RKA for CDHPs?

One of the most valuable exercises I sometimes go through with clients is a road-kill autopsy (RKA) — examining what went wrong with a business model or a policy that has been driving down healthcare highway ahead of where we are today.

I hope we can learn a lesson from the progress (or lack thereof) of Consumer Driven Health Plans (CDHPs).  More specifically, how did CDHPs get so politicized in the first place, and how can health care information technology (HCIT) and chronic disease management continue to maintain bipartisan support?

While the patient is still technically “alive”, I sense the tide turning against consumer driven health plans (CDHPs).  An article in yesterday’s Wall Street Journal —Health Savings Plans Start to Falter [subscription required] —  suggests that CDHPs might never make the mainstream.

President Bush and many big employers have hailed “consumer-directed” health plans and savings accounts as an effective weapon in the battle against runaway medical costs. But several years after the plans got off to a fast start, the approach appears to be stumbling — largely because of consumers’ unease in using them.

But low enrollment and low satisfaction among workers who are offered them raise the question of whether consumer-directed plans will stall before they ever hit the mainstream. Few employers are focusing on the costly measures — such as offering better coverage or more consumer education — that may be needed to accelerate these plans. 

I have never understood how CDHPs became so politicized in the first place.  This issue could have played out very differently, and could have been positioned in a much more bipartisan and constructive way.

Those ‘fer CDHPs have been associated with a conservative, Republican agenda — President Bush, the Galen Institute, the American Enterprise Institute, and others.

Meanwhile, those ‘agin CDHPs have included most Democrats and labor unions.

I am a moderate Democrat and mostly free market in my economics.  I see many positive aspects embedded in CDHPs:

• Providing accurate information about price and quality to patients
• Creating incentives (psychological and financial) for patients to be more involved in their own health care decisions
• Getting away from the health insurance mentality of health care being “free to me, so why not?”
• Getting patients and doctors to collaborate more closely

These aspects of CDHPs could have been positioned as motherhood, apple pie, the American flag.  Instead the debate about CDHPs has been cast as very black/white, good vs. evil, right vs. wrong.  It didn’t have to be this way.

Contrast the way the political debate has played out for CDHPs versus the political debate about healtcare information technology (HCIT).  HCIT has remained a bipartisan issue  On what other topics have you had Hillary Clinton, Patrick Kennedy, Newt Gingrich and Bill Frist co-sponsoring legislation and singing in harmony from the same hymn book?

So far, the debate about chronic care and disease management also has been remarkably bipartisan.  Let’s keep it that way.

Your thoughts?  How did CDHPs get so politicized, and how do we keep HCIT and chronic disease management bipartisan?