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Impact of consumer-directed health plans on low-value healthcare.

ABSTRACT: To assess the impact of consumer-directed health plan (CDHP) enrollment on low-value healthcare spending.We performed a quasi-experimental analysis using insurance claims data from 376,091 patients aged 18 to 63 years continuously enrolled in a plan from a large national commercial insurer from 2011 to 2013. We measured spending on 26 low-value healthcare services that offer unclear or no clinical benefit.Employing a difference-in-differences approach, we compared the change in spending on low-value services for patients switching from a traditional health plan to a CDHP with the change in spending on low-value services for matched patients remaining in a traditional plan.Switching to a CDHP was associated with a $231.60 reduction in annual outpatient spending (95% CI, -$341.65 to -$121.53); however, no significant reductions were observed in annual spending on the 26 low-value services (--$3.64; 95% CI, -$9.60 to $2.31) or on these low-value services relative to overall outpatient spending (-$7.86 per $10,000 in outpatient spending; 95% CI, -$18.43 to $2.72). Similarly, a small reduction was noted for low-value spending on imaging (-$1.76; 95% CI, -$3.39 to -$0.14), but not relative to overall imaging spending, and no significant reductions were noted in low-value laboratory spending.CDHPs in their current form may represent too blunt an instrument to specifically curtail low-value healthcare spending.

SUBMITTER: Reid RO

PROVIDER: S-EPMC6132267 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Impact of consumer-directed health plans on low-value healthcare.

Reid Rachel O RO Rabideau Brendan B Sood Neeraj N

The American journal of managed care 20171201 12

<h4>Objectives</h4>To assess the impact of consumer-directed health plan (CDHP) enrollment on low-value healthcare spending.<h4>Study design</h4>We performed a quasi-experimental analysis using insurance claims data from 376,091 patients aged 18 to 63 years continuously enrolled in a plan from a large national commercial insurer from 2011 to 2013. We measured spending on 26 low-value healthcare services that offer unclear or no clinical benefit.<h4>Methods</h4>Employing a difference-in-differenc ...[more]

PMID: 29261240

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Project description:ObjectiveTo examine the effect of an employer-mandated switch to high-deductible health plans (HDHP) on emergency department (ED) low-value imaging.Data sourcesClaims data of a large national insurer between 2003 and 2014.Study designDifference-in-differences analysis with matched control groups.Data collection/extraction methodsThe primary outcome is low-value imaging during ED visits for syncope, headache, or low back pain. We included members aged 19-63 years whose employers offered only low-deductible (≤$500) plans for one (baseline) year and, in the next (follow-up) year, offered only HDHPs (≥$1000). Contemporaneous members whose employers offered only low-deductible plans for two consecutive years served as controls. The groups were matched by person and employer propensity for HDHP switch, employer size, baseline calendar year, and baseline year quarterly number of total and imaged ED visits for each condition. We modeled the visit-level probability of low-value imaging using multivariable logistic regression with member-clustered standard errors. We also calculated population level monthly cumulative ED visit rates and modeled their trends using generalized linear regression adjusting for serial autocorrelation.Principal findingsAfter matching, we included 524 998 members in the HDHP group and 5 448 803 in the control group with a mean age of approximately 42 years and 48% female in both groups. On visit-level analyses, there were no significant differential changes in the probability of low-value imaging use in the HDHP and control groups. In population-level analyses, compared with control group members, members who switched to HDHPs experienced a relative decrease of 5.9% (95% CI - 10.3, -1.6) in ED visits for the study conditions and a relative decrease of 5.1% (95%CI -9.6, -0.6) in the subset of ED visits with low-value imaging.ConclusionThough HDHP switches decreased ED utilization, they had no significant effect on low-value imaging use after patients have decided to seek ED care.

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Impact of consumer-directed health plans on low-value healthcare.

Publications

Impact of consumer-directed health plans on low-value healthcare.

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