It’s imperative then that decision makers for employer-sponsored health care enter a HDHP plan with an understanding of these potentially harmful effects. (Photo: Shutterstock)

Earlier this year, the Kaiser Family Foundation and the Los Angeles times released findings on member satisfaction with employer-sponsored plans. The results weren’t surprising—most people (68 percent) said their employer-sponsored health insurance coverage was excellent or good. However, that satisfaction decreases to 46 percent for those on high deductible health plans (HDHPs). And if you dig further into the data, it reinforces some troubling messages that research has been suggesting for some time.

While HDHPs have been hailed as a way to make people savvier consumers of health care, that vision of legions of patients becoming engaged shoppers pushing down prices has turned out to be a mirage. People still don’t fully understand the concept of a deductible as it currently stands in healthcare—typically, they assume that it applies for all care and overlook the exclusions around preventive care. And you can’t fault them—deductibles in other areas, such as those for car insurance, don’t work that way. These deductibles also reflect a high percentage of most people’s available cash savings, presenting a serious financial deterrent to care access. The people who’ve proven to benefit the most from high deductible plans are those who use a health savings account (HSA)—which isn’t really the point of creating these plans in the first place.

Related: May 19: ‘Deductible relief day’

A deductible is simply an economic incentive to produce a certain behavior. We have experimented with millions of people and proven definitively that the economic incentive does not have the desired effect—and can have serious healthcare outcomes. However, since HDHPs are now embedded in so many health plans, benefits leaders and the consultants advising them should consider monitoring and managing the “side effects” of HDHP plans—just like healthcare professionals monitor and manage the side effects from any medical treatment.

The explosion in cost-sharing is endangering patient health as millions, including those with serious illnesses, skip care. It’s imperative then that decision makers for employer-sponsored health care enter a HDHP plan with an understanding of these potentially harmful effects. Here are 3 considerations for benefits leaders, consultants, and people covered under these plans to monitor the effects and address them to ensure people are getting the care they need.

Side effect 1: HDHP members see a sharp drop in preventive care utilization, including screening mammography and colonoscopy.

Among those on HDHPs, the rate of screening colonoscopies dropped over 30 percent, and overall preventive care use went down by 10 percent. Preventive services are free on HDHP plans, but the drop in utilization suggests that people have failed to understand that. There are two components to ensuring that members on HDHPs use their preventive care benefits: education and proactive monitoring.

Current data suggests that members using these plans don’t actually realize that preventive care is excluded from their deductible, and it often takes years before they understand the distinction between preventive and acute care.

Employers offering HDHPs should communicate regularly with their members about what counts as preventive care—while most people understand that an annual physical counts, they may not know that certain cancer screenings and vaccinations, for example, are, as well.

Proactive monitoring is also critical. Benefits leaders can and should keep an eye on preventive care utilization among their members—especially those utilizing HDHPs. Targeted outreach with messaging around covered costs to those underutilizing their preventive care options can help bring that usage up to desired levels. Innovative employers can also take steps to make that preventive care more accessible by offering on-site physicals, flu shots, and cancer screenings, and allowing their employees time away from work to take advantage of them.

Side effect 2: HDHP members delay cancer care.

A report from the American Cancer Society found that, for a person diagnosed with cancer in January to have all necessary diagnostic testing as well as possible surgery, radiation, and chemotherapy, they’ll have to pay their entire deductible in the first quarter of the year. When most people lack the financial means to pay their deductibles over the course of a year, the prospect of doing so in a quarter is understandably daunting, causing women with breast cancer on HDHPs to delay care an average of almost nine months when compared to those women not in a HDHP. The challenging part of managing this, however, is the fact that these delays aren’t occurring at one set point in time. Rather, they can happen at any time in the process of screening or caring for cancer.

If screening at the desired rate and time does occur, analytic rigor and hands-on advocacy is needed to ensure that members do not fall off the care pathway or delay further diagnosis and treatment. Consultants and benefit leaders should find partners that can help deliver in this area, and additionally, they should consider financial assistance programs for those with HDHPs to remove or reduce the likelihood that treatment get delayed or avoided altogether.

Side effect 3: HDHP members with chronic disease skip care.

Even if their condition is not new, those with chronic conditions face many of the same challenges that those caring for cancer face. When faced with the prospect of paying a deductible that they may or may not be able to afford, members with HDHPs tend to skip care. Studies have shown that effect holds even with conditions where it’s more commonly known that regular adherence to treatment is a critical factor in quality of life.

For this reason, monitoring is critical. Those with chronic conditions need to have regular touchpoints to ensure they’re sticking to their treatment plan. Preventive programs, including digital health solutions, can be adopted to manage those touchpoints in a method exempt deductibles. And, much like cancer care, employers may want to consider financial assistance programs for employees with chronic care needs.

While it is important to turn a critical eye to HDHPs, there are methods that can be explored to mitigate some of their effects. With proper steps, HDHPs can have the desired effects—helping make consumers savvier about healthcare costs, reducing the burden of premiums for employers—without negative consequences. And as the health insurance community learns more about HDHPs, it’s critical that everyone involved in health plan decision making continue to reassess the HDHP’s role, constantly identifying ways to iterate and improve on them.

Rajaie Batniji is co-founder of Collective Health, a cloud-based employer self-insurance platform that empowers companies to take control of their healthcare benefits,

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