lthough most consumer-driven health plans are designed to emphasize wellness
and prevention to reduce future health care costs, experts say it is too early to
tell whether plan members are using those kinds of services more frequently than
members of traditional health plans.
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."
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