Penny pincher It’s imperativethen that decision makers for employer-sponsored health care entera HDHP plan with an understanding of these potentially harmfuleffects. (Photo: Shutterstock)

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Earlier this year, the Kaiser Family Foundation and the LosAngeles times released findings on member satisfaction withemployer-sponsored plans. The results weren’t surprising—mostpeople (68 percent) said their employer-sponsored health insurancecoverage was excellent or good. However, that satisfactiondecreases to 46 percent for those on highdeductible health plans (HDHPs). And if you dig further into thedata, it reinforces some troubling messages that research has beensuggesting for some time.

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While HDHPs have been hailed as a way to make people savvierconsumers of health care, that vision of legions of patientsbecoming engaged shoppers pushing down prices has turned out to bea mirage. People still don’t fully understand the concept of adeductible as it currently stands in healthcare—typically, theyassume that it applies for all care and overlook the exclusionsaround preventive care. And you can’t fault them—deductibles inother areas, such as those for car insurance, don’t work that way.These deductibles also reflect a high percentage of most people’savailable cash savings, presenting a serious financial deterrent tocare access. The people who’ve proven to benefit the most from highdeductible plans are those who use a health savings account(HSA)—which isn’t really the point of creating these plans in thefirst place.

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Related: May 19: ‘Deductible relief day’

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A deductible is simply an economic incentive to produce acertain behavior. We have experimented with millions of people andproven definitively that the economic incentive does not have thedesired effect—and can have serious healthcare outcomes. However,since HDHPs are now embedded in so many health plans, benefitsleaders and the consultants advising them should considermonitoring and managing the “side effects” of HDHP plans—just likehealthcare professionals monitor and manage the side effects fromany medical treatment.

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

Side effect 1: HDHP members see a sharp dropin preventive care utilization, including screening mammography andcolonoscopy.

Among those on HDHPs, the rate of screening colonoscopiesdropped over 30 percent, and overall preventive care usewent down by 10 percent. Preventive services are free onHDHP plans, but the drop in utilization suggests that people havefailed to understand that. There are two components to ensuringthat members on HDHPs use their preventive care benefits: educationand proactive monitoring.

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Current data suggests that members using these plans don’tactually realize that preventive care is excluded from theirdeductible, and it often takes years before they understand thedistinction between preventive and acute care.

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Employers offering HDHPs should communicate regularly with theirmembers about what counts as preventive care—while most peopleunderstand that an annual physical counts, they may not know thatcertain cancer screenings and vaccinations, for example, are, aswell.

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Proactive monitoring is also critical. Benefits leaders can andshould keep an eye on preventive care utilization among theirmembers—especially those utilizing HDHPs. Targeted outreach withmessaging around covered costs to those underutilizing theirpreventive care options can help bring that usage up to desiredlevels. Innovative employers can also take steps to make thatpreventive care more accessible by offering on-site physicals, flushots, and cancer screenings, and allowing their employees timeaway from work to take advantage of them.

Side effect 2: HDHP members delay cancer care.

A report from the American Cancer Society foundthat, for a person diagnosed with cancer in January to have allnecessary diagnostic testing as well as possible surgery,radiation, and chemotherapy, they’ll have to pay their entiredeductible in the first quarter of the year. When most people lackthe financial means to pay their deductibles over the course of ayear, the prospect of doing so in a quarter is understandablydaunting, causing women with breast cancer on HDHPs to delay carean average of almost nine months when compared to those womennot in a HDHP. The challenging part of managing this, however, isthe fact that these delays aren’t occurring at one set point intime. Rather, they can happen at any time in the process ofscreening or caring for cancer.

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If screening at the desired rate and time does occur, analyticrigor and hands-on advocacy is needed to ensure that members do notfall off the care pathway or delay further diagnosis and treatment.Consultants and benefit leaders should find partners that can helpdeliver in this area, and additionally, they should considerfinancial assistance programs for those with HDHPs to remove orreduce the likelihood that treatment get delayed or avoidedaltogether.

Side effect 3: HDHP members with chronic disease skipcare.

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

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For this reason, monitoring is critical. Those with chronicconditions need to have regular touchpoints to ensure they’resticking to their treatment plan. Preventive programs, includingdigital health solutions, can be adopted to manage thosetouchpoints in a method exempt deductibles. And, much like cancercare, employers may want to consider financial assistance programsfor employees with chronic care needs.

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

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Rajaie Batniji is co-founder of CollectiveHealth, a cloud-based employer self-insurance platform thatempowers companies to take control of their healthcarebenefits,

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