Consumerism Doesn't Simply Mean Shifting Costs to Members

HealthLeaders Media Staff, April 29, 2009

Among the criticisms against consumer-directed health plans (CDHP) is that they are merely a way to transfer costs onto patients, don't create more educated healthcare consumers, and force patients to delay preventive care.

It's up to health plans to prove those assumptions wrong. Aetna took a step in that direction by releasing a six-year study of its consumer-directed plan, called HealthFund. Aetna found that HealthFund members did not put off chronic and preventive care—and the plan actually helped make members better healthcare consumers.

Aetna is making that claim because HealthFund members used generic drugs, didn't utilize emergency rooms for basic care, and accessed online tools and information more often than Aetna's PPO members. The study also found sustained savings in the CDHP over that time period.

"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 consumer-directed health plans for Aetna in Hartford, CT.

CDHPs often enjoy a first-year savings for employers when the new plan is offered, but Campbell says the study showed that the savings continued in succeeding years. Aetna, similar to many insurers, doesn't charge members for preventive care, which Campbell says removes cost barriers so members get the 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 emergency room usage decreased for HealthFund members, which resulted in 5% to 10% lower emergency room use than the control group. Aetna said this shows members are not using the emergency room for non-urgent care and are getting the necessary preventive services.

Critics of CDHPs will surely point to the results and say it's simply a large insurer promoting its product. Regardless, health plans and employers can learn from Aetna's experience.

For instance, 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 where 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.

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