EBRI/Commonwealth… Again?

I used to think that last year's EBRI /Commonwealth study of consumer directed health care (CDHC) was the worst study either organization had ever produced.  I was wrong.  This year's redo takes the honors.

But hey, give them a break.  If all of your health policy views were continually proved wrong, what would you do?  Fall on the sword?  Or produce another study?

For those of you who have not been following the bidding, the latest E&CW report says that people don't like CDHC plans relative to conventional insurance and those who have one are more likely to forgo needed health care.

Here's how the two organizations can save money next year and save a few trees in the process:

  • If the question is: Would you rather have a rich, generous plan from your employer than a skimpy plan?  Don't do a survey.  Assume the answer is: yes.
  • If the question is: Do people who have the opportunity to choose between health care and other uses of the money make those choices more often than people who do not have that opportunity? Don't do a survey.  Assume the answer is: yes.
  • If you can only find 21 people who actually have CDHC plans, don't hire an expensive survey firm to ask them questions.  NCPA employees will answer your questions for free.

There is enormous diversity among CDHC plans.  Some employers make no deposits to the employees' health savings accounts (HSAs).  Others deposit something, but the HSA is essentially a savings account resting beneath a high deductible.  Some make preventive care available with no deductible.  Some have wellness programs.  Some give rewards (like frequent flyer points) for healthy behavior.  Some engage employees with chronic illnesses by phone and email – encouraging appropriate tests and drug therapies.

To treat all these plans as though they were alike, as EBRI and Commonwealth have done, is absurd, ridiculous, preposterous, indefensible, outlandish and….sad……truly sad…..very, very sad……(sorry, I was overcome with grief).

Meanwhile, the best survey data continues to come from the insurers, who – perhaps because they have a financial stake in all this – are a bit more careful.  Whether it's a study of Medisave accounts in Singapore, or MSAs in South Africa, or MSAs, HSAs or HRAs in the United States, all the surveys tend to come to the same conclusion – faced with financial incentives, people make common sense decisions.

In general, surveys are worthless unless they compare similar groups of people whose employers make similar contributions to their health plans.  Then the question is: How do employees manage health care dollars vs. third-party management?

New data from Definity Health (United) surveys 250,000 CDHC enrollees who work for 99 employers and compares their behavior to 10 million people in traditional PPO plans.  They found:

  • CDHC enrollees get as much or more preventive care than people in PPOs.
  • They get 16% more cervical cancer screening, 10% more cholesterol screening and 16% more prostate cancer screening.
  • Among the chronically ill (diabetes, asthma, coronary heart disease and congestive heart failure), CDHC patients receive as much, and often significantly more, evidenced-based care.

Remember, however, that as the plans survey their members they use feedback to change their plan designs to get better results through time.

These data need to be subjected to peer reviewed research.  The sooner, the better.

In the meantime, E&CW internet surveys do not pass muster.

See the EBRI/Commonwealth study at:

See the Definity Health results at: http://www.unitedhealthgroup.com/news/rel2007/Quality_of_Care_Summary_0407.pdf

Comments (7)

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  1. Mike Davis says:

    Thank you John. It’s good to have you around to demonstrate the bias in these exalted studies through application of common sense, leavened with your usual wit.

  2. John Graham says:

    I don’t think a “survey” is of much use at all, because of people’s selective memories. For example, if I’m suffering a lack of price transparency from my insurer, I will be dissatisfied and say so because I am experiencing it now. I will not recall that I have saved $1000 or so in taxes by maxing my HSA because I do not “experience” that.

  3. Grace-Marie Turner says:

    Nicely done, John.

  4. Donna Ledbetter says:

    Enjoyed your piece today, John.

    Your comment that “people make common sense decisions” when faced with financial incentives fits exactly with a piece last year by HealthMarkets Executive Vice President Phil Myhra (attached).

    In an internal study, HealthMarkets reviewed claims from small business members in three markets where consumers have had access to consumer tools. The data represented about 1.5 million member-months.

    HealthMarkets projected the expected use of high-cost doctors and hospitals, and compared that to actual utilization.

    In Houston, for example, based on market share and bed types, HealthMarkets projected that 51 percent of members would use high-cost facilities. In fact, only 23 percent went to those facilities.

    In Dallas, a projected 50 percent of members would pick high-cost doctors. In fact, only 20 percent did so.

    Given the ability to compare relative prices, consumers consistently favored lower cost facilities. With incentives and information, our own data show that consumers – without anyone micromanaging their decisions — make their own prudent health care spending choices.

  5. Charles Gregory says:

    Good info & fun too!

  6. Vijay Goel, M.D. says:

    Thank you for highlighting that survey results and other data don’t mean much when not apples to apples or focus on wishful thinking.

    However, the survey does point to one flaw in HDHP plans today, which I’d also seen while working with CDHP plans at McKinsey & Co. There’s real frustration for the consumer to not be able to shop…they don’t have a sense of what providers or products are the equivalent of Costco vs. Bloomingdales. The HealthMarkets data would indicate that consumers do make different decisions when given cost data.

    In that sense, despite all the focus on cost and quality, why does no one mention the service experience?

    I’ve just started a company focused on identifying healthcare providers who provide superior service as a way to escape the reimbursement race to the bottom. I’m curious as to why I see few competitors…given companies differentiate on service in almost every other retail industry.

  7. Bob says:

    Right on. As we used to say, “figures don’t lie, but liars figure.” Everyone seems to have his/her own self interest rather than the greater good.