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.

Health Plans Moving Toward Value-Based Payment Models

An Availity study finds that almost 60% of surveyed health plans expect to transition to value-based payment models over the next five years, with 60% of those respondents saying they are about halfway through adoption. The study also notes that 90% of health plans believe that automating the way new data that is required under such payment models is exchanged is crucial to success. The study highlights the consensus among plans that information sharing with physicians must be automated – primarily in real-time – for these models to achieve success. Transitioning to payment models that base compensation on outcomes requires physicians and health plans to exchange new kinds of information – different from what is required under today’s predominant fee-for-service arrangements. The study also details the lines of business targeted for new payment models, payment model maturity, and expectations for growth over the next 18 months.

2012 eValue8 top performing plans and key findings released

To help health care purchasers assess and manage the quality and efficiency of America’s health plans, NBCH released the 2012 eValue8 top performing plans, key findings, and 2013 RFI.

A critical element of a purchasers’ value-based purchasing strategy, eValue8 is an annual health care accountability and quality improvement assessment process used by employers and coalitions to gather health care data from plans across the nation.

2012 Top Performing Plans 
Three plans garnered the top overall performing spots this year: Kaiser Permanente Southern California and Kaiser Permanente Northwest for HMO; and Cigna Pennsylvania for PPO. Plans who achieved the highest scores (benchmark) for specific modules include: Cigna in California, Colorado, New Jersey, Tennessee and Washington; and Tufts Health Plan Massachusetts for PPO; Kaiser Permanente in Southern and Northern California, Colorado, and Northwest; Group Health Cooperative in Washington; and Cigna Colorado for HMO.

2012 eValue8 Findings

The 2012 eValue8 process identified opportunities for all health plans to reduce waste, address gaps in care, structure payment reforms and improve consumer engagement. While plans have made progress in transparency of provider measurement, more needs to be done in the area of payment reform.

Additional information on the key findings and 2013 RFI can be found in today's news release.