What's New with HCFO - 02/21/2006 (Plain Text Version)In this issue: HSAs Form Conerstone of President's Health AgendaHSAs Form Cornerstone of President’s Health Agenda The State of the Union on, January 31, provided the first glimpse into the President’s plans for addressing America’s health care needs. (1) Health Savings Accounts (HSAs), the cornerstone of the Bush administration’s efforts to improve access and control costs, continue to be the primary focus. The new proposals strive to expand the use of high-deductible health plans in conjunction with HSAs. The President proposed a number of tax incentives to encourage HSA expansion. These include allowing individuals to set aside enough tax-free money to cover all out-of-pocket expenses, including premiums, rather than just the deductible as allowed by current law. Bush also proposed a tax credit to offset payroll taxes for those purchasing insurance in the non-group market. This is intended to level the playing field so people who buy insurance have the same tax advantages as people who get the HSAs through employers. While these proposals may encourage enrollment in high deductible plans, it is unclear if they will be enough to entice individuals to save the needed funds for health care expenses. Preliminary reports show that half of current participants have not set aside money and over one-third of employers have not contributed funds to savings accounts. (2, 3) This could leave many vulnerable to the high cost sharing requirements for care under the deductible, especially those with high health care needs or lower incomes. The President hopes to address the criticism that HSAs are for the healthy and wealthy by providing a tax credit for lower-income people who enroll in HSAs and allowing employers to make additional contributions to accounts of those with chronic conditions. Since 2003, about 3 million people have enrolled in HSA plans. Estimates indicate the President’s proposals would increase enrollment to 21 million by 2010 and cost $60 billion over five years. (4, 5) It is still unknown if these plans will decrease overall health care spending. Roy Ramthun, Special Assistant to the President for Economic Policy, spoke at the AcademyHealth National Health Policy Conference 2006 on the President’s desire to make the insurance portion of HSAs as portable as the accounts, which could protect individuals from future medical underwriting. To provide true portability, Ramthun stated, “The President is suggesting that it may be time to look at a federal regulatory structure…similar to the ERISA structure that is available through the Department of Labor for self-funded employers today.” (6) Research conducted by HCFO grantee, Phyllis Borzi of The George Washington University, explored the complex variations and liability issues present under ERISA. The interest in an ERISA-based regulatory structure raises serious questions regarding liability and the tension between federal and state malpractice and tort laws. (7) HCFO has recognized the importance of effectively providing health care information and has funded several new grants examining consumer information and behavior. Dr. David Blumenthal of Massachusetts General Hospital is developing effective methods to assist consumers in selecting high performing physicians within consumer-directed health plans. Dr. Jean Abraham of University of Minnesota is examining the use of decision support tools to inform health plan selections and quality. The third project is being conducted by Dr. Meredith Rosenthal of Harvard University to evaluate the potential for Health Risk Appraisals, a tool to engage consumers in health management, to impact enrollee behavior. In addition to the grants mentioned above, information on HCFO grants, issue briefs, and articles addressing Health Savings Accounts, high-deductible health plans and consumer-driven care can be found on the HCFO website. HCFO Funded Research: Title: Involving Consumers in Physician Choice: Making Data into Useable Information for Chronically Ill Patients in Consumer-Directed Health Plans What tools will consumers need to help select high performing physicians, within CDHPs? Physician performance data is one of the tools that can be used to help consumers make these decisions. However, there are important opportunities and challenges facing consumer-directed health plans (CDHPs) trying to engage consumers in using physician performance data (PPD). The specific aims of the project are: 1) to develop methods for informing consumers about physician clinical performance; 2) to test the effectiveness of these methods in helping consumers with chronic conditions in CDHPs to make an informed choice of primary care physician (PCP); 3) to explore how consumer characteristics affect their ability to understand PPD and their response to that data. The objective of this study is to understand how and whether PPD can be appropriately and effectively used in CDHPs. Click here for further information on this grant. Title: The Impact of Consumer Health Plan Decision Support Tools on Health Plan Choice and Quality The researchers will examine the use of decision support tools to inform health plan selections. Because of the concern regarding the abilities of consumers to understand the financial implications of an array of complicated plan designs when choosing among health insurance options, decision support tools are being developed to help consumers evaluate their health plan options. In March of 2006, Ingenix will develop will release a Plan Cost Estimator (PCE) that can track use of individual employees and incorporate prior claims experience into the algorithm for producing cost estimates. Using this decision-support tool, the researchers will investigate the following research questions: 1) what factors are associated with the decision by an employer to provide a decision support tool for its workers during open enrollment; 2) which demographic, health status, and job-related factors are associated with a worker's use of the PCE tool; 3) does decision support tool use directly influence a worker's choice of health plan; and 4) is there an association between low-cost plan choices and quality, and by how much does expected quality change as a result of tool use. The objective of this study is to identify important managerial lessons for employers relative to employee health plan enrollment choices. Click here for further information on this grant. Title: Uptake and Impact of Health Risk Appraisals What is the potential for Health Risk Appraisals (HRAs) to engage consumers in health improvement? HRAs are structured surveys designed to identify a wide range of health risks, including genetic predispositions to disease, poor health habits (e.g. smoking, overweight) and lack of adherence to recommnede care for a chronic condition. HRAs allow health plans and employers to engage consumers in health management before acute events occur. Using data from Cigna HealthCare, the researchers will address the following specific aims: 1) examine the overall rates of HRA completion in a privately-insured population; 2) examine the impact of a consumer financial incentive on HRA completion; 3) examine the characteristics of consumers who opt to complete an HRA; and 4) look for early effects of HRAs on utilization and health behavior. The objective of the project is to help employers and health plans better tailor their outreach programs, evaluate whether to offer incentives, and better understand the impact HRAs will have on enrollee behavior. Click here for further information on this grant.
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