"I don’t think high-deductible health plans are the cure-all for bringing down health care costs," said Charles Cutler, Aetna national medical director for quality and clinical integration, during a July 25 Kaiser Family Foundation webcast on the subject of transparency in health care cost and quality.
Advocates of high-deductible health plans have long argued that individuals forced to spend their own money before health insurance kicked in would be more sensitive to price and, with a financial stake, become more cost-conscious.
This in part has led to the widespread belief among employers interested in offering high-deductible health plans that doing so would cut costs. In a survey released two days after the webcast, Buck Consultants reported that 84 percent of employers surveyed said reducing costs was their primary reason for offering a high-deductible health plan with a health savings or health reimbursement account.
Savings depend on the health of employees. Unhealthy employees who quickly burn through their deductibles are no longer sensitive to price, says Gerard Anderson, director of the Center for Hospital Finance and Management at the Johns Hopkins Bloomberg School of Public Health.
"He was, in a sense, being honest," Anderson, a webcast co-panelist, said of Cutler. "What you recognize is that most of the spending occurs after the deductible is reached. Once that happens, you don’t care how much things cost. Any hospitalization puts you above the deductible."
Though growth of the plans among companies remains strong, it has slowed in recent months, according to a midyear survey of health plans conducted by industry newsletter Inside Consumer-Directed Care. The data correspond to sentiments at a recent conference sponsored by the Midwest Business Group on Health in Chicago.
"Our membership is not embracing that as much as the consultants would lead you to believe," says Cheryl Larson, the group’s director of membership and education. "Five years ago, CDHPs were being pushed and pushed and employers were scratching their heads. And the reality is that penetration is still pretty low."
Instead, Larson has seen a renewed interest in companies wanting to take a hard look at managing employees’ health by offering incentives—discounts on premiums—to those who take blood tests that can determine health risks. The employer then can use the information to manage employee health. Opinion varies on whether such a hands-on approach represents a philosophical difference from the consumerism model of health care.
In April, Watson Wyatt released a survey showing that people who would benefit from a high-deductible health plan would by and large be healthy employees—about 75 percent of the population—who incur 11 percent of health care costs.
To demonstrate their support for high-deductible health plans, insurance companies have moved a lot of their own employees into them, says Paul Fronstin, director of health research and education at the Employee Benefit Research Institute. (Aetna sits on the institute’s board.)
"But they have been doing a lot of other things all along as well," such as wellness programs and lower co-pays for drugs that manage chronic diseases, he says. "There is no silver bullet, and you have to address cost increases among many fronts."