The shine appears to be wearing off the CDHP movement. And fast. Comments from several knowledgeable folks indicate that the movement may have been oversold on its merits. I’m expecting to learn a lot more later this week as I’ll be attending the Consumer Driven Healthcare Summit in Washington as a member of the press.
An exec at one of the largest consumer-directed health plan companies does not believe consumerism is the cure for rising health care costs. Aetna’s Charles Cutler said “I don’t think high-deductible health plans are the cure-all for bringing down health care costs.”
The director of Johns Hopkins’ Center for Hospital Finance and Management agreed, noting “What you recognize is that most of the spending occurs after the deductible is reached. Once that happens, you don’t care how much things cost. Any hospitalization puts you above the deductible.”
And employers are not exactly beating down the doors begging for CDHPs. The Midwest Business Group on Health’s membership director’s perspective was illuminating; ” Our membership is not embracing that as much as the consultants would lead you to believe…Five years ago, CDHPs were being pushed and pushed and employers were scratching their heads. And the reality is that penetration is still pretty low.”
That’s one of the great things about a market-based economy; only the really good ideas, properly executed, have staying power.
What does this mean for you?
A reminder that there are no silver bullets, and that consumerism is just a part of, and not the entire, solution.
I don’t think much of this is new. All but the most hyperbolic advocates of CDHP have been saying that high deductibles are only one part of the solution (along with price and quality data and more effective health promotion efforts). Even then, I think most responsible people had given up on the idea that CDHP would do more than get medical cost trends to more closely match the overall change in consumer prices. Aetna, United, WellPoint all got that it was only a partial fix years ago. The pitch-men for CDHP selling it as a cure-all haven’t been taken very seriously for some time, from what I can tell.
What may be news here is that the resistance to CDHP from employers has not let up as much as many expected. They don’t want their employees to be unhappy with high deductibles, or don’t think they’ll make a difference on cost trends, or still don’t understand what it’s about and are afraid of change, or all three. All of these factors are definitely at work in the market I know well: NYC and environs.