Are CDHP Savings All Smoke and Mirrors?

Is the engaged consumer who will use the power of the marketplace to reduce his healthcare bill in fact a myth? New research shows that consumer-directed health plans too often trade necessary medical care for cost savings.

5 comments on "Are CDHP Savings All Smoke and Mirrors?"
William (10/28/2011 at 3:43 PM)

For over 12 years many academic researchers have misunderstood consumer-directed health care. High deductibles are not CDH plans, they are high deductibles. Without any spending account underneath the deductible there is no need to conserve scare resources, which is the primary incentive in a consumer directed market. Kaiser FF realized this a few years ago and now separates out the HD plans from the CDH plans. I wish they all would.
James (10/13/2011 at 1:32 PM)

I've been enrolled in a CDHP since 2005, and never have skipped care. It could be that I've been fortunate that my employers have offered 100% coverage of preventive care (which I think with reform is mandatory now), and my health plan provides all the education, cost and quality research tools, and nurse coaching that helps me make a informed decisions about how to save money, and what the consequences of skipping needed care would be. I'd be interested to see if RAND notes in their newest report what the typical amount of services to treat the studied episodes of care are. Of course, that could even vary by episode severity. All in all, I'm a fan of these plan designs if they are designed correctly, and not just as a way to shift cost to employees. It's changed my behavior in a good way, and most of my coworkers would agree.
Mary Malone (10/13/2011 at 11:13 AM)

All great points about an increasingly important topic. Here's my (slightly different)take: Where is the evidence that demonostrates that 10 visits produces the "best wrist outcome"? Is the "best wrist outcome" actually achieved with 15 visits (and insurers historically let hospitals bill for only 10)? Perhaps the "best wrist outcome" occures with 3 visits and good patient education for home exercise(but hospitals historically were able to bill for 10 and did?) Maybe the number varies based upon the type of break and type of patient (older, younger, athlete,etc.)? Perhaps the patients know best and an average of 5 visits is the right number. Without research, it is difficult to draw a conclusion.
Maria K Todd, MHA PhD (10/12/2011 at 3:12 PM)

The Results on HSAs and HRAs are in [INVALID] 'Ria was Spot On...Again As I review my old HFMA seminar handouts from CDHP contracting and strategy programs that I frequently presented in 2002, 2004, and 2005, I then predicted that consumers would stretch out preventive care testing giving a false sense of savings to "consumers" similar to what consumers do with the barber, the manicurist, and other service providers when dollars get tight - the wait a week longer between manicure "fills", they stretch out that haircut a week or two longer and go a few more miles before that preventive maintenance oil change. I predicted that this would increase severity, acuity, morbidity and costs in the long run, specifically after about month 37 of participation. Is the fabled consumer who will use the power of the marketplace to reduce his healthcare bill in fact a myth? Probably not. It will be savvier benefits managers who design benefits and choose providers to take advantage of price arbitrage, wider choice through health travel both domestic and international, and better value. Leave it to the big guys at RAND Health to do the hindsight reports. I went out on a limb and was called a heretic, a naysayer, and negative when I had the courage to defend my interpretations publicly with my predictions based on early data in 2002-2005. Ria was right! Again! 'nuff said.
Kerry Willis (10/12/2011 at 3:09 PM)

Avoiding needed primary and preventative care is a design flaw of CDHP. Combine CDHP with a fixed fee Direct Contracted PLan and the flaws are avoided as the preventative care and routine care visits are affordable and on budget as well for around $50 a month


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