Preventive Care a Casualty as CDHP Adoption Grows

Don’t look now but consumer directed health plans (CDHPs) and high-deductible plans may be working — almost too well — according to results of the largest study involving these types of plans. Results from a year-long Rand study suggest that families that have deductibles of at least $1,000 have health care spending that is 14 percent less than families with deductibles of less than $1,000.

Researchers pulled data that included two years of enrollment and health care claims for employees of 53 large U.S. employers, 28 of which offered high-deductible health plans (HDHP) or CDHPs to their employees.

“There are substantial reductions in health care spending in the first year,” says Amelia Haviland, PhD, study coauthor and statistician at Rand. “But you only see this reduction once you get to deductibles that are at least $1,000. What’s concerning is that we see a small but significant decrease in preventive care across the board.” Their findings suggest “people are cutting both necessary and unnecessary care.”

She points to two different reasons why people cut their preventive care when they are enrolled in these types of plans, even when the deductible for preventive care is waived: Members didn’t understand the benefit design because it was the first year of enrollment or they are generally reducing their contact with their providers. It’s the providers who suggest that patients get preventive care.

Clinical executives at insurers need to “think of other ways to keep people connected with the information about their benefit design and the preventive care that they need to get if members are reducing their contact with doctors,” she says.

Families that were enrolled in HDHPs that had moderate health savings accounts sponsored by employers experienced less health care spending than controls.

But for plans that had employers that contributed more than half toward an individual’s deductible, savings were less for the families enrolled.

Between the pre-year (when all families were in traditional plans) and the post-year (when control families stayed in traditional plans and HDHP families were in their first year enrolled in an HDHP) costs increased for those in both high deductible and traditional plans. However, costs increased by much less for those in HDHPs.

High-deductible plans and CDHPs have been gaining favor as one way to help control health care costs. By 2009, about 20 percent of Americans with employer-sponsored health coverage were enrolled in such plans.