Consumer-Driven Plans Increased Health Management

Study looks at how CDHPs lower medical costs

By Stephen Miller, CEBS April 28, 2014

Consumer-driven health plans (CDHPs) are helping American workers and their employers reduce their health care expenses by changing behaviors, according to a study of health claims by Cigna, one of the nation’s largest health insurers.

CDHPs, which are coupled with either a health savings account (HSA) or health reimbursement arrangement, are intended to provide participants with a financial incentive to reduce out-of-pocket health care spending—although whether that’s being accomplished by promoting healthier habits and cost-savvy comparison shopping for services, or by forgoing necessary medical care, has been the subject of debate. To shed some light on the matter, the Eighth Annual Cigna Choice Fund Experience Study compares the claims experiences of more than 3.6 million Cigna customers enrolled in a CDHP with the experiences of those enrolled in a Cigna traditional preferred-provider organization (PPO) health plan or a health maintenance organization (HMO) plan.

The study indicates that individuals covered by CDHPs are more likely to use health improvement programs, comply with evidence-based medical best practices and lower their health risks, resulting in lower annual medical spending compared with those in traditional plans.

“Constraining health care costs doesn’t have to mean shifting costs from one area to another,” said Cigna President, Regional and Operations, Matt Manders. “Over the past eight years, we have seen that by improving health care quality and transparency, and by incentivizing healthy behaviors, we reduce the total cost by shifting behaviors, rather than shifting costs.”

The finding of moderated health care spending by enrollees in CDHPs may prove especially significant given recent evidence of higher overall health care spending, due in part to increased coverage under the Affordable Care Act.

According to the Cigna study, when compared to participants in traditional PPO and HMO plans, those enrolled in a CDHP were:

  • More engaged. CDHP enrollees were nearly 50 percent more likely to complete a health risk assessment, and those with a chronic illness were up to 41 percent more likely to participate in a disease management program, than enrollees in traditional plans.

  • More savvy consumers. Participants in HSA plans were more likely than those in traditional plans to choose generic medications. In addition, CDHP enrollees used the emergency room at a 5 percent lower rate than enrollees in HMO and PPO plans.

  • More likely to actively manage their health benefits. Seventy-five percent of CDHP enrollees were registered with the insurer’s personal health portal or mobile app, and they were 82 percent more likely than those in traditional plans to log in and use these online tools to access information about the most highly rated and most cost-efficient care providers.

  • Receiving recommended care. First-year CDHP enrollees had the same or higher compliance with roughly 500 evidence-based medical best practices compared to their counterparts in traditional plans. Their compliance increased in the second year, indicating that they were not forgoing necessary medical treatment.

  • Reducing total medical costs. The rate of increased health care spending among CDHP enrollees during their first year in the plan was 12 percent lower than the cost trend for enrollees in traditional plans.

Pediatricians Warn of Care Avoidance

Sounding a contrary note, a new policy statement from the American Academy of Pediatricians raises concerns that high-deductible health plans (HDHPs) linked to HSAs or HRAs "promote adverse selection because healthier and wealthier patients tend to opt out of conventional plans in favor of HDHPs. Because the ill pay more than the healthy under HDHPs, families with children with special health care needs bear an increased cost burden in this model." Moreover, "HDHPs discourage use of nonpreventive primary care and thus are at odds with most recommendations for improving the organization of health care, which focus on strengthening primary care."

However, the report also notes:

It is important to understand that if the HRA or HSA is funded by the employer at a sufficiently high level (“fully funded”), patients will not actually suffer financial harm, compared with conventional policies (i.e, preferred provider organization, health maintenance organization, point of service, and indemnity plans). Instead, these features will simply induce patients to make a market calculation in seeking care because the need to tap into the savings account resource will be a much more palpable event as compared with the invisible use of resources with conventional policies.

Stephen Miller, CEBS, is an online editor/manager for SHRM. Follow him on Twitter @SHRMsmiller.

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