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Consumer-Directed Healthcare PowerPoint Presentation

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Description : This presentation on Consumer-Directed Healthcare was created by the School of Pharmacy Relations Committee for AMCP. The objective of this presentation is to understand the purpose of Healthcare Effectiveness Data and Information Set (HEDIS) measures within healthcare, demonstrate how HEDIS measures are developed, examine strategies for applying HEDIS measures, identify ways to get involved in the HEDIS development process, etc.

Tags : Healthcare Effectiveness Data and Information Set, HEDIS, Consumer-Directed Healthcare, healthcare, CDHC

Published on : Jul 01, 2020 | Views : 1443 | Downloads : 2

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Slide 1-

Consumer-Directed Health Care Created by the School of Pharmacy Relations Committee for AMCP Updated: February 2020
Slide 2-

Objectives Understand the purpose of HEDIS measures within healthcare Demonstrate how HEDIS measures are developed through examples Examine strategies for applying HEDIS measures Identify ways get involved in the HEDIS development process
Slide 3-

What is Consumer-Directed Health Care (CDHC) Patients: Control their own health care spending Decide what health plan to join Decide what treatment to receive when Decide on the provider for their treatment
Slide 4-

CDHC Features CDHC consists of health insurance plans that usually have: a tax-advantaged health savings account (HSA) or health reimbursement account (HRA); tools to help make healthcare decisions
Slide 5-

How Do CDHC Plans Differ from Traditional Health Plans Both plans have premiums, but CDHC plans have lower premiums than traditional plans In CDHC, physicians must work closely with members on evaluating costs as well as risks/benefits
Slide 6-

Background of CDHC With health care costs rising faster than inflation, CDHC is being promoted as a way to combat these costs and still provide quality health care Shifting costs to patients may empower them to take charge of their own health care Patients will likely only use services that they need, as they will be paying more out of pocket (e.g. patients will use a retail clinic for a sore throat vs. a trip to the ER) Blumenthal D. Employer-sponsored insurance – riding the health care tiger. NEJM. 2006;355(2):195-202.
Slide 7-

How it works PHA – Personal Health Account OOP – Out-of-pocket CDHP – Consumer Directed Health Plan PPO – Preferred Provider Organization
Slide 8-

Goals of CDHC Plans with savings options Reduce costs by discouraging the use of inappropriate services Encourage patients to compare, shop and request information on cost and quality for services and providers If patients pay more out of pocket for health care, they may be more prudent in seeking health care services Providers must then offer higher quality services at affordable rates in order to compete for business In theory, this will eventually decrease health care costs Blumenthal D. Employer-sponsored insurance – riding the health care tiger. NEJM. 2006;355(2):195-202. Haviland A etl al. Do “Consumer-Directed” health plans bend the cost curve over time?. J Health Econ. 2016; 46; 33-51
Slide 9-

Health Savings Accounts and Relationship to CDHC plans Created by the Medicare Modernization Act of 2003 Accounts allow patients enrolled in a HDHP to contribute and withdraw funds tax-free to cover health care costs Can be contributed by employees and/or employers Once deposited, the funds belong to the employee, and can travel with them to wherever they work When the account balance runs out, the patient then pays out of pocket (similar to a regular deductible) Unused funds can be “rolled over” to the next year Healthcare.gov (2020) https://www.healthcare.gov/glossary/health-savings-account-hsa/; Accessed February 14th, 2020
Slide 10-

HRA vs HSA Squarmilnar – HRA vs HSA. https://squarmilner.com/hra-vs-hsa/. Accessed on March 8th 2020
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HSA/HRA Adoption Approximately 28% of employers offer HSA/HRA with their health plan About 30% of workers are enrolled in a CDHP 2019 Employer Health Benefits Survey. KFF https://www.kff.org/report-section/ehbs-2019-section-8-high-deductible-health-plans-with-savings-option/ Accessed February 14th, 2020
Slide 12-

Other Features of CDHC Plans Some CDHC plans cover preventive care, routine checkups, lab tests, vaccines, and health screenings Some have on-line tools containing medical information for patients (e.g., information on vaccines, hypertension, etc.) Some offer information on both price and quality of the services and physicians High-deductible component protects patients against catastrophic medical expenses Beeuwkes Buntin M. et al, Consumer-directed health care: early evidence about effects on cost and quality. Health Affairs. 2007;25(6):516-530.
Slide 13-

