Aon Hewitt Survey: More Employers Will Offer High-Deductible Health Plans

The Washington Post reports on an Aon Hewitt survey that indicates high-deductible (or consumer-directed) health plans could become the most common form of coverage offered by companies with 500 or more workers in the next three to five years, as companies continue trying to cut health-care costs. Aon Hewitt said its annual survey of more than 800 large and mid-size U.S. employers found that 56 percent are offering CDHPs as a plan choice and another 30 percent are considering offering one in the next three to five years.

Employers are considering these plans because they make workers aware of how much their care costs, which could help slow growth in health care expenses for companies. Patients tend to think more about what they need and how to get a better deal for it. That means the employee may fill a prescription with a generic drug instead of the pricier brand-name medicine. They also may look for a better deal on an MRI exam instead of heading to the nearest hospital.

Health care expenses and administrative costs for the coverage grew about 4 percent last year for employers with CDHP plans, according to Aon Hewitt. That compares with growth of 6 percent and 7 percent for more traditional health insurance plans with lower deductibles: HMOs and PPOs.

Health Affairs Article on Consumer Engagement

The August 2013 issue of Health Affairs features an article co-written by NBCH Annual Conference keynote speaker Reed Tuckson on UnitedHealthcare's experience with new patient engagement techniques. Patient engagement is crucial to better outcomes and a high-performing health system, but efforts to support it often focus narrowly on the role of physicians and other care providers. Such efforts miss payers’ unique capabilities to help patients achieve better health. Using the experience of UnitedHealthcare, a large national payer, this article demonstrates how health plans can analyze and present information to both patients and providers to help close gaps in care; share detailed quality and cost information to inform patients’ choice of providers; and offer treatment decision support and value-based benefit designs to help guide choices of diagnostic tests and therapies. As an employer, UnitedHealth Group has used these strategies along with an “earn-back” program that provides positive financial incentives through reduced premiums to employees who adopt healthful habits. UnitedHealth’s experience provides lessons for other payers and for Medicare and Medicaid, which have had minimal involvement with demand-side strategies and could benefit from efforts to promote activated beneficiaries.

EBRI Research on Effectiveness of Consumer-Directed Health Plans

Consumer-directed health plans (CDHP), designed to make employees make more cost-and health-conscious decisions, have been shown to reduce the long-term use of outpatient physician visits and prescription drugs, according to new research by the nonpartisan Employee Benefit Research Institute (EBRI) authored by a team led by Paul Fronstin, Ph.D. (past speaker at the March 2013 NHLC meeting in Dallas, TX).

The research used data from two large employers—one that adopted a health savings account (HSA) plan for all of its employees in 2007, and another with no CDHP—and found that after four years under the HSA plan, there were 0.26 fewer physician office visits per enrollee per year and 0.85 fewer prescriptions filled, although there were 0.018 more emergency department visits (all of which are considered statistically significant). Additionally, the likelihood of receiving recommended cancer screenings was lower under the HSA plan after one year and, even after recovering somewhat in later years, still lower than baseline at the study’s conclusion.

The theory behind CDHPs is that as participants are exposed to a high deductible before insurance benefits are triggered, enrollees will be induced to make better health care use decisions, such as not going to an emergency department when a visit to a physician would suffice. Although usually offered alongside more traditional health plan designs, CDHPs are slowly increasing as employers’ only health insurance offering.

The research findings are published in the June 2013 issue of Health Affairs, and can be accessed online here. This work was conducted through the EBRI Center for Research on Health Benefits Innovation (EBRI CRHBI). The following organizations provided the funding for EBRI CRHBI: American Express, Blue Cross Blue Shield Association, Boeing, CVS Caremark, General Mills, Healthways, IBM, John Deere & Co., JP Morgan Chase, Mercer, and Pfizer.

