A new report from Truven Health Analytics offers another examination of utilization and costs for people covered by high-deductible health plans. (Truven Report) The report uses an employer-based plan database to analyze data from 2007 to 2013. During this time, the number of firms offering high-deductible plans doubled and enrollment nearly quadrupled. The study design looked at people who weren’t enrolled in a CDHP in 2009 and then signed up for one in 2010 and were continuously enrolled from 2o10 to 2012. This set of members was then matched to a non-CDHP cohort. Note, however, that the CDHP enrollees were not in sole-option plans; in other words, they chose to be in the CDHP as opposed to other plan options. In 2009 the two groups had similar health costs, after that the CDHP members had lower overall costs, largely due to lower utilization. The lower utilization included higher cost services like imaging and lower cost ones like lab testing. The highest cost difference was in the prescription drug category. An employer saved about $750 per year per CDHP enrollee. The total cost savings were less, more like around $500 a year, because the member is picking up more of the cost in a high-deductible plan. So you can see the attraction to the employer. And for members, it wasn’t reported how much of the additional costs were paid for by a health savings account.
Rates of adherence to some recommended care guidelines, such as mammogram and cervical cancer screening, was also lower for the CDHP group. Quality of care measures for diabetes and coronary artery disease were slightly below those for the comparison members. Use of generic medications was higher and imaging use was lower, as were professional office visits and inpatient hospital use. ER use for potentially avoidable visits was below the comparison group. And those CDHP members who had a chronic disease were less likely to receive specific care for that condition than the matched cohort members. While the report shows clear cost savings, it does nothing to allay fears that people under the high-deductible plans are skimping on appropriate as well as inappropriate care.