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Are CDHP Savings All Smoke and Mirrors?

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

Haviland says more studies are planned to determine the extent to which necessary medical care is sacrificed for cost savings. But for now this CDHP research project presents troubling news for the triple aim of healthcare reform—better care, better health, and lower cost. Everyone, especially employers and health plans, should stop and think about such lofty expectations. Is the fabled consumer who will use the power of the marketplace to reduce his healthcare bill in fact a myth?

It’s important that all parties take a hard look at how cost-cutting and care-cutting play out in high-deductible health plans. Healthcare reform is expected to further encourage enrollment in these plans, which will probably be among the key offerings in health insurance exchanges. That could translate into millions of new enrollees who might not receive the medical care they need.

Consider the example of the episode of care for a broken wrist once more. Assuming that each physical therapy session is billed at $120, then the patient could save $600 by forgoing five sessions. But what are the long-term costs? Nerve damage? Limited use of that hand? Maybe health insurers, lawmakers and employers need to stop talking about lower healthcare costs to the exclusion of the other two parts of the triple aim. Better care and better health offer a sustainable way to control healthcare costs. That’s the message consumers need to hear.


Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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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.