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Are CDHP Savings All Smoke and Mirrors?

Margaret Dick Tocknell, for HealthLeaders Media, October 12, 2011

The second report, released in April 2011, looked at the effect of high-deductible plans on the medically vulnerable. It found that people with chronic health problems or low incomes are no more at risk to reduce needed healthcare than anyone else.

The third report, out this month, looks at the effect of high-deductible plans on spending for an episode of care—the set of services required to manage a specific medical condition over a certain period of time. The good news from this study is that people always look for ways to conserve their healthcare dollars. The bad news is that, once again, one of the ways they save is by avoiding preventive care.

The episode of care for a broken wrist includes the ER, x-rays, doctors, and rehabilitation services. The researchers discovered that once care is initiated—the ER visit for that broken wrist, for instance—patients still have some control over how much they spend on healthcare services and they still find ways to save money on that episode of care.

How? Amelia Haviland, the study’s lead author and a senior statistician at RAND, explains that patients trim costs in three ways: they use fewer name-brand drugs, see fewer specialists, and limit their hospital stays.

“Unfortunately,” said Haviland in a telephone interview, “that only happened about one-third of the time. Usually patients achieved a savings during an episode of care by receiving less care.” So, in the case of that broken wrist, maybe a patient would go for five sessions of physical therapy instead of 10.

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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.