Consumer-driven health plan enrollment represents anywhere from 10 percent to 13 percent of the employer-sponsored health benefits market and it's been growing at a good clip through the recent recession. If healthcare reform continues as planned and if estimates are to be believed, CDHP enrollment could be half of the private insurance market by 2019.

There are a few ifs in that scenario, but the numbers were particularly relevant to a conference workshop at America's Health Insurance Plans conference in San Francisco on June 16. New research from the University of Southern California verified what many other studies have shown that healthcare spending dramatically slows for those enrolled in CDHPs.

The USC researchers studied data from 3,000 health plans, 800,000 U.S. households and from more than 50 large employers. It found that healthcare costs for those in CDHPs dropped by 20 percent in their first year of switching from traditional to high-deductible coverage. There were also moderate declines in consumers getting preventive tests, such as mammography, cervical cancer screenings and childhood immunizations, among other things.

The study is important for two reasons: first, it is perhaps the first large comparison of claims data that looks at a group of enrollees in traditional coverage versus the same group of enrollees in CDHP (most studies simply compare one group of CDHP enrollees to another group of traditional); and it indicates for whatever reason a reluctance among enrollees to seek medical care even though some of the preventive services may have been available for free. It seems consumers weren't making wise choices even when the deductible was waived, said Neeraj Sood, Ph.D, an associate professor at USC who led the four-year study.

He says if the first-year spending patterns held true for the long term and that 50 percent of the market is in CDHPs by 2019 (through exchanges or their employer plans), the system would save $57 billion.

Some might say that's great news consumers in charge of their own dollars reined in unnecessary spending. The other side is that maybe they reined in too much. Did some of those women really need a mammography and missed the chance for an early diagnosis of breast cancer. Will children who missed an immunization develop the disease.

Sood says he still needs to look at the second-year CDHP data to determine whether spending constraint lasted. But one thing is abundantly clear, CDHPs are making an impact.


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