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Do CDHPs increase use of wellness services?

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Although most consumer-driven health plans are designed to emphasize wellness and prevention to reduce future health care costs, experts say it is too early to tell whether plan members are using those kinds of services more frequently than members of traditional health plans.

While insurers and vendors promoting CDHPs all claim to have statistics showing that members are more likely than their peers at health maintenance organizations or preferred provider organizations to access preventive health care services, such as cancer screenings, studies by benefit consultants and other organizations are finding just the opposite.

Most benefit experts chalk up the lower use of wellness and preventive care services by CDHP members to misunderstanding, and stress the need for stepped-up communications and incentives to ensure they use the benefits that the vast majority of CDHPs pay at 100% (see story, page 14).

Minnetonka, Minn.-based UnitedHealth Group Inc. reported in April that CDHP members were 16% more likely to receive cervical and prostate cancer screenings, 10% more likely to receive cholesterol screenings and 8% more likely to receive colon cancer screenings.

Likewise, Broomfield, Conn.-based CIGNA Healthcare reports that CDHP members are 12% to 13% more likely to access wellness and preventive services than their traditional health plan counterparts. The insurers say CDHP members seek out such services since they are generally paid at 100% and because their plans provide consumer engagement tools encouraging usage.

At Destiny Health, there is a 20% to 60% increase in preventive care usage for people in its Vitality wellness program, said Stuart Slutzky, vp of product development at the Chicago-based CDHP vendor.

Hartford, Conn.-based Aetna Inc., which is still studying preventive care utilization in CDHPs vs. traditional health plans, said initial data shows that CDHP members made greater use of preventive care than other plan members, said Dr. Charles Cutler, chief medical director for national accounts.

However, non-CDHP vendors tell a different story.

A November 2006 study by the Menlo Park, Calif.-based Kaiser Family Foundation found that CDHP participants are less likely than their non-CDHP counterparts (73% vs. 85%) to have received any health care services since enrolling in their current plan. They are also less likely to have had a medical checkup (63% vs. 74%). The KFF study also found that 25% of CDHP members skipped a recommended test or treatment, compared with just 15% of their non-CDHP peers.

The KFF study attributed the lower utilization to the cost of such services and CDHP participants who previously tapped health care benefits less often.

A study by Ann Arbor, Mich.-based Thomson Healthcare compared claims data from CDHP and PPO members from 11 large employers over a three-year period and found that PPO members used more preventive services than CDHP members (see chart).

For example, just 18.5% of CDHP members had prostate cancer screenings in 2004 vs. 31.7% of their PPO counterparts, 16.9% of CDHP members received cholesterol screenings compared with 26.4% of their PPO peers, 36.6% of CDHP plan members received cervical cancer screenings vs. 42.6% of PPO members, and 40.6% of CDHP members received mammograms vs. 49.5% of PPO members.

Although the percentages accessing such services increased in the study's third year, usage among CDHP members still lagged that of the PPO group: 28% of CDHP members received prostate cancer screenings in 2006 vs. 36.6% of their PPO counterparts, 22.2% of CDHP members had cholesterol screenings vs. 31.5% of PPO members, 46.1% of CDHP members underwent cervical cancer screenings compared with 46.3% of PPO members, and 48% of CDHP members had mammograms vs. 50.3% of PPO plan participants.

"One of the major issues is people think they shouldn't have tests because they think they'll have to pay for them," said Carl Mowrey, managing director of compensation and benefits at Smart Business Advisory & Consulting L.L.C. in Chicago.

"They don't understand that it's not going to come out of their accounts," said Elizabeth Dudek, Ann Arbor, Mich.-based vp-practice leadership at Thomson Healthcare.

There are other reasons CDHP members may shy away from preventive health care services, one consultant found.

In a survey Watson Wyatt Worldwide conducted in conjunction with Harris Interactive on all health plan members' attitudes about preventive care, the consultant found people often "save up" conditions until they have two or more before seeing a doctor, said Cathy Tripp, national leader for consumerism based in Minneapolis.

Not only does this defeat the purpose of many preventive care services, it also can cause confusion for claims administrators trying to separate services that should be 100% covered from those that are subject to the CDHP deductible, she said.

On a related front, Watson Wyatt is working with Santa Monica, Calif.-based RAND Corp. on a four-year study financed by the California Healthcare Foundation of CDHP members' use of wellness and preventive health care services. Early results show CDHP members "are more engaged in lots of other consumer areas, like quality and cost information or taking the health risk assessment or using modeling tools," Ms. Tripp said. "But not all of them are getting preventive care."

Jay Savan, a principal at Towers Perrin in St. Louis, said the problem of employees not seeking preventive care is universal and not exclusive to CDHP members.

"Most employer-sponsored plans cover preventive care at 100%. But less than a majority of people get the amount and frequency of preventive care that they need in a given year. For example, only 30% generally get annual physicals," he said. "Ultimately, whether it's a consumer-driven plan or not, we do a horrible job of telling people that health is an individual's responsibility."