The Health Insurance Experiment The classic, decades old RAND Health Insurance Experiment confirmed: patients used fewer services when they paid more for them out of pocket patients reduced the use of necessary and unnecessary services at the same rate RAND Health. The Health Insurance Experiment: a classic RAND study speaks to the current reform debate. Research Highlights, July 24, 2007. www.rand.org/pubs/research_briefs/RB9174/index1.html. Accessed January 23, 2011.
Slide 14-

The Health Insurance Experiment Patients with CDHC plans generally spent less on health care and used fewer health care services CDHC plans had mixed effects on quality of care (Patients used more preventive services but some may have forgone care) Patients had a lower level of satisfaction Patients lacked adequate information to make informed medical care choices .
Slide 15-

Pros of CDHC Plans May lower health care costs Lowers costs for employers Patients play a bigger role in managing their health care May reduce the use of inappropriate health care services Beeuwkes Buntin M. et al, Consumer-directed health care: early evidence about effects on cost and quality. Health Affairs. 2007;25(6):516-530.
Slide 16-

Cons of CDHC Plans Lack of information on pricing and quality of services and providers Overall, low health literacy in US Sicker patients may need to pay more out of pocket and may not be able to afford it Potential for patients to skip services/care they need
Slide 17-

Cons of CDHC Plans Continued May disproportionately attract healthy patients (since premiums are lower in these plans than in traditional plans) If healthier patients leave traditional plans, then sicker patients left in these plans may drive up costs This concept is known as adverse selection Beeuwkes Buntin M. et al, Consumer-directed health care: early evidence about effects on cost and quality. Health Affairs. 2007;25(6):516-530.
Slide 18-

Considerations The challenge of a CDHC plan design is to promote cost-consciousness and discourage the use of inappropriate services without deterring patients from seeking needed care New evidence suggests that CDHC is associated with Reduction in both appropriated and inappropriate care Reduction in health services utilization Consequently, reduction in health care costs Beeuwkes Buntin M. et al, Consumer-directed health care: early evidence about effects on cost and quality. Health Affairs. 2007;25(6):516-530. Agarwal R et al. High-Deductible Health Plans Reduce Health Care Cost and Utilization, Including Us of Needed Preventive Services. Health Affairs. 2017; 36(10)
Slide 19-

References Beeuwkes Buntin M. et al, Consumer-directed health care: early evidence about effects on cost and quality. Health Affairs. 2007;25(6):516-530. Blumenthal D. Employer-sponsored insurance – riding the health care tiger. NEJM. 2006;355(2):195-202. Carey M A. HAS Provisions Draw Praise, Scrutiny. The Commonwealth Fund. http:// http://www.commonwealthfund.org/Content/Newsletters/Washington-Health-Policy-in-Review/2006/Dec/Washington-Health-Policy-Week-in-Review---December-18--2006/HSA-Provisions-Draw-Praise--Scrutiny.aspx. Accessed January 23, 2011. Consumer-Directed Health Arrangements: Background Brief. The Henry J Kaiser Family Foundation. http://www.kaiseredu.org/Issue-Modules/Consumer-Directed-Health-Arrangements/Background-Brief.aspx. Accessed January 23, 2011. Employer health benefits: 2019. Washington D.C.: Kaiser Family Foundation, 2019. https://www.kff.org/report-section/ehbs-2019-section-8-high-deductible-health-plans-with-savings-option/. Accessed February 14,2020. RAND Health. The Health Insurance Experiment: a classic RAND study speaks to the current reform debate. Research Highlights, July 24, 2007. www.rand.org/pubs/research_briefs/RB9174/index1.html. Accessed January 23, 2011.
Slide 20-

References Baker L, Bundorf K, Royalty A, et al. Consumer-Oriented Strategies for Improving Health Benefit Design: An Overview. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jul. (Technical Reviews, No. 15.) 1, Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44064/ Haviland A etl al. Do “Consumer-Directed” health plans bend the cost curve over time? J Health Econ. 2016; 46; 33-51 Squarmilnar – HRA vs HSA. https://squarmilner.com/hra-vs-hsa/. Accessed on March 8th 2020 Agarwal R et al. High-Deductible Health Plans Reduce Health Care Cost and Utilization, Including Us of Needed Preventive Services. Health Affairs. 2017; 36(10)
Slide 21-

Thank you to AMCP member Pranav Patel and Jeff Larson for updating this presentation for 2020
Slide 22-

To improve patient health by ensuring access to high-quality, cost-effective medications and other therapies. Mission & Vision

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