PHILADELPHIA, PA – Although consumer-directed health plans are changing the nature of medical cost-sharing and decision-making, gaining in enrollment and attracting attention as a potential component of health reform, many physicians aren’t prepared to advise patients enrolled in these plans, according to a new survey in the American Journal of Managed Care.
Broadly conceived, CDHPs combine high-deductible insurance products with medical savings accounts. In theory, high deductibles create incentives to limit unnecessary care and shop for services based on cost and quality. Medical savings accounts allow patients or their employers to save pre-tax dollars for future healthcare needs.
While some patients typically might turn to their primary care doctors for advice, the survey finds that many doctors aren’t prepared to answer their questions.
“I have a CDHP myself, and I understand that I will be more engaged, in terms of the questions I ask, because I have more access to the (information),” said Joe Mondy, assistant vice president for communications at Cigna, in Bloomfield, Conn. “Cigna, for example, can arm patients (with) a list of questions that helps to generate better conversation with the provider.”
CDHPs are part of a larger phenomenon of employers shifting cost to employees in premiums, co-pays or deductibles, according to co-author Giridhar Maylla, a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania.
CDHPs are relatively new to the market – only 8 percent of employees with insurance through employers had them in 2007, a 5 percent increase from 2006. More disconcerting, Maylla said, is that one in four physicians polled didn’t understand what types of costs their patients may face while using the plans.
“Difficult decisions like whether to get diagnostic tests may be even tougher for patients without informed physician advice,” said study co-author Craig Pollack, MD, a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania.
Enrollment in CDHPs has grown tenfold, from 440,000 to 5.5 million in the past three years, and is likely to continue growing. The U.S. Treasury Department estimates enrollment may reach 25 million by the next decade.
“Providers are wary. There is potential for increased receivables and consumers are more responsible,” said Carl Doty, senior analyst for healthcare and life sciences with Forrester Research. “It is harder for providers to collect the bills. They are used to ignoring them and waiting for insurance to catch up.”
“CDHPs radically differ from traditional plans, but they will continue to exist and expand over the next decade,” said Maylla. “Patients and physicians both need make an effort to make each other aware of the type of insurance program they are covered by.”
When it comes to HSAs, insurers need to step up to the plate, said Doty. They control the overall plan design along with the banks, yet so far no one is doing much.
The researchers surveyed physicians about their knowledge of CDHP benefit design, readiness to advise patients on financial issues and views on the use of quality-care data in patient decision-making.