New AF4Q Evaluation Publication: Consumer Engagement

The Aligning Forces for Quality (AF4Q) Evaluation team is pleased to announce a new publication on consumer engagement strategies. AF4Q, a Robert Wood Johnson Foundation program, aims to raise the quality of health care by engaging all key stakeholders, including consumers. The variety of AF4Q communities’ consumer engagement activities reveals the multidimensional nature of consumer engagement. In this paper, the authors explicitly articulate these dimensions, develop a framework for classifying the universe of consumer engagement initiatives, and apply this framework to one AF4Q community’s consumer engagement program. The paper discusses the differences in capacity and motivation to act versus actually taking action, and differentiates among four engaged behavior types: healthy, self-management, shopping and health care encounter behaviors.

The purpose of the framework is to help describe and compare consumer engagement programs and stimulate a productive discussion about advancing health and health care through consumer engagement. The applied example illustrates how this framework could help advance the field by expanding policymakers and practitioner’s awareness of the wide range of consumer engagement approaches, providing a structured way to organize and characterize interventions retrospectively, and helping them consider how they can meet program goals both individually and collectively.

Milbank Quarterly has made this article permanently free of charge online. You can access the article by following the link above.

Large Companies Are Increasingly Offering Workers Only High Deductible Health Plans

Historically, one of the perks of working at a big company has been generous health benefits with modest out-of-pocket costs. But increasingly, large companies are offering their employees only one option: a plan with a relatively high deductible linked to a savings account for medical expenses.

According to the annual health benefits survey by Towers Watson and the National Business Group on Health, 66 percent of companies with 1,000 employees or more offered at least one such plan this year. This figure is expected to grow to nearly 80 percent next year, according to the survey. At nearly 15 percent of companies surveyed, an account-based plan was the only option -- an increase from 7.6 percent in 2010.

In addition to saving companies money, shifting to health plans with higher deductibles and savings accounts is supposed to help workers become more cost-conscious in choosing health care. But the extent to which this is occurring is unclear. Because these account-based plans often expose workers to higher out-of-pocket spending, experts say the onus is on employers to give employees information they need to compare cost and quality and make good health care choices.  Whether this shift toward high deductible health plans continues may depend on whether good data and information can be made available to employees so that employers actually do see costs come down.

New Study on Patients' Willingness to Consider Costs in Medical Decision Making

A new study in the latest issue of Health Affairs found that a majority of patients were reluctant to consider cost when making medical decisions, nor did they want their doctors to do so. Researchers investigated the attitudes of 211 focus group participants in Washington and Santa Monica, Calif. Participants were asked to weigh their own out-of-pocket costs as well as the costs borne by their insurer. The participants, researchers said, did not generally understand how insurance works and felt little personal responsibility for helping to solve the problem of rising health-care costs. They were unlikely to accept a less expensive treatment option, even if it was nearly as effective as a more expensive choice.

Specifically, the study identified the following four barriers to patients’ taking cost into account: 

• A preference for what they perceive as the best care, regardless of expense;
• Inexperience with making trade-offs between health and money; 
• A lack of interest in costs borne by insurers and society as a whole; and 
• Behavior characteristic of a “commons dilemma,” in which people act in their own self-interest although they recognize that by doing so, they are depleting limited resources. 

Surmounting these barriers will require new research in patient education, comprehensive efforts to shift public attitudes about health care costs, and training to prepare clinicians to discuss costs with their patients. Campaigns such as Choosing Wisely, as well value-based purchasing programs like reference pricing can help start to educate patients about appropriate utilization of services.

New RWJF Study: Consumer Attitudes on Health Care Costs

New Robert Wood Johnson Foundation research shows many Americans don't understand why health care costs are increasing nor how the trend affects them on a daily basis. RWJF orchestrated a series of eight focus groups in four major U.S. cities: Chicago, Denver, Philadelphia and Charlotte, N.C. Four of the focus groups included people with employer-sponsored health insurance, two groups were comprised of people who were self-insured, one group was all Medicare beneficiaries and the final group was uninsured.

Here are some takeaways from the RWJF's findings:

• Patients defined "health care costs" as their out-of-pocket costs, which include premiums, deductibles, co-pays and other costs taken from their paychecks.

• Participants in the focus groups said increasing health care costs were forcing them to cut back in other areas of their lives, such as taking fewer vacations or postponing a major purchase.

