HCCI: Consumer-directed plans cut spending, service use among people with chronic conditions 

A dollar sign created by Monopoly game houses is surrounded by Monopoly money. Dice and the car token appear next to the dollar sign as well.
New Health Care Cost Institute research dives into spending in consumer-driven health plans. (Getty Images/martince2)

People enrolled in consumer-driven plans spend less on care even if they have a chronic condition, new research shows. 

The Health Care Cost Institute (HCCI) analyzed data on 10 million people in such plans, which include high-deductible coverage and either a health savings account or a health reimbursement arrangement, and found 13% lower spending overall.  

They broke out plan members with Type 2 diabetes, hypertension and chronic obstructive pulmonary disease and also found lower costs, ranging from 3% for those with hypertension and 10% for diabetics. 

Spending was lower in these plans across all the settings included in the study. Inpatient care spending was 13% lower among this population, outpatient spending was 7% lower and spending on drugs was 26% lower. 

“When you look at these trends, the lower spending that we observed was not just in one category,” Bill Johnson, Ph.D., senior researcher at HCCI and one of the report’s authors, told FierceHealthcare. “Lower spending and lower healthcare use seem to be across the board.” 

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People enrolled in these plans used 12% fewer outpatient care services, the study found, which indicates they’re not necessarily using less low-value care. 

This trend extended to those with chronic conditions. For example, members with hypertension used between 4% and 6% fewer professional services, which produced negligible savings. 

Lower spending on drugs compared to people in other types of health plans was also consistent among people with chronic illnesses, according to the study. 

Johnson noted that the study doesn’t dive into the “why” behind these spending trends, but there is a growing body of research that indicates people cut back on care when they are enrolled in a high-deductible plan. 

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A survey conducted by the Kaiser Family Foundation (KFF) and the Los Angeles Times found that people enrolled in plans with the highest deductibles—$1,500 or more—were more likely than those with lower deductibles to describe their plans as “confusing” or “frustrating.” They were also less likely to give a positive review of their insurance plans. Just 12% of people in that group gave their plan an “A” grade.  

The KFF survey also found significant affordability issues, with 40% of people enrolled in any employer plan citing struggles with paying for care in the past 12 months. These issues have led employers to start rethinking high-deductible health plans