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Early in this plan year, high-deductible health plans (HDHPs) might make members more selective, however, once the deductible is met, the bets are all off.

A recent Employee Benefit Research Institute (EBRI) study reveals that once the health plan members meet their deductible, the probability of employing low-value health services increases by 83%. This applies to services like Vitamin-D deficiency test, imaging for simple headaches, prostate-specific antigen test, Pre-operative testing before outpatient hernia repair, and cancer-screenings for certain age groups.

Using health plan deductibles is a common strategy to motivate employees to utilize their wellbeing benefits for lower healthcare costs.  The high cost sharing levels have increased the tendency of the members to distinguish the high-value and low-value care services. Simply put, cost sharing is a means to teach members to choose their services for the plan year wisely.

Despite having a high health plan deductible, some members will satisfy it, and they will have to pay little or nothing for the consequential care. On the other hand, enrollees who are still under the deductible may face up to 100% cost sharing. It is very likely that once the deductible is met, the patient scrutiny may be relatively less, over the health services value, recommended by the health care providers.

In this study, EBRI collected data from the 2015 Truven Health Analytics MarketScan® Commercial Claims and Encounters Databases (CCAE) and the Benefit Plan Design (BPD) Database of 1.5 million full-time employees with employment-based health benefits. The study concluded that there was a striking increase in the utilization of low-value healthcare services among the members who reached their health plan deductible, compared to the ones who did not satisfy their plan deductible.  The most common low-value health care services after satisfying the health deductible include –

  • Imaging for Uncomplicated Headache – 83%
  • Chest X-Rays Before Low-Risk Surgery – 73%
  • Chest X-rays before hernia repair surgery – 73%
  • Vitamin D Testing – 68%
  • Baseline Lab Testing Before Low-Risk Surgery – 28%
  • Imaging for Low-Back Pain – 28%
  • Pre-operative testing before outpatient hernia repair – 28%
  • Prostate-Specific Antigen (PSA) Testing – 21%

Similar findings were seen for cancer screenings also –

  • Colorectal cancer screenings among members under age 50 – 126%
  • Colorectal cancer screenings among members above age 50 – 60%
  • Breast Cancer Screening for women of age 40 and above – 11%
  • Breast Cancer Screening for women of age less than 40 – 16%
  • Cervical Cancer Screening for women of age 21 and more – 11%
  • Cervical Cancer Screening for women of age 21 and less – 33%

According to the EBRI, the health plan deductibles have been highly promoted as a tool to motivate and engage members, and also reduce the use of low-value care. The study also found that members with employment-based insurance, who met their health plan deductibles had a higher probability to receive low-value healthcare services compared with those who had have not satisfied their deductibles.

The findings of this study were consistent with that of many others, in which, despite the use of HDHPs, there was no significant reduction in the use of 26 most common health services.

The findings of this study were consistent with that of many others, in which, despite the use of HDHPs, there was no significant reduction in the use of 26 most common health services. Also, HDHP enrollment did not change the scenario to avoid using low-value services.

The report also suggested that the lack of refinement in the health plan design concerning the low-value services contributed to the patterns where the members satisfied their deductibles. It emphasized the designing and implementation of health plans that can reduce the use certain low-value services, rather than the ‘blunt’ health plan deductibles. One of the best ways to avoid choosing only the common low-value services is to ensure that plan sponsors encourage smarter shopping opportunities to the members for choosing the right services.

Post Author: Admin