Study: High-deductible health plans aren't making members better healthcare consumers

Though high-deductible health plans (HDHPs) have proliferated, members who have them often don’t act as empowered, discerning consumers, which can lead to delays in care, according to new research. 

A pair of studies published in the latest issue of Health Affairs dug into the behaviors of people enrolled in HDHPs and found that while the plans are intended to incentivize patients to shop around for care, they more often led patients to put off care.

In one of the studies, researchers at the University of Michigan surveyed more than 1,600 members in HDHPs and found that fewer than half (about 40%) were saving for future healthcare costs. Other behaviors were even less common: just a quarter of those surveyed had spoken with a doctor about price, and about 14% had compared prices. 

Jeffrey Kullgren, M.D., the study’s lead author and an assistant professor in the Department of Internal Medicine at UM, told FierceHealthcare that the people who weren’t engaging in these behaviors cited two main reasons why: they hadn’t thought about doing so, or they assumed it wouldn’t matter. 

This is even as more tools and data for price shopping are becoming available, Kullgren said. 

“It appears that few people are translating that consumer mindset into how they seek, when they seek and where to seek healthcare,” Kullgren said. 

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The number of people in HDHPs has increased steadily since they first came on the insurance scene a little over a decade ago. In 2018, about 46% of people under the age of 65 were enrolled in an HDHP, according (PDF) to the National Center for Health Statistics. 

However, employers are beginning to turn away from these plans and seeking other alternatives to mitigate healthcare costs. And as individuals spend more on care, they seek out less, studies show

Case in point: In a second study, researchers at Harvard Medical School found that HDHPs led to notable delays in diagnosis and care for breast cancer for some patients.

The study used data from Optum on more than 318,000 women from between 2003 and 2014.

Low-income women in the study who were enrolled HDHPs saw delays of about 1.6 months for a first mammogram, 2.7 months to a first biopsy and then 6.6 months to early-stage breast cancer diagnosis, compared to women who weren’t enrolled in a HDHP. 

These women also saw a delay of about 8.7 months to their first chemotherapy treatment. Timelines were similar for high-income women enrolled in HDHPs, according to the study. 

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J. Frank Wharam, the study’s lead author and an associate professor at Harvard Medical School, told FierceHealthcare that while for breast cancer patients these delays may not necessarily put them at significantly higher risk for poor outcomes, it’s a worrying trend. 

“These delays are concerning, and in an ideal world, they shouldn’t happen,” Wharam said. 

He said that HDHPs are in their infancy, in terms of research, so it’s crucial for future studies to continue to pin down how these plans could be impacting patients' health. 

Kullgren and his team suggest several ways that employers, health plans and providers can make the benefits of HDHPs clearer and encourage better consumer behavior. For one, employers can add health savings accounts alongside HDHPs, which made members far more likely to save and shop, Kullgren said. 

In addition, payers and employers can do more to empower and educate members about their plans, benefits and how to shop for care. Increased insurance literacy, he said, is crucial to turning patients into better consumers. 

Providers can also help to fill the gaps, he said. They should be encouraged to discuss price with patients and should be armed with billing and cost data to do so.  

“One of the most important bottom lines here is the opportunity to change how people in high-deductible health plans think about seeking healthcare,” Kullgren said. “I think there’s real untapped opportunity.”