Consumer-Directed Health Plans Reduce The Long-Term Use Of Outpatient Physician Visits And Prescription Drugs

Health Affairs June 2013 vol.32 no.6 1126-1134

Consumer-Directed Health Plans Reduce The Long-Term Use Of Outpatient Physician Visits And Prescription Drugs

¹Paul Fronstin (fronstin{at}ebri.org) is a senior research associate at the Employee Benefit Research Institute, in Washington, D.C.
²Martín J. Sepúlveda is an IBM Fellow and vice president of health industries research for the IBM Corporation, in Somers, New York.
³M. Christopher Roebuck is president of RxEconomics, a health economics and policy consulting firm in Hunt Valley, Maryland.

Abstract

Consumer-directed health plans (CDHPs) are designed to make employees more cost- and health-conscious by exposing them more directly to the costs of their care, which should lower demand for care and, in turn, control premium growth. These features have made consumer-directed plans increasingly attractive to employers. We explored effects of consumer-directed health plans on health care and preventive care use, using data from two large employers—one that adopted a CDHP in 2007 and another with no CDHP. Our study had mixed results relative to expectations. After four years under the CDHP, there were 0.26 fewer physician office visits per enrollee per year and 0.85 fewer prescriptions filled, but there were 0.018 more emergency department visits. Also, the likelihood of receiving recommended cancer screenings was lower under the CDHP after one year and, even after recovering somewhat, still lower than baseline at the study’s conclusion. If CDHPs succeed in getting people to make more cost-sensitive decisions, plan sponsors will have to design plans to incentivize primary care and prevention and educate members about what the plan covers.

June 05, 2013 - Topic: Public Health

Workers Cut Health Visits After Switch to High-Deductible Plan

U.S. workers made fewer visits to their physicians and pharmacies after their employers moved them into a high-deductible health plan with a health savings account, according to a study published this week in Health Affairs, Modern Physician reports.

Study Details

For the study, a team of researchers -- Paul Fronstin, a senior researcher at the Employee Benefit Research Institute; Martín Sepúlveda, vice president of health industries research at IBM; and health policy and economics consultant M. Christopher Roebuck -- compared medical and prescription billing data for two employers between 2006 and 2010. One of the companies switched to HDHPs in January 2007, while the other did not.

Study Findings

The study found:

Routine screenings for cancer declined during the year after the insurance plan switch, although screenings for breast, cervical and colorectal cancers later rebounded;
Emergency department visits increased during the third year after the switch; and
Hospital use remained consistent before and after the switch.

According to the researchers, their findings indicate that beneficiaries of HDHPs might forgo preventive treatment because they are confused about the plan's coverage. For example, rates for routine cancer screenings fell even though the costs for the screenings were waived under the plans. Meanwhile, the unexpected increase in ED visits might indicate a lack of adequate primary care, particularly among patients with chronic conditions, the researchers said.

According to Modern Physician, the study's finding corroborates a 2011 RAND study, which found that beneficiaries of consumer-directed plans tend to reduce their use of both medically appropriate and inappropriate services because of the potential increase in out-of-pocket costs.

The authors of the new study concluded that insurers must "design plans to incentivize primary care and prevention and educate members about what the plan covers" (Evans, Modern Physician, 6/4).