Advocates for Evidence-Based Health Policy Speakers
Trimming the Fat
The use of costly, unnecessary medical tests that provide little benefit to the patient, known as low-value healthcare services, is a major cause of wasteful spending in the healthcare system. The recent rise of consumer-directed health plans (CDHP) aims to decrease wasteful healthcare spending by enabling consumers to enroll in high-deductible health plans with health savings accounts (HSAs) that allow them to pay for out-of-pocket services with pretax dollars.
These plans theoretically hold patients more accountable for their healthcare decisions thereby discouraging the use of low-value healthcare services. However, do plans that promote cost sharing like CDHPs actually reduce the use of low-value services?
A recent study aimed to answer this question. The study used insurance claims data from UnitedHealthcare commercial plan members to compare the spending of patients who stayed with a traditional plan with that of patients who switched to a CDHP over a 2-year study period. Low-value services done in the outpatient setting were identified. Overall outpatient spending, annual low-value spending, and annual low-value spending per $10,000 of outpatient spending were then measured. The results showed that switching to a CDHP resulted in decreased annual outpatient spending by $231.60 but yielded no significant difference in low-value spending or low-value spending per $10,000 in overall outpatient spending.
The results of this study are somewhat limited in scope because they just account for outpatient expenses among patients enrolled in employer sponsored insurance plans. Therefore, trends that may be seen in government sponsored insurance plans (Medicare and Medicaid), the ACA marketplaces, or the inpatient setting cannot be assessed. However, the fact that there was no significant difference in patients’ spending on low-value services supports literature that describes that patients do not make the best decisions regarding their health care needs when given a choice. So, when thinking about reducing wasteful spending in the healthcare system, provider-directed initiatives, such as the Choosing Wisely campaign, may be more impactful than patient-directed interventions.
Abstract
OBJECTIVES: To assess the impact of consumer-directed health plan (CDHP) enrollment on low-value healthcare spending.
STUDY DESIGN: We performed a quasi-experimental analysis using insurance claims data from 376,091 patients aged 18 to 63 years continuously enrolled in a plan from a large national commercial insurer from 2011 to 2013. We measured spending on 26 low-value healthcare services that offer unclear or no clinical benefit.
METHODS: Employing a difference-in-differences approach, we compared the change in spending on low-value services for patients switching from a traditional health plan to a CDHP with the change in spending on low-value services for matched patients remaining in a traditional plan.
RESULTS: Switching to a CDHP was associated with a $231.60 reduction in annual outpatient spending (95% CI, -$341.65 to -$121.53); however, no significant reductions were observed in annual spending on the 26 low-value services (–$3.64; 95% CI, -$9.60 to $2.31) or on these low-value services relative to overall outpatient spending (-$7.86 per $10,000 in outpatient spending; 95% CI, -$18.43 to $2.72). Similarly, a small reduction was noted for low-value spending on imaging (-$1.76; 95% CI, -$3.39 to -$0.14), but not relative to overall imaging spending, and no significant reductions were noted in low-value laboratory spending.
CONCLUSIONS: CDHPs in their current form may represent too blunt an instrument to specifically curtail low-value healthcare spending.
PMID: 29261240
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