Blog Post

How High-Deductible Plans May Endanger Health – and Thoughts on How to Respond

This is a follow up to the Low-Cost Health Plans Create Need for Better Communications piece in Becker's Hospital Review
December 18, 2014

We got a lot of response to the Becker’s Hospital Review piece about how the exploding popularity of high-deductible health insurance is threatening policymakers’ best-laid, seemingly utopian plans for American “wellness” and population health management.
These high-deductible plans are supposed to work like this:

  • People pay a small premium, and then cover the first $1,000-to-$6,500 of their health expenses every year.
  • The insurance company covers a substantial portion of the expenses after that.

Despite monthly premiums as low as $69, people with these plans still find paying for even routine care out of pocket intimidating. They are, as a result, foregoing care. And, despite the great national hope to control health care expenses in the long run by having providers help people become and stay healthy, customers are not about to spend the money necessary for professionally guided preventative medicine, either.
A number of experts were kind enough to weigh in. A sampling:

  • Don’t insure primary care. The CEO of two hospitals in Pennsylvania said the answer for getting people to pay for preventative medicine was simple. Primary care docs should just stop taking insurance. By stopping, they could shed the infrastructure costs (coding, billing, extra office space, software, employees) associated with submitting bills to and fighting insurers. They could then charge people a flat, non-intimidating $25 per visit.
  • Health plans will never overcome these obstacles to wellness. One respondent – from an elite organization that includes more than a dozen hospitals, physician groups, community partnerships and, not least, health plans in New England – pointed out that as patients keep moving between plans, insurance companies are less likely to invest on an individual’s health prevention program. This has always been a problem for health plans: “Wellness” programs pay off in the long run, but by the time they do, the customer is with a different plan. By then “they’ll be someone else’s problem.” He also pointed out that “you can’t treat, monitor, and affect [patients’] chronic condition if they’re no longer coming in due to a new plan year’s deductible, or their carrier doesn’t allow them to select you as their PCP, or you’re no longer in their plan’s network.”
  • Many don’t spend enough for insurance to ever kick in. The president of an imaging company pointed out that many people in a normal year will never use up their deductibles, and their insurance company will rarely pay a dime toward their care. “How many people do we know who have consumed $6,500 in routine healthcare during the course of one year?” he asked. “I personally don’t know any.”
  • Heading to retail-based clinics instead of primary care offices. Kelly Raskauskas, director of communications at Connecticut State Medical Society, agreed that, for primary care (perhaps including preventative medicine), people will go to retail-based clinics, which tend to be lower-cost. “From a quality and continuity of care perspective, though, the concern is that in most cases these clinics don’t provide encounter data to the primary care physician and there is little to no provision for patient follow up.”
What do you think? Patients with high deductibles are so worried that every doctor call is going to cost them that they’re foregoing care. Solutions? I’d be happy to hear your thoughts.  Email me at

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