Insurance professionals need to use CDHPs

More and more, health insurance professionals who design consumer-driven and high deductible plans are using them personally, a trend that bodes well for their improvement.

As of last year, more than 26 million Americans with commercial insurance were covered in either an account-based consumer-driven health plan or one eligible for a health savings account, spanning about about 15 percent of the private insurance market. And some $23 billion was held in HSAs and health reimbursement accounts, across almost 12 million individuals. 

CDHPs and high-deductible plans in general have been gaining in popularity among employers, but they are not necessarily greeted with enthusiasm by the many middle and upper-middle income employees who use them.

High out-of-pocket payments replacing generous coverage are one thing not to like from the perspective of employees, but that has also come in tandem with the fact that shopping around for health services subject to the deductible has been difficult to do because of the dearth of available pricing information for patients. The default process for patients continues to often be choosing the doctor, test or procedure first, then learning the cost afterwards.

That poor consumer experience has come along with underwhelming financial results. A study last year in Forum for Health Economics & Policy examined the behavior of those with and without CDHPs for nine common outpatient services -- and found that people with CDHPs only paid less for a doctor's office visit, only about 2 percent less on average.

At the same time, there has been a movement underway to bring cost transparency to patients -- with pressure on both providers and insurers -- and a flood of new technologies aimed at helping patients in how they find, choose and pay for medical tests and treatment. I

Insurers are designing CDHP networks and cost sharing, and choosing or creating their supportive shopping technologies -- and they're also increasingly attracting their employees to the high-deductible, account-based options.

One such company is Cambia Health Solutions, parent of Regence Blue Cross and numerous technology and service companies, where some 70 percent of employees are enrolled in health plans with health savings accounts, Mark Stimpson, Cambia HR VP wrote recently.

That critical mass of participation wasn't always the case, though, Stimpson said. The popularity of HSAs, which can roll over funds, along with other benefits for employees, have coincided with the advent of comparison and shopping tools developed and sold by Cambia's HealthSparq, which now counts 60 insurers among its clients, many of them Blues.

Like the cost estimator website Healthcare Bluebook and others, HealthSparq isn't able to give members an exact cost of a test or treatment, although offers a close range for both individual services and episodes of care and is able to tap into the datasets of client insurers, with the goal of refining its estimates of what members will pay based on their deductibles, co-pays and claims to date.

"The more employees are exposed to medical costs, the more important it is that they be able to find out the cost, convenience, and quality of care before they walk through the clinic door," Cambia's Stimpson wrote in a recent blog.

And the more health insurance company employees are exposed to CDHPs, the more likely they are to work at refining the plans and their supporting products -- like HealthSparq or another Cambia company, Wellero, a two-way eligibility and payment app for consumers and providers whose co-founder Hanny Freiwat uses a high-deductible plan.

Insurers like Highmark, which also owns health system, have said they see account- and high-deductible health plans as a large part of the future of insurance, and are hoping to attract more of their own workers to the option.

Meanwhile, at the executive level of large insurers, pressure to bring changes to the status quo of price opacity for consumers is also increasing: Aetna, Humana and UnitedHealthcare are partnering with a research nonprofit to build what an online comparison tool that they say will "offer consumers the most comprehensive information about the price and quality of healthcare services."