Transition from Health Maintenance Organizations to Consumer Driven Health Plans: Measurement of Initial Impacts for Members with Chronic Conditions

• Main Author: Goff, Carl F.
• Format: Others
• Published: VCU Scholars Compass 2007
• Subjects: Medicine and Health Sciences
• Online Access: https://scholarscompass.vcu.edu/etd/5723; https://scholarscompass.vcu.edu/cgi/viewcontent.cgi?article=6820&context=etd

New consumer driven health insurance products are designed to contain health care costs by making consumers more accountable for the care they receive through being responsible for more cost sharing, making decisions regarding health care providers they will use, and increasing exposure to and use of health information for services and providers. Potential benefits of consumer driven products include increased information regarding personal health and a more knowledgeable patient base. Potential drawbacks of consumer driven products include negative impacts on consumers with chronic and complex health conditions. The purpose of this study was to ascertain differences in health services utilization and health status for health plan members with diagnoses that are consistent with heart failure, coronary artery disease and/or diabetes mellitus who make the transition from a health plan Health Maintenance Organization (HMO) to a Consumer Driven Health Plan (CDHP). Health plan members who changed plans were compared to those who remained in the HMO during a one year time period (2006). Utilization measures included primary care physician visits, specialist physician visits, inpatient admissions, outpatient procedures and emergency room visits. Health status was measured by member acuity risk scores. Selection bias was partially controlled by including only members who did not have a choice between an HMO or CDHP in the study. Logistic analysis and MANOVA were used to obtain study results. No statistically significant differences in utilization for members in the CDHP were seen for primary care visits, specialist physician visits, inpatient admissions and emergency room visits when compared to members in the HMO. Controlling for age, gender, income level, physician coinsurance levels and acuity, the utilization of outpatient procedures was significantly lower in the CDHP. The independent variable showing significance for all utilization analyses was the 2006 risk score that was used as a proxy for member acuity. Study results for comparison of changes in health status could not be obtained due irregularity in predicted 2007 risk scores for members in the CDHP. In this initial study of the first year of CDHP experience, benefit design seemed to have limited influence on the behavior of individuals. Future studies may include longitudinal analyses and refinement of risk measurement techniques.