Do CDHPs Increase Use of Wellness Services
While insurers and vendors promoting CDHPs all claim to have statistics showing that members are more likely than their peers at health maintenance organizations or preferred provider organizations to access preventive health care services, such as cancer screenings, studies by benefit consultants and other organizations are finding just the opposite.
Most benefit experts chalk up the lower use of wellness and preventive care services by CDHP members to misunderstanding, and stress the need for stepped-up communications and incentives to ensure they use the benefits that the vast majority of CDHPs pay at 100 percent.
Minnetonka, Minnesota-based UnitedHealth Group Inc. reported in April that CDHP members were 16 percent more likely to receive cervical and prostate cancer screenings, 10 percent more likely to receive cholesterol screenings and 8 percent more likely to receive colon cancer screenings.
Likewise, Broomfield, Connecticut-based Cigna Healthcare reports that CDHP members are 12 percent to 13 percent more likely to access wellness and preventive services than their traditional health plan counterparts. The insurers say CDHP members seek out such services since they are generally paid at 100 percent and because their plans provide consumer engagement tools encouraging usage.
At Destiny Health, there is a 20 percent to 60 percent increase in preventive care usage for people in its Vitality wellness program, says Stuart Slutzky, vice president of product development at the Chicago-based CDHP vendor.
Hartford, Connecticut-based Aetna Inc., which is still studying preventive care utilization in CDHPs versus traditional health plans, says initial data shows that CDHP members made greater use of preventive care than other plan members, says Dr. Charles Cutler, chief medical director for national accounts.
However, non-CDHP vendors tell a different story.
A November 2006 study by the Menlo Park, California-based Kaiser Family Foundation found that CDHP participants are less likely than their non-CDHP counterparts (73 percent versus 85 percent) to have received any health care services since enrolling in their current plan. They are also less likely to have had a medical checkup (63 percent versus 74 percent). The KFF study also found that 25 percent of CDHP members skipped a recommended test or treatment, compared with just 15 percent of their non-CDHP peers.
The KFF study attributed the lower utilization to the cost of such services and CDHP participants who previously tapped health care benefits less often.
A study by Ann Arbor, Michigan-based Thomson Healthcare compared claims data from CDHP and PPO members from 11 large employers over a three-year period and found that PPO members used more preventive services than CDHP members did.
For example, just 18.5 percent of CDHP members had prostate cancer screenings in 2004, compared with 31.7 percent of their PPO counterparts; 16.9 percent of CDHP members received cholesterol screenings, compared with 26.4 percent of their PPO peers; 36.6 percent of CDHP plan members received cervical cancer screenings, versus 42.6 percent of PPO members; and 40.6 percent of CDHP members received mammograms, compared with 49.5 percent of PPO members.
Although the percentages of members accessing such services increased in the study’s third year, usage among CDHP members still lagged that of the PPO group: 28 percent of CDHP members received prostate cancer screenings in 2006, versus 36.6 percent of their PPO counterparts; 22.2 percent of CDHP members had cholesterol screenings, compared with 31.5 percent of PPO members; 46.1 percent of CDHP members underwent cervical cancer screenings, versus 46.3 percent of PPO members; and 48 percent of CDHP members had mammograms, compared with 50.3 percent of PPO plan participants.
"One of the major issues is people think they shouldn’t have tests because they think they’ll have to pay for them," says Carl Mowrey, managing director of compensation and benefits at Smart Business Advisory & Consulting in Chicago.
"They don’t understand that it’s not going to come out of their accounts," says Elizabeth Dudek, Ann Arbor, Michigan-based vice president of practice leadership at Thomson Healthcare.
There are other reasons CDHP members may shy away from preventive health care services, one consultant found.
In a survey Watson Wyatt Worldwide conducted in conjunction with Harris Interactive on all health plan members’ attitudes about preventive care, the consultancy found that people often "save up" conditions until they have two or more before seeing a doctor, says Cathy Tripp, Watson Wyatt’s national leader for consumerism based in Minneapolis.
Not only does this defeat the purpose of many preventive care services, it also can cause confusion for claims administrators trying to separate services that should be 100 percent covered from those that are subject to the CDHP deductible, she says.
On a related front, Watson Wyatt is working with Santa Monica, California-based Rand Corp. on a four-year study financed by the California Healthcare Foundation of CDHP members’ use of wellness and preventive health care services. Early results show CDHP members "are more engaged in lots of other consumer areas, like quality and cost information or taking the health risk assessment or using modeling tools," Tripp says. "But not all of them are getting preventive care."
Jay Savan, a principal at Towers Perrin in St. Louis, says the problem of employees not seeking preventive care is universal and not exclusive to CDHP members.
"Most employer-sponsored plans cover preventive care at 100 percent. But less than a majority of people get the amount and frequency of preventive care that they need in a given year. For example, only 30 percent generally get annual physicals," he says. "Ultimately, whether it’s a consumer-driven plan or not, we do a horrible job of telling people that health is an individual’s responsibility."