It gets tiresome to review Employee Benefit Research Institute (EBRI) studies of consumer-driven health programs, especially when they selectively use information to make a political point. In this case, EBRI wanted to conclude that consumer-driven health is no big whoop, which is probably an improvement over previous work that wanted to conclude consumer-driven health is a bad idea.
This version is an improvement in part because it at least gives a nod to some of the information coming from vendors. But this too is selective. For example, the paper concludes, “The studies agree that the use of preventive services did not change (upward or downward) as a result of the CDHP.” Sounds definitive? But “the studies” examined are only three and they are pretty limited. One looked only at cancer screening among a population from 2001 to 2005. Another looked at only four employers. The final one was based on Aetna data with a large population base, but EBRI says it supports using an HRA instead of an HSA because “the findings support the case for cost sharing that varies with the effect of the use of the services on future costs and health.” Why variable cost sharing should work better with an HRA instead of an HSA escapes me, and EBRI doesn’t explain the thought. It is just one example of little toss-in digs that pepper the paper.
Omitted from consideration is a wealth of information from vendors like Blue Cross Blue Shield, CIGNA and others that indicate substantial improvement in patient behavior with a consumer-driven health plan. Now, granted these vendor reports are rarely published in peer-reviewed publications, but if the purpose of this paper is to compile “what we know about consumer-driven health plans,” one might think it would be worth including such information anyway.
Similarly, this paper omits any mention of one of the most rigorous studies done on the topic — The American Academy of Actuaries “Emerging Data on Consumer-Driven Health Plans,” published just a year ago. This paper was peer reviewed by 33 actuaries who are named in the paper. On prevention, the AAA paper concluded, “All of the studies reviewed reported a significant increase in preventive services for CDH participants.” How EBRI can ignore such a finding is beyond me, and suggests that it is driven more by a political agenda than any effort to establish a real understanding.
The prevention section is a small part of the EBRI paper, but similar problems crop up throughout. Another example is the continued inclusion of a couple of studies that looked at Humana’s original experiment with HRAs in 2001. The Humana design of this product was just awful and the company had concluded it was a failure and completely redesigned the product even before the researchers wrote their papers. As I recall, there was no rollover allowed and cost sharing applied to only a limited number of services. To continue to use this research as an example of the problems with CD Health is simply dishonest. If anything, Humana’s experience should be used as an example of how real markets work. Something is tried out and evaluated. If it doesn’t work well, it is pulled back and remodeled based on what has been learned.
But so it goes in this era of political agendas trumping any honest attempt to understand and learn.