New Survey: Consumer-Directed Healthcare Hasn’t Curtailed Wasteful Spending on Low-Value Health Services

New Survey: Consumer-Directed Healthcare Hasn’t Curtailed Wasteful Spending on Low-Value Health Services



Enrollment in consumer-directed health plans (CDHPs) is way up: Nearly 90 percent of Affordable Care Act Marketplace enrollees opt for CDHPs, so that enrollment on the whole has increased from 4 percent to 29 percent over the last decade.

Prior research has demonstrated that CDHPs encourage more value-conscious healthcare choices, reducing overall outpatient spending, but a new study published this month in the American Journal of Managed Care sought to find out whether those who switched from a traditional health plan to a CDHP reduced their spending in particular on low-value healthcare services.


As much as $586 million is spent annually on low-value health services such as population-based vitamin-D deficiency screenings and annual cardiac screenings for asymptomatic patients, according to a separate study released this year by Health Affairs.


In this most recent study, researchers from the USC Schaeffer Center for Health Policy and Economics and the RAND Corporation measured spending on 26 low-value healthcare services such as “medical tests and procedures that provide unclear or no clinical benefit to patients.” The study took into account insurance claims data from 376,091 patients aged 18 to 63 years who were continuously enrolled in a high-deductible health plan from a large national commercial insurer from 2011 to 2013, comparing their spending on low-value services with the spending of patients who remained in a traditional health plan.


While the study found that switching to a CDHP is associated with a $231.60 reduction in annual outpatient spending, no significant reductions in annual spending on low-value services were observed—a finding that was consistent for laboratory services, imaging services and services that are more sensitive to patient preferences.


Researchers concluded, “As CDHP enrollment continues to grow, our findings suggest that their broadly increased overall cost sharing may encourage patients to cut spending indiscriminately, rather than to specifically reduce low-value care. Modification of the consumer incentives in CDHPs, more targeted VBIDs, or efforts focused on providers, rather than patients, may be necessary to expressly reduce wasteful spending.”


A growing body of research is springing up around the problem of overtreatment and overuse of medical services and the associated costs. In 2012, the American Board of Internal Medicine introduced its Choosing Wisely campaign, working with numerous physicians and professional societies to identify nearly 500 common medical tests and procedures that might not have clear benefits for patients and should sometimes be avoided. The campaign aims to help patients choose care that meets the following requirements: it’s supported by evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary.


Find more information about consumer-directed healthcare benefits here.