Cigna study sings praises of consumer-directed care

Other research, however, finds that some patients who are enrolled in high-deductible plans delay necessary treatment.

By Emily Berry — Posted Nov. 8, 2010

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One insurer's research says consumer-directed health care is serving enrollees the way it's designed to by encouraging members to make good choices.

But a separate study released in October found that some people enrolled in high-deductible health plans -- particularly those who don't have a health savings account attached or money put aside in one -- delayed necessary health care, echoing earlier research that found when people in consumer-directed health plans are under financial pressure, they cut back on needed care along with unnecessary care.

Enrollment in high-deductible health plans topped 10 million in January, according to insurer trade group America's Health Insurance Plans.

Philadelphia-based Cigna released its fifth annual report on the experiences of enrollees in consumer-directed plans, covering the 897,000 people who were in the Cigna Choice Fund. The plans always include a health savings account in addition to a high-deductible policy.

Cigna found that compared with members of other plans, people enrolled in consumer-directed plans were more likely to make key positive health spending choices: avoiding costly and unnecessary emergency department visits, switching to generic drugs and learning about their health conditions.

Members of consumer-directed health plans were just as satisfied with their care than their counterparts in traditional PPO and HMO plans. Cigna adjusted the results to account for health status, said Cigna Medical Director Jeffrey Kang, MD.

Cigna said that although medical costs for its members in traditional plans went up 11.9%, except for those in Cigna Choice, costs were down 4.4% from 2008 to 2009. It said the overall share of out-of-pocket costs for traditional and consumer-directed plans ended up at 17%.

Customer satisfaction was about even -- 83% for Cigna Choice and 82% for other plans. Cigna's study did not note how much money its Cigna Choice members put aside in health savings accounts.

Care down without HSAs

When high-deductible plans aren't paired with savings accounts, enrollees are more likely to delay needed care, according to a study released Oct. 28 by the UCLA Center for Health Policy Research.

The study was funded by the California Office of the Patient Advocate, a state agency representing health plan members.

Researchers found that many Californians in high-deductible health plans do not have accompanying health savings accounts and that many have low incomes, leaving them vulnerable if they develop a serious illness. Researchers said 31% of PPO customers with high-deductible health plans had money in a savings account, while the same was true for only 23% of HMO members.

The report, which was based on a 2007 survey of California residents, found that 3 million people in the state were enrolled in high-deductible plans.

The researchers also found that enrollees in high-deductible PPO plans were more likely to say they delayed needed medical care than those with deductibles of less than $1,000.

Both research papers come when there's less discussion about the consumer's role in the health care system than there is about physician payments and how best to promote quality care.

Dr. Kang said consumer-directed health care is one step in a process of giving all the players in the health care system incentives to do the right things. "We see that when people are armed with the appropriate incentives and the right information and the right program, they are capable of and do make the right choices."

Motivating the consumer-patient to make good decisions clears the way for the next step in building a better health care system, he said.

The next angle is making sure physicians are rewarded for high-quality, lower-cost care. Dr. Kang said dealing only with consumers' behavior doesn't make sense, and neither does addressing only physician choices -- they go hand-in-hand. "I think people feel pretty comfortable that these consumer-directed health plans work," he said. In the next phase, "let's think about how we ... [incentivize] and pay physicians."

Many health plans, including Medicare, are pushing for quality pay for physicians. But physician organizations, including the American Medical Association, have cautioned plans about how they rate physicians and how the ratings are used. They noted several studies released in 2010 by the RAND Corp. that found large numbers of inaccuracies in health plan ratings of doctors.

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Cigna study trumpets HSAs

Cigna released a study of its members in high-deductible plans with health savings accounts, comparing them with other Cigna plans. Cigna said the study is further evidence that consumer-directed health plans are effective in reducing costs without a drop in quality -- though other studies say that if patients don't set aside money for an HSA, high-deductible plans could lead to patients delaying care.

Cigna Choice (CDHP) Other plans
Change in costs, 2008 to 2009 -4.4% 11%
2009 satisfaction rate 83% 82%
Member responsibility for out-of-pocket costs, by episode
Chronic 15% 18%
Major Acute 17% 16%
Maternity 14% 12%
Healthy 10% 17%
Total 17% 17%

Source: Cigna Choice Fund Experience Study, Cigna, October (link)

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External links

"Profiling California's Health Plan Enrollees: Findings from the 2007 California Health Interview Survey," UCLA Center for Health Policy Research, October (link)

"Cigna Choice Fund Experience Study," Cigna, October (link)

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