High-Deductible Health Plans: Mixed Results in Clinical Outcomes, Associated Costs

May/June 2012, Vol 5, No 3 - Conference Highlights AMCP

The use of high-deductible health plans (HDHPs) is a growing strategy by employers to control costs, who claim that they encourage member responsibility and reduce unnecessary care utilization. Opponents of HDHPs suggest that this may result in some members going without necessary care. Katrina Moore, PharmD, and colleagues at SelectHealth, Murray, UT, conducted a retrospective database analysis to compare medical and pharmacy costs, as well as clinical outcomes, between members in traditional health plans (N = 21,480) or in an HDHP (N = 971). They also compared outcomes for those choosing an HDHP compared with members offered only an HDHP option by their employer.

There were no significant differences in median changes in glycated hemoglobin values or in low-density lipoprotein levels among the different plan options. However, there was a small, but significant, difference in the median number of asthma exacerbations among members enrolled in an HDHP compared with those in a traditional plan, with fewer exacerbations seen in the latter (P = .011). These results were not affected by whether a member had the ability to choose an HDHP, although more data are needed.

In addition, members switching to an HDHP had higher out-of-pocket pharmacy costs, but lower medical costs, in the year after switching from a traditional plan. Furthermore, the health plan had significantly lower medical and pharmacy costs associated with members switching to an HDHP during that year.

The investigators noted that these results suggest that more studies are needed to evaluate the true impact of HDHP on healthcare costs and utilizations. [Moore K, Dunn J, Mitchell M, et al. Clinical outcomes in high-deductible health plans.]

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