A Report Card On The Freshman Class Of Consumer-Directed Health Plans

Abstract

We used a series of case studies of first-generation consumer-directed health plans to investigate their early experience and the suitability of their design for reducing the growth in health benefit spending and improving the value of that spending. We found three fundamental but correctible weaknesses: Most plans do not make available comparative measures of quality and longitudinal cost-efficiency in enough detail to help consumers discern higher-value health care options; financial incentives for consumers are weak and insensitive to differences in value among the selections that consumers make; and none of the plans made cost-sharing adjustments to preserve freedom of choice for low-income consumers.I n the wake of the backlash against managed care, U.S. health benefit programs are undergoing a transformation. 1 The fulcrum for management of costs and quality has shifted from insurers and physicians toward consumers. Consumer-directed health plans, the result, vary in multiple dimensions but share (1) enhanced tools to support informed choice of providers and treatments; (2) expansion of programs to enable consumers to manage their health and health care; and (3) stronger financial incentives for consumers to control spending. 2 Proponents of consumer-directed plans argue that they will catalyze health system reform by making enrollees better consumers of health care. They forecast that such plans will curb consumers' demand for low-value health services and stimulate their preference for more-affordable and higher-quality providers and treatments.3 Skeptics suggest that the plans amount to Trojan horses carrying camouflaged reductions in risk protection and financial access to care. 4 They are concerned that consumer-directed plans offered alongside other plans will skim off the healthier members of the risk pool, resulting in a redistribution of resources from the sick to the healthy. 5 In this paper we evaluate the early experience and design of fourteen first-generation consumer-directed health plans. We examine six design features that relevant health services research suggests will be required for such plans to reduce spending growth and increase value substantially. In addition, we reflect on early estimates of impact reported by the industry and independent researchers. We H e a l t h T r a c k i n g

Comparing Quality of Care Between a Consumer-Directed Health Plan and a Traditional Plan: An Analysis of HEDIS Measures Related to Management of Chronic Diseases

“…6 Unpublished health plan studies have reported lower rates of utilization by CDHP enrollees for inpatient and acute health services, and increases in generic drug utilization. [7][8][9][10] One of the few published studies of CDHPs compared risk-adjusted utilization for CDHP enrollees to that of enrollees in a traditional plan over 3 years, and found that the biggest differences in utilization occurred for types of utilization over which the member had the greatest control. 11 In this study, CDHP enrollees had fewer emergency room visits, filled fewer prescriptions, and had fewer professional encounters, even after adjusting for case mix.…”

The Impact of Consumer-Directed Health Plans and Patient Socioeconomic Status on Physician Recommendations for Colorectal Cancer Screening

“…Price information, too, may be provided to a physician by a primed consumer. Not only is such information becoming increasingly available through insurers offering CDHPs [41][42][43] , but also over 70% of physicians currently feel ready to advise patients regarding the cost of medical care. 33 Although recent research suggests that physicians do not consider out-of-pocket costs owing to discomfort, proportion of practice covered by Medicaid, region of the country lack of time, and a perceived inability to intervene, [44][45][46][47] CDHPs enrollees may compel physicians to reconsider these issues.…”

On Reducing Information Asymmetry in U.S. Health Care

“…High malpractice insurance, furthermore, will discourage high-potential students from pursuing the medical professions (Aggarwal, 2008;Berk & Monheit, 2001). Finally, • When the health care patient control center reaches the patient customer, the untold problems of health care neglect, obesity, substance abuse, spousal abuse, food addictions, smoking, bulimia, anorexia and the like imbalances the symmetry of information of health care (Rosenthal, Hsuan, & Millstein, 2005).…”

“…There are major weaknesses that remain with current health care offerings that must be addressed through better information on quality, improved cost-efficiency comparisons and more appropriate cost-sharing incentives (Rosenthal et al, 2005). Reduction of information asymmetry is critical since patients tend to defer to the judgment of a doctor or other health care professional who can exploit such asymmetries by inducing demand at will (Xirasagar & Lin, 2006).…”