High Deductible Health Plans Create Cost-Related Barriers to Care

High deductible health plans pose a barrier to care by increasing costs for patients and causing scheduling and financial turbulence for providers, according to a survey of providers conducted by the National Opinion Research Center (NORC) at the University of Chicago.

NORC conducted a survey of 706 independent physician practices from December 11, 2019 to December 18, 2019, before the coronavirus touched American soil.

“High-deductible health plans were supposed to make us better healthcare consumers, but they have failed,” said Donald J. Palmisano, Jr., executive director and chief executive officer of the Medical Association of Georgia. “They force people attracted by low premiums to choose between healthcare and housing, or food. They’re an idea that turned out to be bad for both patients and doctors.”

The study found that 80 percent of providers interviewed had patients who denied or deferred care due to cost. Eight out of ten providers (79 percent) specifically noted high deductibles as the primary cost barrier.

High cost barriers in large part due to high deductibles can have serious impacts on patient care as providers alter their optimal care responses to fit the financial needs of their patients.

For example, over half of the providers (55 percent) admitted that they had to change their treatment timing due to patient cost barriers. It is common knowledge among providers who have seen the effects of delayed treatment and medication nonadherence that delaying care can result in more severe and more costly conditions for patients later.

Along the same lines of medication adherence, two-thirds of the providers responded that these cost barriers have forced them to decide against prescribing certain drugs and 86 percent noted that they have switched the type of drug they prescribed due to high costs. Over six in ten providers (61 percent) also said that they had to change the type of medical treatment they gave patients as a result of high costs.

The effects of these delays and changes are not limited to the patient experience. Over four in ten providers (41 percent) said that their bad debt had grown in the past two years.

Adjusting appointment times due to avoided care was challenging for providers as they shifted their schedules and tried to manage their capacity. Independent providers have also experienced financial cost as three-quarters of providers said that they have had to wait for over a month to receive the payment for their services from both payers (74 percent) and patients (75 percent).

Furthermore, high deductible health plans affect providers because they have to dedicate so much time to educating patients about their coverage.

Many payers try to inform their providers about cost-cutting alternatives for patients as part of their value-based care partnerships. Payers also seek to partner with providers who utilize robust EHR systems that offer real-time prescription information to ease the decision-making process for the provider and patient.

However, despite payers’ efforts and tools that support quick, cost-effective decision-making, most of the providers said that their staff spends over 300 hours annually engaging educating patients on their coverage. Payer efforts to improve price transparency seem to be falling short as providers feel ill-equipped for the conversation, with a mere 15 percent saying they have the necessary cost information and feel confident that they can help patients make an informed decision.

Most providers said that they need more information on deductible amounts (78 percent), deductible balance due (68 percent), and the amount of adjusted bills (67 percent).

“Before COVID-19, patients had to delay or forego medical care due to the financial challenge of satisfying their insurance plan’s high deductible,” said Kelly Kenney, chief executive officer of the Physicians Advocacy Institute, which commissioned the survey. “The pandemic has made it clear that making patients wholly responsible for thousands of dollars their insurance plan used to cover benefits no one but insurers.”

Payers are seeing the effects of delayed care on a macro scale as they look toward a high influx of patients seeking out treatment that coronavirus forcibly deferred. Understanding the role that high deductible health plans plan in increasing cost burdens for patients and providers alike will be crucial as the country finds a way forward.