Are Smarter CDHP Consumers a Myth?

Consumer Driven Health Plans CDHPs do not stimulate price shopping for most common outpatient services, according to a survey by the independent Berlin-based publishing group, De Gruyter. For eight out of nine services analyzed, prices paid by CDHP and traditional plan enrollees did not differ significantly. The only exception is that CDHP enrollees paid 2.3% less for office visits.

There was no evidence that consumers with CDHP plans who had lower than expected medical expenses did more price shopping or that consumers did more price shopping before reaching the deductible. Patients may be returning to the same providers they used before meeting their deductible or they are not sensitive to this within-year change in the price. Consumers may not have been able to shop for some diagnostic services if the service was bundled with a physician visit. Also, a patient’s physician may always use a particular facility for such services. There may be a limited scope of low-cost providers. Other studies have shown that the price transparency of health services is low; and early state-level efforts to improve price transparency have shown little effect so far .

The authors say that the findings should be viewed in light of the study’s limitations. For example, traditional plans may be able to negotiate a lower price point for a larger share of their providers. Also, a traditional plan may have larger networks with many providers offering the same relativly low price point. This would make low price providers the default option for many traditional plan enrollees, whereas CDHP enrollees may have a harder time finding prices at the lower end of the distribution. Second, the study only looks at price outcomes, but not quality. So CDHP enrollees may make value-based decisions using quality outcomes that researchers did not observe.

Price shopping may not be an immediate response to enrolling in a CDHP plan, perhaps because patients don’t  perceive the degree of price variation. A key to encourage price shopping may be the availability of clear signals of price, such as generic drugs, or out-of-network providers. Another important determinant of price shopping may be repeated use of a service. The researchers say that giving enrollees more education about benefit designs and launching carrier specific, price and quality transparency initiatives may be the next steps for employers, health plans, and policy makers to increase consumerism in health care decision-making. For more information, click here.

Last Updated 06/29/2022

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