CDHPs: Stand and Deliver

While a tiny 1 percent of U.S. workers are enrolled in CDHPs, lots of people are suggesting that they have an extremely rosy future, notably the health insurance industry, the employers who see big cost savings, and the banks slavering over the profits from the be made a billion-dollar inflow of health savings account funding. Still, those without financial skin in the game, such as The Commonwealth Fund and the Employee Benefits Research Institute, are highly critical of CDHP models.

But this tension can't last forever. This year, I'd submit, will be the year in which forces pro- and against the CDHP model will have a knock-down, drag out over the benefits of this model. I believe that 2007 will be the last chance CDHP backers have, for the foreseeable future, to prove that their model makes sense--that it doesn't compromise patient health while attempting to lower premiums.

To be fair, the term "CDHP" doesn't cover every model, so it's probably unreasonable to suggest that all CDHPs are on trial for their life this year. After all, CDHP benefit designs are beginning to shift, with some health plans doing a better job of including low-cost preventative care than others. Also, some interesting efforts are already underway to provide individually tailored coverage for CDHP users, charging them little or nothing for preventive care that meets their precise personal needs. (Eye screenings might be free for a given diabetic patient, for example.)

Still, it's not clear that CDHP enrollees won't skip necessary preventative care due to an empty HSA or simple desire to postpone expenses. If the insurance industry and insurers can't jump this hurdle, CDHPs may be a dead issue by 2008.