Members in Consumer-driven Health Plans Seen More Educated, Healthier, Wealthier

New findings of a study of members enrolled in consumer driven health plans has found that those individuals tend to have higher incomes, higher educational levels, and report better health behavior than do those in traditional health plans.

The report was produced by the nonpartisan Employee Benefit Research Institute (EBRI). The study examined trends over the 2005–2011 period.

Consumer-driven health plans (CDHPs) generally consist of high-deductible health plans (HDHP) with either a health reimbursement arrangement (HRA) or Health Savings Account (HSA).

As of 2011, some 21 million individuals, representing about 12 percent of the market, were either in a CDHP or an HSA-eligible health plan, the report said.

“Consumer-driven health plans are a growing presence in the health insurance market, so it’s important to understand how they differ from traditional health plans,” observed Paul Fronstin, author of the report and director of EBRI’s Health Research and Education Program.

He said it is “often assumed that CDHP enrollees are more likely to be young than those with traditional coverage, because they use less health care, on average. However, in most years, the survey found that CDHP enrollees were less likely than those with traditional coverage to be between the ages of 21 and 34.”

Other findings from the EBRI report include:

  • CDHP enrollees were roughly twice as likely as individuals with traditional coverage to have a college or post-graduate education. HDHP enrollees were also more likely than traditional-plan enrollees to have a college or graduate degree.
  • CDHP enrollees have consistently reported better health status than traditional-plan enrollees.
  • During the survey period, HDHP enrollees have been consistently less likely than those with traditional coverage to report that they smoke, but no recent differences were found in exercise rates, and differences were not found in obesity rates.

For more information following is a link to EBRI’s news release:

http://www.ebri.org/pdf/PR968.26Apr12.CDHPs.pdf

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25 Percent of Provider Reimbursement Seen Tied to Performance

Over the coming decade, a third (35 percent) of doctors expect that between 10 percent and 25 percent of provider reimbursement will be tied to performance.

And, a fifth (22 percent) of doctors think that the proportion at risk will be in excess of a quarter of reimbursement.

Half (49 percent) of physicians say they currently feel “not at all prepared” to accept greater financial risk for managing patient care, found a study by the Optum Institute for Sustainable Health.

http://www.institute.optum.com/

Evaluating Oncology Management Programs: Trends in Payer Oncology Management and What You Need to Know for Success

MANASQUAN, NJ — Payers and providers across the country are grappling with choices for programs regarding oncology management and potential collaboration to control costs while also increasing the effectiveness of care.

There is a lot of discussion and many models being proposed for management of oncology costs. Both physicians and payers are seeking information to help in separating the wheat from the chaff and looking for help in choosing the best model for their needs especially in this challenging climate.

Evaluating Oncology Management Programs:Trends in Payer Oncology Management and What You Need to Know for Success is a 60-minute audio webcast scheduled for December 2, 2010, at 1:30 p.m. EST.

This program identifies the issues of concern in oncology management, outlines the current seven models under discussion/implementation, and reviews the players, pros and issues with each model.

Participants will learn how to:

  • Evaluate the results of two oncology trend reports while learning key perspectives on oncology policy and management from both payers and physicians as well as implications of the study results
  • Review the details of oncology management and collaborative models in play across the country, including drug pricing, guidelines and pathways
  • Understand how to evaluate the current models and what questions to ask in choosing a best fit for your organization
  • Develop strategies regarding oncology management and take away steps for implementation and collaboration with oncology providers

The session also includes:

  • Live Open Line question and answer session

The presenter for the program is Dawn G. Holcombe, president of
DGH Consulting and is sponsored by The Managed Care Information Center.

For complete details, please visit:
www.healthresourcesonline.com/edu/Evaluating-Oncology-Management-Programs.htm

Are CDHPs Reducing Medical Costs Without Cutting Care?

It’s safe to say that the jury is still if not out, at least somewhere between curious and skeptical about the overall benefits of consumer directed health plans. 

