Originally posted March 30, 2015 by Alan Goforth on www.benefitspro.com.

Consumer-directed health plans can help contain health care spending for years after they’re put into place, according to the first major study of its type.

“Do ‘Consumer-Directed’ Health Plans Bend the Cost Curve over Time?” released by the National Bureau of Economic Research, analyzes the three-year effects of CDHPs.

“We estimated spending trends for three years across … the country in an analysis estimating CDHP impacts, without the threat of individual level selection bias,” the authors of the study wrote. “We find that health-care cost growth among firms offering a CDHP is significantly lower in each of the first three years after offer. This result suggests that, at least at large employers, the impact of CDHPs persists and is not just a one-time reduction in spending.”

An unrelated study by the Society for Human Resource Management found that 19 percent of respondents that offer employee coverage said consumer-driven plans were the most-effective means of controlling the rising cost of health coverage.

Annual health care spending, according to the research bureau’s findings, was 6.6 percent, 4.3 percent and 3.4 percent lower on average for the first three years, respectively, for companies with CDHPs when compared to companies without them.

CDHPs, which combine high deductibles with personal medical accounts, were designed to reduce health-care spending through greater patient cost-sharing. Several studies have shown that they reduce spending during the first year, but little research had been conducted into the longer-term economic impact. One concern was that CDHP enrollees would decrease their use of necessary care, which would lead to increased spending in the long term due to greater complications.

The National Bureau of Economic Research analyzed data from 13 million individuals in 54 large U.S. firms.

“We find that spending is reduced for those in firms offering CDHPs in all three years,” the report said. “The reductions are driven by spending decreases in outpatient care and pharmaceuticals, with no evidence of increases in emergency department or inpatient care.”

Researchers found that the CDHP savings effect varied considerably across spending category:

  •  Prescription drugs. Compared with firms not offering CDHPs, annualized spending growth on pharmaceuticals was 5 to 9.5 percentage points lower in the three years after firms offered CDHPs.
  •  Outpatient services. Spending growth on outpatient care was 3 to 6.8 percentage points lower in the first three years relative to non-offering firms.
  • Emergency room use. No differences were detected in cost growth for emergency room care in any of the first three years after a CDHP was offered.

Researchers caution against drawing implications for populations other than the ones studied.

“The results presented here are limited to large employers,” the report said, “and therefore may not extend to Medicaid beneficiaries, the individual or small group market, or to the health insurance exchanges where, on average, deductibles and out-of-pocket maximums are higher and/or enrollees have fewer financial resources.”

However, the longer-term study should alleviate some previous concerns.

“These findings do not support either the concern that decreases in spending will be a one-time occurrence or that short-term decreases in spending with a CDHP will result in increases in spending in the long term due to complications of foregone care,” it said.