Consumer-driven health plans, which accounted for only 3 or 4 percent of the commercial insurance market less than a decade ago, are now a major factor. Twenty-three percent of employees with employer-sponsored insurance coverage are enrolled in a CDHP, according to a Mercer survey, and CDHP members account for 16 percent of all commercial enrollees in the United States, according to HealthLeaders-InterStudy data. Expect the percentage to grow as the looming 2018 Cadillac Tax on high-cost health plans drives employers to offer cheaper benefits with lower premiums and increased cost sharing.
Large employers, such as FedEx, are finding CDHPs particularly attractive and have shifted their entire workforce into these plans. In fact, more than 30 million people, or roughly 10 percent of the U.S. population, could be enrolled in a CDHP by 2018 if current growth rates continue. As a result, more patients will be encouraged to become cost-savvy consumers who avoid unnecessary procedures and demand the most cost-effective treatments.
But an important, unanswered question remains: How do patients enrolled in CDHPs actually behave?
The most that we can glean from studies is that consumers tend to reduce their utilization of healthcare during their first one or two years in a CDHP, particularly through reductions in prescription drug spending. One of the primary purposes of CDHPs is to reduce care that isn?t needed. However, it isn?t clear whether the reductions in services tend to be necessary or unnecessary, and long-term utilization trends are not observable in most studies due to short study periods of only one or two years.
Another issue with some studies is the limited generalizability of their findings. Some studies focus on one employer or a small group of employers that offers a CDHP and compare that entity to other employers with traditional plans. While useful, results from these studies are limited because they pertain to only one group of employees in one industry at one geographic location. Larger studies that include a variety of full-replacement firms spread out geographically might be more desirable because results could be better generalized to the broader population.
An additional issue that affects earlier studies is the population of enrollees itself. Surveys on the characteristics of the CDHP population have traditionally shown enrollees to be healthier, better educated, and wealthier than traditional plan members. However, many of these studies were conducted before enrollment numbers began to swell around the turn of the decade. As a result of the rapid growth in enrollment, the population of enrollees may now include a larger proportion of less wealthy and sicker individuals. Therefore, results from studies of the CDHP population from the mid-to-late 2000's may not be as applicable to today's CDHP population.
It is critical to determine how consumers choose their healthcare after they enroll in a CDHP because indiscriminant reductions in care could lead to delayed treatment of a potentially serious condition and higher utilization (and costs) down the road. On the other hand, the presence of health information tools, off-deductible preventive drug lists, and preventive service coverage could contribute to long-term reductions in unnecessary care and overall healthier enrollees who seek out only the most cost-effective treatments.
The current data on CDHPs is a good start and provides valuable information about short-term consumer behavior. However, until more information is obtained on the specifics of consumer behavior over longer time periods and across different populations, we can?t be certain if CDHPs actually function as desired. For now, the jury is still out.
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