• Many participants said they want to understand what their tests and procedures cost before they agree to them. They also believed higher costs for a procedure were tied to the location of a hospital or other facility.

There are important implications for employers from this research regarding the need to educate employees about health care costs, and that there is an appetite for more such information to be provided.  Work on public reporting of these types of data must be continued and improved.

New Study Finds Better Doctor-Patient Relationships Leads to Better Medication Adherence

A new study published in JAMA Internal Medicine finds that physicians can improve medication adherence by cultivating better relationships with patients. Researchers looked at 9,377 patients taking medications to lower their blood sugar, blood pressure, or cholesterol. Adherence was determined by measuring delays in refilling prescriptions. Patients who felt their doctors listened to them, had involved them in decisions and gained their trust followed doctors' orders more often and took their drugs as prescribed. Patients who gave their doctors poor marks in communicating were less likely to adhere to their medications. The study's authors note that future studies should investigate whether improving communication skills among clinicians with poorer patient communication ratings could improve their patients' cardiometabolic medication refill adherence and outcomes. This study indicates there is a strong motivation for employers as payers to take an active role in improving the doctor-patient relationship because such improvements have the potential for long-term cost savings through better medication - and potentially other treatment - adherence.

AHRQ Posts Comparative Effectiveness Research Summaries

AHRQ's Effective Health Care Program has created free summaries comparing the effectiveness of various treatments for different health conditions. Summaries are available for both clinicians and consumers, covering a wide range of conditions, including diabetes, mental health issues, and cancer. AHRQ does warn that these research summaries are not clinical recommendations or guidelines and should not be interpreted as such.  Presumably, AHRQ also does not intend for this information to be used in coverage or payment decisions by payers. The publication of this type of information, though, is a step in the right direction toward engaging consumers more in their own care and creating a foundation for patients and clinicians to have informed discussions about treatment options. 

Visitors are invited to join the e-mail list to receive updates when new research summaries are posted.

BPC Releases Report on Potential for mHealth

A report from the Bipartisan Policy Center’s Health Project, led by former Senate majority leaders Tom Daschle (D-S.D.) and Bill Frist (R-Tenn.), says that mobile health is a promising avenue for increasing patient engagement, which should be one of the major goals of health care reform. But barriers to mobile adoption and increased engagement include lack of awareness, lack of innovation, and privacy concerns. The BPC was founded by Daschle and other former Senate Majority Leaders Bob Dole (R- Kansas), Howard Baker (R-Tenn.), and George Mitchell (D-Maine) in 2007, and its mission is to “drive principled solutions through rigorous analysis, reasoned negotiation, and respectful dialogue.”

The BPC Health Project highlighted patient engagement as a key goal in their January report “Transforming Healthcare: The Role of Health IT.” By reviewing a wide range of available literature, they found that patients who are more directly involved in their health have less pain and faster recovery, are more adherent to doctors’ treatment plans, and are less likely to choose elective surgeries. In the latest report, entitled “Improving Quality and Reducing Costs in Health Care: Engaging Consumers Using Electronic Tools,” the BPC looked at two categories of electronic tools, those that promote education and self-care, and those that enhance patient-physician communication.

In the report the center outlines some suggestions to the government for overcoming the barriers to adoption. Increasing awareness of electronic tools among both consumers and providers is one suggestion. Employers could play an active role in increasing awareness of such tools. The report also emphasizes the need to develop and disseminate standards and best practices for adoption, especially in small clinics where the cost could be prohibitive.

Health Affairs Study: CDHP Enrollees Unaware of Free Preventive Services

The authors of this Health Affairs study surveyed people in California who had a consumer-directed health plan and found that fewer than one in five understood that their plan exempted preventive office visits, medical tests, and screenings from their deductible, meaning that this care was free or had a modest copayment. Roughly one in five said that they had delayed or avoided a preventive office visit, test, or screening because of cost. Those who were confused about the exemption were significantly more likely to report avoiding preventive visits because of cost concerns. Special efforts to educate consumers about preventive care cost-sharing exemptions may be necessary as more employers and health plans, including Medicare and some Medicaid programs, adopt this model.

