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Aetna study: CDHP patients do not put off preventive care

Cheryl Clark, for HealthLeaders Media, June 1, 2009

Whenever there is talk about consumer-directed health plans (CDHP), the recurring questions revolve around whether the plans force patients to delay preventive care and whether they actually create more educated consumers.

In a six-year study of healthcare claims and utilization, health insurer Aetna found that members in the insurer’s consumer-directed plan, called HealthFund, received chronic and preventive care, used generic drugs, and accessed online tools and information more often than Aetna’s PPO members. The study also found sustained savings over that time period.

In addition, HealthFund members didn’t visit the ER as often as PPO members, which Aetna suggested is because members of the consumer-directed plan are better informed about where to access healthcare.

“What we were able to find is that we were able to sustain control of costs over time without sacrificing care,” says Kathy Campbell, director of CDHPs at Aetna in Hartford, CT.

Campbell says the insurer conducted the study because it wanted to test whether HealthFund has long-term cost savings and improves consumerism over a longer period.

Aetna studied 2.6 million Aetna members, including 410,000 HealthFund members with a health reimbursement arrangement (HRA) or health savings account (HSA) and 2.1 million members enrolled in PPOs. The study looked at 200 employers with the HealthFund plan.

CDHPs often enjoy a first-year savings when the new plan is offered, but Campbell says the study showed that the savings continue in following years.

The study also found that:

  • Employers saved $21 million per 10,000 members over five years in full-replacement HRAs and HSAs
  • Employers who offered Aetna HealthFund plans as an option saved $7 million per 10,000 members over five years
  • Employers who offered Aetna HealthFund plans as an option and implemented the strategies that Aetna identified as best-in-class saved $23 million per 10,000 members over five years

“In these difficult economic times, employers are looking for tried-and-true strategies that will allow them to continue to offer their employees a comprehensive and affordable benefits package,” Aetna president Mark Bertolini said in a statement. “As the first national health plan to offer consumer-directed products, Aetna has the longest experience with these plans and the best insight into what strategies are successful.”

Aetna doesn’t charge members for preventive care, which Campbell says removes cost barriers to care so members get the preventive care they need to ward off future health problems.

The study found that Aetna HealthFund members accessed the same or higher levels of preventive, diabetes-related, and chronic care. Researchers also discovered that ER usage decreased for HealthFund members, which resulted in 5%–10% lower ER use than the control group. Aetna said this shows members are not using the ER for nonurgent care and getting the necessary preventive services.

Five strategies of best-in-class employers

To find the employers that are effectively implementing consumerism practices, Aetna looked at 11 best-in-class customers, which included more than 144,000 employees. The Aetna study found that best-in-class performers used five strategies for success:

  • Promote a strategy in which employers are engaged healthcare consumers
  • Build a benefits package with appropriate member responsibility
  • Engage employees
  • Emphasize wellness and healthy behaviors
  • Steer enrollment toward the Aetna HealthFund plan option

The best-in-class performers introduced coordinated strategies in the areas of benefit structure, information and tools, and a culture that fostered engagement, such as getting management to lead the effort through example.

“If the management team—and this is from the top down—understands how important this is, it makes a difference. Also, engaging people so they enroll in the plans—that made a difference in the results,” says Campbell.

The best-in-class also helped employees and their families make informed decisions to better manage their health, spending, and overall wellness through providing cost of care, benefits information, and the Aetna Navigator member Web site. They also reduced employee premium contributions for those in HealthFund.

Consumerism practices are evident not only in best-in-class performers. Aetna found that the gap between best-in-class and average customers closed during the study. Campbell says best-in-class remained at the same levels, whereas the average customer moved closer to its high-performing peers. This greater member education is also evident in PPOs where the consumerism movement has stretched into those plans, including doctor ratings and quality information.

“It’s not because the best-in-class has gotten worse, but that a lot more plan sponsors are figuring out the right strategies,” says Campbell.

Through offering incentives for completing health risk appraisals and taking wellness programs, employers are getting smarter about how to use their dollars. Campbell says Aetna’s study results show that properly designed consumer-directed plans can reduce costs while improving overall health.

“This is a viable option for employers who are looking to engage their employees in taking better care of their health and being a better healthcare consumer, and [consumer plans] do save money,” says Campbell.

Alexander Domaszewicz, principal at Mercer in Newport Beach, CA, said in a statement that the analysis shows the importance of “providing credible data that will help employers evaluate the performance of these plans.

“The study reinforces the evidence we’ve seen emerge throughout the decade—that strategies, such as encouraging employee financial responsibility, offering robust coverage for preventive care, and providing a full suite of online tools and information, is helping employers achieve cost savings, promote a healthier work force, and still meet plan sponsor attraction, retention, and employee satisfaction goals. We need to recognize, however, that many employees need high-touch outreach and face-to-face support when they face complex illnesses. The ideal strategy when implementing consumer-directed health plans combines all of these approaches in the right way,” Domaszewicz said.

Campbell says Aetna plans to conduct the same study next year and investigate member engagement further.