But studies are beginning to come in that suggest there may be real reductions in costs to the system from consumer directed plans.  

Earlier this year, a multi-year study that compared the healthcare claims experience of nearly 440,000 members covered by CIGNA CDHPs and traditional HMOs and PPOs was released. 

The study found that CIGNA Choice Fund account-based consumer-driven health plans (CDHPs) reduced medical cost trend by 13 percent relative to HMO and PPO plans, even as individuals enrolled in CDHPs use more preventive services and comply with their medical treatments.  

“In these tough economic times, it’s critical that we all do what we can to cut medical costs without cutting care,” said CIGNA Chief Medical Officer Dr. Jeffery Kang. “Critics of consumer-driven health plans contend that people will sacrifice their health to save money; when in fact our data show that account-based plans save money even as individuals receive the same or higher levels of care than those in traditional health plans.”  

According to Dr. Kang: “In our latest study of medical claims for 440,000 people covered by CIGNA plans, we reviewed claims for 22,000 individuals who have either hypertension or diabetes and found that medical cost trend was substantially less for those with CDHPs, while their treatment regimens were the same or better than those in traditional HMOs and PPOs.”  

Key findings of the 2009 CIGNA Choice Fund Experience Study include:  

Chronic Conditions: Medical cost trend was substantially less for CIGNA Choice Fund customers with diabetes (20 percent less) or hypertension (18 percent less) than for individuals with either of those diseases in traditional CIGNA health plans. Notably, these individuals maintained similar treatment regimens regardless of whether they were covered by CDHP, HMO or PPO plans; suggesting that the lower cost trend are likely a result of better chronic disease management, rather than patients foregoing recommended care.  

Pharmacy: In the first year, pharmacy cost trend for those covered by CIGNA Choice Fund plans was 10 percent lower than traditional plan cost trend, with the use of generic medications being nearly 5 percent higher among individuals covered by CIGNA CDHPs.  

Overall Medical Trend: In the first year, normalized medical trend for CIGNA Choice Fund plans was -3.3 percent versus 10.6 percent for traditional plans. The study also shows lower medical trend for CDHP continues in subsequent years. People with CIGNA Choice Fund continued to receive recommended care at compliance rates that were similar or better than those covered by traditional CIGNA health plans.  

“Not only does the data show that consumer- driven individuals becoming smarter about their care, individuals enrolled in CIGNA Choice Fund continued to receive recommended care at the same or higher levels as those enrolled in traditional plans in an evaluation of compliance with more than 300 evidence-based measures of healthcare quality. Preventive care visits for CIGNA Choice Fund individuals were 8 percent greater when compared to traditional plans and preventive care visits for renewal year CIGNA Choice Fund were 15 percent greater when compared to traditional plans.  

Pharmacy cost trend for those newly enrolled in CIGNA Choice Funds was 10 percent lower than those enrolled in traditional plans. When compared to the prior year, usage was higher for new CIGNA Choice Fund individuals and average unit trend cost was lower, for maintenance medications, suggesting that these individuals were compliant with their medications while exercising lower-cost options such as purchasing their medications by mail order and electing to use generic medications.  

Study results suggest that people with CIGNA plans are becoming more engaged in their healthcare, with increasing numbers of individuals turning to online information and decision support tools offered via myCIGNA.com.  

Currently an average of 55,000 individuals visit myCIGNA.com each business day to get the most out of their healthcare benefits. Online capabilities include CIGNA Care Connections, a personalized online search engine that helps those with CIGNA health plans find the highest quality and cost efficient physicians and hospitals, conduct side-by-side cost comparisons for generic, brand name and available therapeutic alternative medications at more than 57,000 pharmacies nationwide and locate the cost effective medical facilities, including convenience care clinics.

Address: CIGNA, One Liberty Pl., 1650 Market St., Philadelphia, PA 19192;    (215) 761-1000   (215) 761-1000 , www.cigna.com.