People in CDHPs may not have easy access to cost, quality data
A recent study by RAND researchers published in the journal Health Affairs indicates that consumer-directed health plans could save $57 billion annually if they grew to comprise 50 percent of all employer-sponsored health insurance in the U.S. But are health plans delivering the kind of information people using these plans need to truly direct their own healthcare decisions?
Amelia M. Haviland, PhD, lead researcher of the study, is an Associate Professor of Statistics and Public Policy at Carnegie Mellon University and an adjunct senior statistician at RAND. Her research focuses on efforts to slow the growth of healthcare costs and improve healthcare quality. Haviland recently discussed these issues with Healthcare Finance News Senior Editor Chris Anderson.
Q: What affects do you see for employers and employees who use CDHPs and HSAs?
A: We tend to look at things more at the family level, so this study in Health Affairs and three previous studies are about changes in costs and use for families who are in these plans versus families who stay in traditional plans. We did find in some other analyses that we reported in the American Journal of Managed Care a couple of years ago that when we look at the employer level, even employers with lower take-up rates, there tends to be some spillover that people in the more traditional plans tend to be having slower cost increases and cost growth over time. We don't know exactly why, but it is likely because the employers are making a bunch of decision tools available to all of their employees, not just employees in the consumer directed plans, there does seem to be some spillover.
Q: How powerful were these tools in helping employees make better decision about their healthcare?
A: Nearly all of the employers we studied did provide some kind of decision support tools to their employees on cost and quality and they also uniformly said those tools were poor. The quality information was a little bit better than the cost information, but neither was very good. These employers are automobile manufacturers, telecommunications companies, major retailers and fast food companies – the kinds of places where the insurance carriers want to give them their best products and the tools were crummy. My general impression of this and our colleagues at Towers Watson tend to confirm this is that there has been very little improvement in those tools until maybe the last six months, where three of the top six carriers have come out with technology-based apps that try to convey some cost and quality information that is substantially better than what was available before.
Q: Is it your impression that we are only beginning to enter an era where finally we are getting both good quality and pricing information?
A: I think there are the first glimmers that it may be possible, but we will really have to see where it goes. There are a couple of states that have passed laws on price transparency and they are starting to post those prices, but it is still too early to know what kind of impact that will have. Research tells us the quality information that gets posted online about medical providers gets used very rarely by patients. People tend to go with their doctors' recommendations or word of mouth and doctors and patients don't trust the quality ratings.
Q: What are the implications of this?
A: Well the consumer-based plans, the VBID – value-based plans – are all taking this stance of putting much more of the responsibility on patients to make decisions on what care to forego, what care to get and who to get it from. I always say to employers that getting these plans is only the first step. If people are going to make clinically wise choices they need to have ways to do that with their doctors and they need information. We all need to acknowledge that this is a huge information challenge: both getting them the information and having them process it to make their choice.