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Are High Deductibles Just Discouraging Good Care?

By Gregory A. Freeman  
   February 20, 2018

A survey of health plan leaders suggests they are realizing what consumers already knew: High deductibles keep people from obtaining needed proper healthcare.

High deductibles are not having the effect that health plan leaders hoped, according to the results of a recent survey of insurance executives. Rather than encouraging members to become more active in their healthcare decisions and using resources wisely to improve their health, high deductibles just make them avoid healthcare altogether.

That includes avoiding preventive healthcare that could save the insurers money in the long run, the survey report says. Health plans are getting the message and only 3.4% of top executives call high deductibles a good way to change consumer behavior, according to the Industry Pulse survey, commissioned by software analytics provider Change Healthcare and the HealthCare Executive Group (HCEG).

“Contrary to popular belief, respondents report high-deductible health plans aren’t the best way to turn passive patients into active healthcare consumers,” the report says. “This bucks the theory about these plans giving patients ‘skin in the game.’ Instead, high-deductible plans may lead to care avoidance rather than fostering shopping and price-comparison behaviors.”

The largest block of survey participants (25.4%) report incentives are the key to encouraging engaged, positive health behavior, the report says, especially those aligned with factors such as diet and exercise, which consumers have far more control over than figuring out the optimal cost of a hospital procedure.

The survey also asked respondents about the alternative payment models currently employed by their organization and which model they believed would be most effective in the next three years. Risk-sharing arrangements, such as accountable care organizations, were the top replies, with 45.6% currently using them and 23.8% predicting they will be the most effective over the next three years.

Pay-for-performance was the next most common response, with 43% of respondents using them and 18.4% predicting optimal efficacy by 2020. The other top responses were full capitation, partial capitation.

Social determinants of health have become a top priority for health plans, with more than 80% of respondents saying they are promoting value-based healthcare by addressing the social needs of their members.

The survey included more than 2,000 healthcare leaders, 52% vice president and above and 27% at the president or C-suite level.

"Healthcare organizations are transitioning from negative to positive incentives to influence consumer behavior much faster than most would expect. Payers are also taking aggressive steps to advance value-based care and crack the code to successful consumer engagement," said David Gallegos, senior vice president for consulting services with Change Healthcare.

Gregory A. Freeman is a contributing writer for HealthLeaders.

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