Impact of Consumer-Directed Health Plans on Low-Value Healthcare

Objectives

To assess the impact of consumer-directed health plan (CDHP) enrollment on low-value healthcare spending.

Study Design

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.

Methods

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.

Results

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.

Conclusions

CDHPs in their current form may represent too blunt an instrument to specifically curtail low-value healthcare spending.