More Evidence Suggesting that Consumer Driven Health Plans Can Have a Negative Impact on Chronic Care

What impact will CDHPs (consumer driven health plans) have on patients with chronic conditions? Jason Shafrin of Healthcare Economist blog refers to a recent study examining this important issue:

The authors also found that increased cost sharing led to a slight increase in hospitalizations. However, when the subpopulation of individuals with chronic health conditions is examined, large increases in hospitalization rates are found. This means that individuals with chronic health conditions forego office visits and drug purchases due to the increase in price, but this decision will worsen their health and thus increase the chance they are hospitalized.

My colleague John Riedel and I have spoken a number of times on the impact of CDHPs on chronic DM.    You can view a recent copy of our PowerPoint presentation — “CDHPS + DM = Population Health?”.

CDHPs are a wildcard as to their ultimate impact on chronic care.  On the one hand, CDHPs and DM are eye-to-eye about the need for high-quality:

  • Consumer information
  • Consumer tools (supported by a robust, customized technological infrastructure)
  • Consumer incentives

This creates an incentive for appropriate cost reductions.

However, CDHPs and DM are NOT eye-to-eye when cost sharing creates the potential for patients to:

  • Defer needed care
  • Reduce adherence to prescribed treatment regimens

This creates potential for inappropriate cost reductions.

Although not widely understood, there also is a tremendous difference between the likely impact of HRAs (Health Reimbursement Arrangements) and HSAs (Health Savings Accounts).

Overall, CDHPs are a wildcard — we need more evidence. Your thoughts?