Consumer Driven Health
Plans: Will they work for
consumers?
Shoshanna Sofaer, Dr.P.H.
School of Public Affairs
Baruch College
Presentation Overview
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If CDHPs are to meet their objectives:
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What information will consumers need?
What decision support will consumers
need?
Implications if the information and
decision support are not provided
Synthesis of key points made by the
panel – To be determined!
February 2, 2005
National Health Policy Conference
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Presumed CDHP objectives
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Increase the value (appropriate and
effective health care received for dollar
spent) of health care coverage, for both
purchaser and consumer
Create incentives for consumers to be
more cost and value conscious
Provide information to help them make
prudent decisions
February 2, 2005
National Health Policy Conference
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What do we want consumers
to do?
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Become less risk averse in their choice
of health care coverage, as reflected in
plan choices that have:
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Higher deductibles
Lower premiums
At least somewhat restricted networks
Why would a sensible person with a
serious illness make this choice?
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National Health Policy Conference
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What do we want consumers
to do?
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Make rational health-related choices:
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Using services they really need and ONLY
services they really need
Choosing high value providers, procedures,
treatments, Rx, etc.
Moving towards healthier behaviors and
lifestyles
Using available information and support so
they can do all this
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National Health Policy Conference
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What do they need?
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Information about
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Their health care coverage options and
how they work (compared to each other)
How the CDHP they choose works, and
where their “accounts” stand
The relative value of various treatment
options
The relative quality of various providers
February 2, 2005
National Health Policy Conference
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What do they need?
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More information:
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The relative cost of various treatment
options
The relative cost of various providers
Sources of decision support and help in
making behavioral/lifestyle changes
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National Health Policy Conference
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What do they need?
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Decision support, to help them use
information to figure out:
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The implications of their coverage choices
When they need/do not need to use health
care services
When they can also/instead use self-care
February 2, 2005
National Health Policy Conference
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What do they get now?
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We here report on a study to assess the
information and decision support
provided by major CDHPs
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Funded by Robert Wood Johnson
Foundation
Co-led by Shoshanna Sofaer and Judith
Hibbard
Preliminary findings/highlights only at this
point
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National Health Policy Conference
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What do they get today?
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Quite well designed information on how
their CDHP works and what is
happening to their accounts
In some plans, personalized decision
support around the need for services
and self-care
Limited comparative quality information
on hospitals
February 2, 2005
National Health Policy Conference
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What they generally don’t
get today
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Comparative quality information on the full
range of providers
Evidence on the value of alternative
treatments, procedures and medications
Comparative information on the cost or price
of providers and treatments
Proactive support for healthy and prudent
behaviors (preventive care, disease
management, use of effective and less
expensive alternatives)
February 2, 2005
National Health Policy Conference
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What they generally don’t
get today
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Proactive support for healthy and
prudent behaviors
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Reminders about preventive services;
Disease management support
Advice on use of effective and less
expensive alternative medications,
providers, treatments, etc.
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National Health Policy Conference
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Why and why not?
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Right now, the CDHP strategy appears
to focus primarily on insurance choices
not the use of health care
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Will this really influence the most
significant sources of health care costs?
Won’t this lead inevitably to risk selection,
or put another way, if all the high cost
folks are not in CDHPs what difference will
they make?
February 2, 2005
National Health Policy Conference
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Why and why not?
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The kind of information needed to help
people make health care decisions is
typically NOT available, for example:
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Comparative quality information on
physicians and medical groups
Any information on cost or price
Price information may never be available,
since price is determined as much by who
is buying as what is being sold by whom
February 2, 2005
National Health Policy Conference
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Why and why not?
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It is still early days in the development
of these plans and their associated
information and decision support
Most seem very open to improving what
they provide over time
It is not clear, however, that they are
being pushed to do this by purchasers
February 2, 2005
National Health Policy Conference
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Other issues re information
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What is available has been designed for
the
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Literate
Computer literate
English speaking
Fairly educated person/family
What happens for everyone else?
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National Health Policy Conference
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Implications
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These finding lead to an important
policy question:
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Are CDHPs a solution to address the cost
of individual purchasers, and a subset of
individual consumers, or a solution to
address the cost of health care overall?
Is it possible they will increase disparities
in health care quality and health status?
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National Health Policy Conference
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