Managed Care - March 2009 - (Page 42) Key findings of the Cigna Choice Fund Experience Study s the excerpt, below, from the study indicates, Cigna may have good reason to tout its CDHP plan. Are all variables weighed? The authors note that “The study excluded catastrophic claims more than $50,000 from all populations to reduce random variations within smaller sets of data.” For more on the effects of catastrophic claims on our health care system, see our cover story on page 14. A • Medical cost trend for consumer-driven health plans (CDHP) continues to be less than the trend for HMOs and PPOs The trend for first year Cigna Choice Fund enrollees was more than 13 percent lower. • Use of preventive care increased First-year preventive visits increased, and renewal year visits remained significantly higher than traditional plans. • • Use of best medical practices was constant People in Cigna Choice Fund continued to receive recommended care at compliance rates similar to people with traditional plans. • Reduction in costs for chronic diseases Compared to people in traditional plans, medical cost trends were substantially less in Cigna Choice Fund plans for people with diabetes (20 percent less) or hypertension (18 percent less), and these people maintained similar treatment regimens. Medication compliance improved while costs decreased Use of maintenance medications that support chronic conditions increased while costs decreased, and Choice Fund enrollees’ use of generic drugs was at a higher rate than people in traditional plans. there was no statistical difference in use of the these measures 88 percent of the time, and 9 percent of the time, the CDH enrollee’s compliance was better than those in PPOs and HMOs. Moreover, statistical compliance for CDH enrollees improved further when they renewed enrollment for a second or third year. Cigna officials say that the lower costs are more likely to be due to better chronic disease management than to patients failing to comply with appropriate recommendations for care. Kang says that the consumer-directed model prevents the insurer from coming between patient and doctor, a role health plans have found more and more untenable in recent years anyway. their health care with their own funds or employer contributions, they have incentives to be more informed about their health, says Kang. These include incentives for using health risk assessments and prevention screenings. Improving quality to cut costs “The whole notion of consumer-directed care — improving quality that improves cost — plays out in our study of our CDH plan enrollees,” says Kang. “Ones with hypertension or diabetes are using our advice and advocacy in the form of disease management programs, health advisers, and cost and quality information — and as a result are getting the same or better levels of care.” Because Choice Fund enrollees are paying for Health adviser These programs can trigger a call from a personal health adviser, who receives an online alert if the member’s health risk assessment or claims experience indicates risk for illness. The adviser contacts the member to discuss potential risks and provide personalized coaching on how that person can reduce those risks and improve health. In addition, CDHP members have access to 100 percent coverage for preventive care, personal health advisers, and online cost and quality tools that provide side-by-side comparisons to help people make choices. They draw funds from employer-paid accounts or from their own pretax accounts. “Critics contend that people will sacrifice their health to save money, when in fact our data show that account-based plans save money even as individuals receive the same or higher levels of care than those in traditional health plans,” says Kang. MC 42 MANAGED CARE / MARCH 2009
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