Jeff Kullgren

Helping Patients with Chronic Conditions Overcome the Challenges of High Deductibles

Research Project Description
Jeff Kullgren, Helen Levy, Michele Heisler

Nearly half of Americans with private health insurance are enrolled in a high-deductible health plan (HDHP) and thus face the risk of high out-of-pocket (OOP) health care spending. Compared to individuals with more generous coverage, HDHP enrollees have higher OOP expenditures and are more likely to forego high-priority office visits, long-term medications, and clinical preventive services. These challenges are of particular concern for patients with chronic conditions who routinely need services that are subject to plan deductibles.

One promising approach to help HDHP enrollees with chronic conditions overcome the challenges of high deductibles is to support their use of 3 beneficial cost-conscious strategies when planning for and seeking health care. First, HDHP enrollees with chronic conditions could communicate with providers about their high deductibles and individual health care needs. These discussions would inform providers of patients? high cost-sharing, identify services that patients will need in the future, and determine whether it would be acceptable to receive these services at lower-cost facilities to save on OOP expenditures. Second, HDHP enrollees with chronic conditions could use widely available online price comparison tools to estimate and save for the cost of future services. For example, patients with type 2 diabetes mellitus (T2DM) need routine laboratory tests that are usually subject to plan deductibles. These patients could use online tools to estimate and, when possible, save for the costs of these services. Third, when HDHP enrollees with chronic conditions need a routine, non-urgent service, they could use online tools to choose where to receive it. For example, HDHP enrollees with T2DM could use online tools to identify lower-cost places to receive laboratory tests. When quality could vary, patients could use price and quality information to choose care settings that will optimize the value of their OOP spending.

Our research has shown that these beneficial cost-conscious strategies can help HDHP enrollees with chronic conditions pay less for health care and better access needed services, yet few are using them. This disconnect offers an important opportunity to help HDHP enrollees with chronic conditions better manage their OOP spending and access needed services. Our team of experts in consumer-directed health care, cognitive psychology, behavior change theories, health economics, and interventions to improve chronic disease self-management will for the first time develop and pilot test a novel intervention to help HDHP enrollees with chronic conditions use these strategies when planning for and seeking health care.

Healthwell Foundation

Funding Period: 1/1/2020 to 12/31/2021

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