Survey Reveals that Consumer-Directed Health Plans (CDHPs) Confound Most Docs

Clinical laboratories can provide that missing education about CDHPs to patients

Even as enrollment in Consumer-Directed Health Plans (CDHPs) and Health Savings Accounts (HSAs) climbs steadily year after year, a new study reveals that most physicians are unprepared to help their patients understand and better use these forms of health insurance. This is a barrier to CDHP acceptance and an opportunity for clinical laboratories.

CDHPs—and their close cousins, HDHPs (high-deductible health plans_—are designed to shift more responsibility for healthcare decisions to patients. Many physicians, however, are unprepared to advise patients enrolled in CDHPs about cost-effective treatment options. This is the finding of a 2008 survey of 525 randomly selected doctors published in the American Journal of Managed Care . Nearly half, 43%, of doctors responding to the survey admitted knowing “a little” or “not at all” about CDHPs or HSAs. At least 33% of surveyed physicians said they are “somewhat” knowledgeable. Only 24% of physicians surveyed claimed “much” or “a great deal” of knowledge about CDHPs.

Yet, these physicians continue to see growing numbers of patients who are insured by CDHPs, HDHPs, and HSAs. A new report from the insurer trade group, America’s Health Insurance Plans, estimates 8 million Americans are now enrolled in CDHPs nationwide, up from 5.5 million one year ago. Predictions are that enrollment in these types of health plans will continue to increase. A recent survey by Watson Wyatt and the National Business Group on Health, found that approximately half of companies now offer workers a CDHP, up from 47% in 2008, and another 8% are expected to adopt a CDHP by 2010.

“We were surprised by the number of physicians who said they didn’t know enough to properly advise patients,” wrote Craig Pollack, a Clinical Scholar Program researcher at the University of Pennsylvania and co-author of the study. “I think as these plans roll out, it’s really important to educate doctors about (them) and about some of the differences between these plans and more traditional models of insurance.” Pollack stressed that doctors need to discuss out-of-pocket costs and budget limitations with patients and gather information about costs for medications, tests, specialty consultations and hospital charges before ordering away.

Despite lack of knowledge about how these plans work, 40% of 528 physicians surveyed reported that about 5% of the patients served by their practice are enrolled in CDHPs. In an interview with Modern Healthcare, Ted Epperly, President of the Academy of Family Physicians, acknowledges that the 15-minute office visit is a deal breaker in terms of time to discuss costs and budgets with patients. He suggests that doctors delegate this task to staff members, but be reimbursed for staff time under the patient-centered home concept

Healthcare reform may ultimately change the adoption rate of CDHPs by consumers and employers. But it is likely that the traditional carte blanche physicians enjoy in ordering health services will end. Government and private payers are likely to offer doctors financial incentives for recommending health services that are cost efficient without compromising care quality. In this regard, laboratory tests are a good value and likely to be among most ordered health services in the new world of health care reform.

For clinical laboratories, the findings of the survey published in the American Journal of Managed Care highlight an opportunity. Consumers need guidance about how to best use the financial and medical benefits of their CDHP. Clinical laboratories would improve patient loyalty by providing that information, particularly at the time when specimens are collected. That is also likely to have a direct financial benefit for the clinical lab: it can collect full payment for its service at time of collection. – P. Kirk

Consumer Directed Health Plans