Helping Patients With Chronic Conditions Overcome Challenges of High-Deductible Health Plans: Mixed Methods Study

Abstract

Background A growing number of Americans are enrolled in high-deductible health plans (HDHPs). Enrollees in HDHPs, particularly those with chronic conditions, face high out-of-pocket costs and often delay or forgo needed care owing to cost. These challenges could be mitigated by the use of cost-conscious strategies when seeking health care, such as discussing costs with providers, saving for medical expenses, and using web-based tools to compare prices, but few HDHP enrollees engage in such cost-conscious strategies. A novel behavioral intervention could enable HDHP enrollees with chronic conditions to adopt these strategies, but it is unknown which intervention features would be most valued and used by this patient population. Objective This study aimed to assess preferences among HDHP enrollees with chronic conditions for a novel behavioral intervention that supports the use of cost-conscious strategies when planning for and seeking health care. Methods In an exploratory sequential mixed methods study among HDHP enrollees with chronic conditions, we conducted 20 semistructured telephone interviews and then surveyed 432 participants using a national internet survey panel. Participants were adult HDHP enrollees with diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, or asthma. The interviews and survey assessed participants’ health care experiences when using HDHPs and their preferences for the content, modality, and frequency of use of a novel intervention that would support their use of cost-conscious strategies when seeking health care. Results Approximately half (11/20, 55%) of the interview participants reported barriers to using cost-conscious strategies. These included not knowing where to find information and worrying that the use of cost-conscious strategies would be very time consuming. Most (18/20, 90%) interviewees who had discussed costs with providers, saved for medical expenses, or used web-based price comparison tools found these strategies to be helpful for managing their health care costs. Most (17/20, 85%) interviewees expressed interest in an intervention delivered through a website or phone app that would help them compare prices for services at different locations. Survey participants were most interested in learning to compare prices and quality, followed by discussing costs with their providers and putting aside money for care, through a website-based or email-based intervention that they would use a few times a year. Conclusions Regular use of cost-conscious strategies could mitigate financial barriers faced by HDHP enrollees with chronic conditions. Interventions to encourage the use of cost-conscious strategies should be delivered through a web-based modality and focus on helping these patients in navigating their HDHPs to better manage their out-of-pocket spending.

Evaluating a novel online behavioural intervention to encourage cost-conscious strategies among US adults with chronic conditions who are enrolled in a high-deductible health plan: a proof-of-concept pilot study

“…Another strength is use of mixed methods in evaluating intervention outcomes that included both numerical survey ratings and qualitative interviews. 23 A weakness of this study is that the intervention participants all needed access to a computer or smartphone as well as a sufficient level of familiarity and comfort with technology. Further, the intervention website and emails were delivered in English only.…”

“…We designed the pilot intervention based on a prior mixed-methods study of intervention preferences of HDHP enrollees with chronic conditions. 23 In this prior study, we first conducted 20 semi-structured telephone interviews to explore participants’ experiences with HDHPs, challenges in managing healthcare costs and their ideas for an intervention to encourage use of cost-conscious strategies. Second, in this prior study we collaborated with Dynata, which hosts a national internet survey panel, to survey 432 individuals who had been enrolled in an HDHP for over a year and had at least one chronic condition to determine their preferences for an intervention to support use of cost-conscious strategies.…”

“…Participants were asked to complete a baseline survey adapted from our previous study. 23 The baseline survey included questions about participants’ health insurance plans, measures of health insurance literacy, healthcare utilisation and consumer behaviours in the past 12 months, confidence in using the cost-conscious strategies, willingness to be randomised in a hypothetical trial for the future study and demographic information.…”