Cigna’s Report on High-Deductible Plans

Whatever the pluses and minuses of consumer-directed health plans, or more accurately, high-deductible health plans, may be, they are growing rapidly, as shown by this year’s surveys of employers by employee benefit consulting firms.  Cigna offers a full set of CDHP plans, as do most of the large health insurers, and has regularly reported on results for that population versus members in its other health plan designs.    Cigna just released the 2010 analysis.  (Cigna Report)

The report standardizes the respective populations for health status mix and removes catastrophic claims to help ensure an accurate comparison.  It should be noted, however, that even after health status adjustment, enrollees in CDHP may be more motivated and engaged in their health before enrolling and that may be a reason they were comfortable enrolling.   In the first year of enrollment, CDHP plan enrollees appear to have costs that are 15% lower than those of enrollees who continue in a traditional plan.  That difference appears to persist through the entire five-year history reported in the analysis and actually growths over time.  This is at odds with the findings of other research, which has found a short-term drop, but a return to the same level of costs over time.

While costs are lower, these enrollees have higher use of preventive services and have at least equal use of evidence-based services.  They are more likely to use online health information tools, to complete health assessments and to work with a health coach.  Costs are controlled by less use of services like emergency rooms and brand-name drugs and by participation in wellness and disease management programs.  These customers were also as satisfied as the usual health plan group.   Overall, it appears that Cigna’s CDHP offerings work well for its employer customers and members, but again, other research raises caution flags about some of the potential effects of these plans on patient behavior.