Rich Daly | January 22,2016
Enrollees in high-deductible health plans (HDHPs) were no more likely than those in traditional plans to price-shop among providers, according to new research.
During their most recent healthcare visit, 1,099 HDHP enrollees were no more likely than 852 enrollees in traditional plans to consider going to another healthcare professional for their care, or to compare out-of-pocket cost differences across healthcare professionals, according to aresearch letter published Jan. 19 in JAMA Internal Medicine.
However, slightly larger shares of HDHP enrollees (71 percent versus 68 percent) thought out-of-pocket costs were important when choosing a physician, and larger shares (56 percent versus 50 percent) said they would use additional sources of healthcare price information if available.
“Simply increasing a deductible, which gives enrollees skin in the game, appears insufficient to facilitate price shopping,” the authors wrote. “If encouraging price shopping is a viewed as an important policy goal, then there is a need for greater availability of price information and innovative approaches to enrollee engagement with this information.”
The findings underscored the importance of price to all privately insured patients, according to Mark Rukavina, principal at Community Health Advisors, who noted that half or more say using price information is important.
“Quite an impressive figure, given that this was barely part of the discussion for insured patients not that many years ago,” Rukavina said in an interview. “As cost sharing becomes a greater burden for families, patients will come to expect that providers and insurers will be able to provide information on prices.”
The recent findings followed a September report that 24 percent of workers are covered by a HDHP—up from 4 percent 10 years ago, according to the Kaiser Family Foundation’s (KFF’s) 2015 Employer Health Benefits Survey. Some health policy experts have cited the growth of HDHPs—defined by KFF as plans with deductibles of at least $1,000 for single coverage and $2,000 for family coverage—as the primary mechanism by which employers have been able to limit premium increases in recent years.
Advocates for HDHP plans say the plans can encourage judicious use of healthcare services, while critics say they can discourage the use of needed care.
The recent findings indicated to some healthcare finance leaders that patients are still acclimating to the relatively new concept of widespread price shopping in health care.
“Currently, consumers may not be using the pricing tools at the levels expected by many health plans and providers, but we need to try various tools to see how consumers want to use them in their medical decision making,” said Richard L. Gundling, vice president for healthcare financial practices at HFMA. “It’s too early to draw a conclusion that consumers are rejecting these tools outright.”
Provider Efforts
The JAMA findings run counter to December 2015 research from the 2015 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, which identified cost-conscious behavior by HDHP enrollees compared with traditional plan members. For instance, HDHP plan members were more likely to check whether the plan would cover care; to ask for a generic drug instead of a brand-name drug; to ask a physician to recommend a cheaper drug; and to use an online cost-tracking tool provided by the health plan.
Hospitals have been financially hit by the rise of HDHPs, according to recent reports, because of the growing amount of uncollectable out-of-pocket costs. And growing numbers have responded by increasing their price transparency efforts.
For instance, St. John Health System in Oklahoma joined Zero Card, a transparent medical network that allows patients to see and compare the costs of care in advance, according to published reports.
Other initiatives are compelling providers to share more price data. For instance, in 2015 North Carolina hospitals were required to begin publicly posting the costs of the most frequently reported DRGs. Among an increasing number of state transparency efforts is a push by Florida Gov. Rick Scott to pass a hospital price transparency law in the recently started legislative session.
Insurer Data
Providers generally prefer that insured patients obtain pricing data from their insurer, and most patients appear to be taking that approach, according to the EBRI data. Specifically, 56 percent of HDHP enrollees tried to obtain preservice costs from their insurers’ websites, compared with 29 percent who sought it from a provider’s website. The only significant difference with HDHP enrollees was that they were more likely than traditional plan enrollees to have found information from the health plan’s customer service department.
Interestingly, traditional plan enrollees were even more likely to check their insurer’s site (60 percent) and less likely to check the provider’s site (19 percent).
Insurer transparency tools include Aetna’s member payment estimator, which has evolved to add more detailed payment information on more services—650 healthcare services in a recent count. In 2011, Aetna policyholders who used the estimator before receiving care saved an average of $170 out-of-pocket on 34 common procedures, according to company data.
Aetna also offers a provider estimator tool, which is restricted to providers but gives the same patient payment information.
Source: HFMA