New V-BID Center Research Shows Guarded Consumer Support for V-BID Concepts

This new issue brief from the Center for Value-Based Insurance Design at the University of Michigan indicates that consumers are generally supportive of V-BID concepts but are concerned about interference in the doctor-patient relationship and fairness in V-BID approaches to cost-sharing. There was broad support for “carrot” V-BID plans (making valuable care more affordable) especially when these designs were perceived as saving money and lowering insurance premiums for all beneficiaries.

Participants in the V-BID Center study also defended the values of individual responsibility and fairness when it comes to health, yet opinions were mixed regarding the use of clinical nuance in plan design. Some preferred that health plans offer incentives to a broader group of people (rather than singling out specific conditions) while others favored targeting support for those that demonstrate the greatest health needs.

Altarum Survey Shows Increase in Health Care Consumerism

Patients are morphing into health care consumers with growing use of technology for medical shopping and health engagement, according to a survey conducted by Altarum, the health services research organization.

Virtually all (99%) of U.S. health citizens want to play a role in medical decisions about their care. However, consumers vary in just how much of that responsibility they want to assume:

- 35% want to make the final decision with some input from doctors and other experts

- 29% want to be completely in charge of their decisions

- 28% want to make a joint decision with equal input from their doctor

- 7% want their doctor to make the decisions, providing some input themselves

Just 1% want the doctor to be completely in charge of treatment decisions.

The cost of care is an issue consumers are keen to know more of in health care. Altarum asked consumers about two health behaviors when receiving advice or services from a health provider — looking for information about doctor quality ratings before choosing where to go, and asking before a visit how much the cost would be. Overall, fewer than half of consumers asked about prices (42%) or investigated quality before receiving the health service (39%).

Importantly, engaging in these two behaviors was less likely among folks who were in poor/fair health than those in excellent health, with 29% looking for quality information on providers and 34% asking about cost — compared with 62% of people in excellent health asking about quality and 60% asking about cost.

The survey found, consistent with other polls, that most consumers trust and like their doctor. Furthermore, 76% of consumers also believe that their doctor would “never” recommend a test or procedure unless it was necessary.

What’s concerning in Altarum’s findings is that the poorer a consumer perceives his or her health to be, the less empowered that individual feels. While 75% of those in excellent health say they’re confident they can reduce costs of care by shopping for better prices, only 30% of those in poor/fair health are confident in doing so. Thus, 70% of those in poor/fair health are uncertain/not at all confident that they’ll be competent health shoppers, able to reduce their health costs. Yet it’s those in poorer health who tend to be higher cost patients.

While several entrepreneurial companies are positioning themselves to play starring roles in shedding light on prices and quality in health care — such as Castlight Health, Change:Healthcare, Clear Health Costs — it is unclear whether their business plans are positioning them to serve the sicker, less health literate population. This is a key issue for policymakers to target.

Open Enrollment Often a Stressful Time for Employees

As the open-enrollment season for health benefits approaches, many workers will be making some bad choices, according to a new survey. "Far too many people don't really understand their benefits," says Audrey Tillman, executive vice president of Corporate Services at Aflac. "In fact, most employees are on autopilot." The majority of American workers — 56% — estimate that they waste up to $750 each year because of costly mistakes they have made with their health insurance benefits, according to the Aflac WorkForces Report, a July survey of more than 2,000 consumers released last week.

This is the second year Aflac has conducted a health care survey, and the situation is getting worse. In 2011, 24% of workers were confident about their decisions, compared to 16% this year.

Among common errors that Aflac found:

•Many employees, 89%, say that they simply elect the same benefits options every year, regardless whether their personal situation or circumstances change.

•Nearly half of workers (47%) say that they rarely or never exceed their deductible costs.

•Only 16% contribute the right amount to flexible spending accounts.

But Americans clearly understand that selecting health benefits is an important issue. Rising out-of-pocket medical expenses are one of the most costly financial burdens they face, say 43% of workers, Aflac found.

As benefits change, workers need to pay closer attention to their selections during open enrollment, the experts say. Many plans have started increasing in-network deductibles, emergency room co-payments, and prescription drug co-payments. But there also are some new plan benefits that could help workers as more companies offer financial incentives to promote wellness and health-improvement programs.

