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Consumer-Driven Health Plans: Impact on Utilization and Expenditures for Chronic Disease Sufferers

Nair, Kavita V. PhD; Park, Jinhee CPhil, MA, MS; Wolfe, Pamela MS; Saseen, Joseph J. PharmD, FCCP, BCPS; Allen, Richard Read MS; Ganguly, Rahul PhD

Journal of Occupational & Environmental Medicine:
doi: 10.1097/JOM.0b013e31819b8c1c
Original Articles
Abstract

Objectives: The impact of consumer-driven health plans (CDHPs) on utilization and expenditures for members with chronic diseases.

Methods: Analyzed claims data from a national employer who switched from a preferred provider organization (PPO) plan to offering only CDHPs in 2005. A matched comparison group of PPO members was used. Analysis was conducted using generalized estimating equations for repeated measures.

Results: Compared with the PPO group, the CDHP group had lower: outpatient visits (−36% vs −22%), laboratory services (−34.3% vs −19%), emergency room (odds ratio [OR]: 0.1 vs 0.6), and inpatient visits (OR: 0.35 vs 0.68), and medication adherence (OR: 0.7 vs 1.0). Reductions in health care expenditures were not statistically different between the groups (−28% vs −15%, P = 0.5).

Conclusions: Switching to a CDHP resulted in lower utilization and adherence. Potential underutilization of necessary services should be addressed in future research.

Author Information

From the School of Pharmacy (Dr Nair, Dr Wolfe, Mr Saseen), University of Colorado at Denver, Aurora, Colo; GlaxoSmithKline (Dr Park, Dr Ganguly), Research Triangle Park, NC; and Peak Statistical Services (Dr Allen), Evergreen, Colo.

Address correspondence to: Kavita V. Nair, School of Pharmacy C238-L15, University of Colorado Denver, Academic Office 1, 12631 E. 17th Avenue, Room L 15-1404, PO Box 6511, Aurora, CO 80045; E-mail: kavita.nair@ucdenver.edu.

©2009The American College of Occupational and Environmental Medicine