The Impact of HDHPs on Service Use and Spending for Substance Use Disorders

Eisenberg, Matthew D.; Kennedy-Hendricks, Alene; Schilling, Cameron; Busch, Alisa B.; Huskamp, Haiden A.; Stuart, Elizabeth A.; Meiselbach, Mark K.; Barry, Colleen L.

doi:10.37765/ajmc.2022.89250

Cited by 9 publications

(10 citation statements)

References 22 publications

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“…We retained only those individuals enrolled via employers with a most common plan start date in January, which allowed us to match individuals who were offered an HDHP to those who were not and thus remained in traditional plans (i.e., comparison enrollees). HDHP offer employers (i.e., treatment employers) were identified as those that had at least 2 years with <5% enrollment in HDHPs directly followed by at least 1 year with >5% enrollment in HDHPs, following previous literature (Eisenberg et al, 2017; Eisenberg et al, 2022; Haviland et al, 2016) . Enrollees employed by employers that always offered an HDHP were excluded from the sample.…”

Section: Methodsmentioning

confidence: 99%

“…SUD services were identified using a combination of: Current Procedural Terminology (CPT) codes, Health care Common Procedure Coding System (HCPCS) codes, revenue codes, AMA place of services codes, SUD diagnosis codes, and pharmacy outpatient claims. More details about the specific identification of SUD services can be found in previously published work (Eisenberg et al, 2022). The unit of analysis was the person-quarter.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…In addition, HDHPs may increase the existing cost barrier to SUD treatment: commercial HDHP enrollees with SUD and mental health conditions spend less overall than traditional plan enrollees on health care but have higher out-of-pocket spending as well as a higher share of out-of-pocket spending relative to total spending (Eisenberg, Du, et al, 2020). Commercial health plan enrollees who are offered an HDHP are less likely to use SUD treatment compared with those who are only offered a traditional, low-deductible plan (Eisenberg et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

“…HDHPs have been linked to decreases in SUD treatment use and spending (Eisenberg et al, 2022). However, it is not known if HDHPs relate to changes in the timing of use and spending of SUD treatment services throughout the plan year relative to traditional, low deductible health plans, based on the differences in cost exposure enrollees face throughout the plan year.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Do High-Deductible Health Plans Incentivize Changing the Timing of Substance Use Disorder Treatment?

Hollander

Kennedy-Hendricks

Schilling³

et al. 2023

Med Care Res Rev

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A high-deductible health plan (HDHP) may incentivize enrollees to limit health care use at the beginning of a plan year, when they are responsible for 100% of costs, or to increase the use of care at the end of the year, when enrollees may have less cost exposure. We investigated both the impact of the deductible reset that occurs at the beginning of a plan year and the option to enroll in an HDHP on the use of substance use disorder (SUD) treatment services over the course of a health plan year. We found decreases in SUD treatment use following the increase in cost exposure related to a deductible reset. There was no variation in this behavior between HDHP offer enrollees and comparison enrollees who were not offered an HDHP. These findings reinforce that cost-sharing poses a barrier to SUD care and continuity of care, which can increase the risk of adverse clinical outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Do High-Deductible Health Plans Incentivize Changing the Timing of Substance Use Disorder Treatment?

Hollander

Kennedy-Hendricks

Schilling³

et al. 2023

Med Care Res Rev

View full text Add to dashboard Cite

show abstract

“…Given that care for mental health disorders and SUDs continues to be a pressing public health concern and the high out-of-pocket cost associated with treatment, 4 a deeper understanding of the complex effects of HDHPs on this population is crucial for informing policy and regulatory decisions.Three 2022 studies investigated the intent-totreat effect of offering HDHPs on the use of SUD treatment services. [5][6][7] Eisenberg et al 5 found a 7.7% reduction in ambulatory services and a 4.3% reduction in medication treatment-the services public health officials aim to encourage. Meiselbach et al 6 built on these findings and found that more than three-quarters of reduced spending attributed to an HDHP came at the expense of care from the family member with an SUD.…”

mentioning

confidence: 99%