It seems that each week brings with it a new research study on the impact of consumer-driven health plans (CDHPs). Are they saving any money? Are they helping to educate health plan members to be better consumers? Are these consumers making good choices about their health care spending, or are they skimping on preventive care?
The latest of these studies came from American Journal of Managed Care, an independent, peer-reviewed publication dedicated to disseminating clinical information to managed care physicians, clinical decision makers, and other health care professionals.
The study analyzed claims and enrollment data for 808,707 households from 53 large US employers, 28 of which offered high deductible health plans (HDHPs) or CDHPs. The study focused only on the first-year experience in an HDHP or a CDHP.
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Here's what they found: Families enrolling in HDHPs or CDHPs for the first time spent 14% less than similar families enrolled in conventional plans. Families in firms offering an HDHP or a CDHP spent less than those in other firms. This was due to lower growth in inpatient, outpatient, and prescription drug costs. However, significant savings for enrollees were realized only for plans with deductibles of at least $1000, and savings decreased with generous employer contributions to healthcare accounts.
All good news on the saving money front, but here is the catch; the study showed that enrollment in HDHPs or CDHPs was also associated with moderate reductions in the use of preventive care. Among the users of HDHPs or CDHPs the study spotted a decrease in child immunization rates and a drop in cancer screenings.
The authors of the study did admit there were several limitations in their work. First, the focus of the study was only on the first-year experience in an HDHP or a CDHP. Second, the amount of information examined about what kind of care is reduced is limited. While the results suggest that some appropriate care, namely, preventive services, is reduced in HDHPs or CDHPs, the authors say that further exploration of how these plans produce cost savings is needed to assess whether HDHPs or CDHPs should be embraced as a cost-saving approach or introduced with caution.
Third, the authors say the study's validity may have been impacted, as with all observational studies of HDHPs or CDHPs, by family-level and firm-level selection. In other words, could these be healthier groups to begin with and that is why they selected this kind of plan.
Regardless of the limitations, the study once again underscores the need for education about HDHPs and CDHPs, both for employers and for the plan members.
For employers, the study suggests that there is a minimum deductible threshold that produces cost savings. That being $1,000 for family coverage. It also shows that there is a fine line between employee contributions that are enough to attract participation, but not too much to impact plan utilization. While the study found that plan cost reductions were maintained at a similar level when an account option was added with a low employer contribution (<$500 [mean, $399.32]), it was discovered that plan cost reductions were attenuated when employers made more generous contributions (>$500 [mean, $768.38]) to the accounts.
Likewise education of plan members is needed to help them better understand what is and what is not covered by HDHPs and CDHPs. While it may be prudent to shop for the best prescription drug prices, it is probably not a good idea to skip a heath screening meant to help with the early detection of costly diseases, especially when most of these screening are actually covered by HDHPs and CDHPs as a first dollar benefit.
For more information about the study go to: http://www.ajmc.com/login
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