Coalitions have a unique role to play in assisting their employer members to educate their employees about these important issues.  With issues related to health insurance exchanges, and Medicaid expansion on the horizon, employers are going to be relied upon more and more to educate and inform their employees about the choices they have regarding health benefits.

Health Leaders Media Compares Three Hospital Ranking Tools

The tools available to hospitals, medical professionals, and consumers for evaluating health care facilities on quality of care, safety, and other measures is growing. The U.S. government posts data on readmissions, mortality, and other measures on its Hospital Compare site. That data may be used by others to build their own ranking systems. In June, the Leapfrog Group introduced "Hospital Safety Score" which assigns letter grades based on safety metrics. (See materials from NBCH's June 19, 2012 All-Member Call.) In July, Consumer Reports' hospital safety ratings were rolled out.

To see how top hospitals measured up across three ratings systems, Health Leaders Media compares hospital safety scores from the Leapfrog Group and Consumer Reports alongside the overall rankings of U.S. News & World Report's 17 top-rated hospitals. As health care data transparency becomes more and more important for all stakeholders in the market, including regional coalitions, employers, and employees, being able to make the data actionable will be a key component to using it successfully to achieve better population health and lower costs.  Regional coalitions have an important role to play in navigating these different tools and topics to help put useful information into the hands of those who make decisions.

Contest Seeks Online Apps for Health Care Quality Comparisons

The Robert Wood Johnson Foundation has announced a contest calling on software developers to create online tools to help consumers find health care quality information, the Newport News Daily Press reports (Salasky, Newport News Daily Press, 10/28).

The contest is part of the foundation's Aligning Forces for Quality initiative (Goedert, Health Data Management, 10/28). The initiative is designed to improve the quality of health care in 16 communities around the U.S. Read more...

Partnership for Prevention: Leading by Example Reports Available

Partnership for Prevention, with support from the Centers for Disease Control (CDC), is proud to have developed two new publications: "Leading by Example: The Value of Worksite Health Promotion to Small- and Medium-Sized Employers," which you can dowload it here, and "Leading by Example: Creating Healthy Communities through Corporate Engagement," which you can download here.

VOTE for DFWBGH's Road Trip! program

DFWBGH's Road Trip! program has been selected from over 4,000 possible candidates to participate in a vote-gathering contest, called "Aetna Voices of Health", which honors Martin Luther King, Jr. for his vision of racial equality and the unveiling of his new monument in Washington DC.

Please visit the Aetna Voices of Health website and vote for DFWBGH and Road Trip!
(You can vote 10 times, so use the back arrow to return to the voting page after each of your first 9 votes. Remember: Every vote you cast brings us closer to the grand prize!)

Watch DFWBGH's 3-minute video about Road Trip! and find out more about this innovative worksite employee engagement and empowerment program that's receiving rave reviews from employers who tried it.

Private biz profits when public health improves

We know that obesity and other health problems like diabetes and asthma are often compounded by an unhealthy environment: neighborhoods with no safe place to walk or bike, communities with lots of opportunities to buy unhealthy food or cigarettes but no place to purchase fresh produce, and environments where polluted air can trigger asthma and other ailments.

We also know that the health of our local economy depends on a healthy workforce. Chicago employers must join with leaders in transportation, housing, energy and other sectors to find solutions to these unhealthy environments. We must start investing in building healthy places for people in the Chicago area to live—and work. Read the full article featuring Larry Boress...

Health Reform- Many Americans Don't Know What It Means

Numerous polls have shown that the public remains divided about health reform – and remarkably ill-informed about it. An August Kaiser Family Foundation tracking poll found that even people who would most benefit – the uninsured – were remarkably clueless.

Only about half of the uninsured said they are familiar with the main provision of the law, and only three in 10 thought it would help them get health care. Nearly half thought it would have no effect on them, and 14 percent thought they would be hurt by the law, possibly because they understand there is a mandate requiring them to get insurance, but don’t understand there are subsidies to help them afford that insurance. Read the full post...