealth's 11,000 Nevada CDHP members represent less than 1 percent of the state's residents.

The company did not start selling its services locally until 2006, though. That was after UnitedHealth, a national company with no network of its own in Las Vegas, took over regional carrier Pacificare.

Radio and Internet advertising in the first months focused on the combination of those two companies. The message will shift in May to consumer-driven products, said Cheryl Randolph, spokeswoman for UnitedHealth.

The ads will be directed to small businesses "to introduce the power of consumer-driven health plans to help contain costs, afford tax benefits and keep employees healthier," she said. "Marketing is also being directed at the large employer through traditional sales channels and broker distribution."

Back when Pacificare operated on its own, not many of its customers were interested in CDHP or even Preferred Provider Organizations. Randolph said 85 percent of Pacificare's Nevada customers bought its Health Maintenance Organization or Point-of-Service managed care plans.

Since this spring, 80 percent of UnitedHealth's new business has been its PPO products.

"This PPO growth signifies the market's interest in the increased provider choice and information transparency that such PPO products provide," she said. "As such, UnitedHealthcare's PPO products will act as the first introduction to consumer-driven health care in the Nevada market."

Likewise, Anthem Blue Cross Blue Shield just recently started recruiting Nevadans for consumer-driven plans. A line of CDHPs for small groups and individuals was just launched last month. Anthem also sells to large groups.

Anthem made the products available in 2005 after buying Lumenos, a CDHP company that has been selling plans now for more than four years.

Anthem spokeswoman Sally Vogler said releasing sales figures is against company policy. "Early indications, however, are exceptionally positive," she said.

Regarding marketing, she said: "We're basically keeping our brokers up-to-date with what we're doing. We may do limited advertising, but haven't to this point. Word of mouth on these products seems to be contagious."

Anthem, which is based in Denver, points to data from outlets like Forrester Research. The surveyor found that CDHP consumers who have chronic conditions are 20 percent more likely to stick to doctor's orders.

"This is a powerful figure - for both members and their employees - because consumers with these conditions, such as diabetes or high blood pressure, generally have complex, sometimes expensive, health regimens they must follow," Vogler said. "Successfully following these regimens can mean better health outcomes and lower long-term costs."

Both UnitedHealth and Anthem will have to get over Nevada's coziness with managed care plans.

According to Sierra Health Services spokesman Peter O'Neill, CDHPs have had little success in Southern Nevada because residents have access to cheap, comprehensive health plans through employers or labor unions. Compared to those, high-deductible plans are unattractive.

"We have offered plans with HSAs for several years," O'Neill said. "They have virtually no traction here in Nevada, and our membership has never crept much above 1,000."

Leaders at other insurance companies offer the same reasoning.

"Nevada may be a bit behind the nation in adopting these programs: We're still a bit in the 'copay-driven mentality,' " Vogler said.

But still: "We believe the employers in Nevada are ready for this and are asking for it," she added.

UnitedHealth - which sees many Las Vegans "quite satisfied" with managed care - expects momentum in CDHP will be more noticeable among individuals and small groups.

"We'll continue to see an upswing in enrollment for CDHP as the products become more visible in the marketplace and more educational advertising is done," Randolph said.