Funding Source: Center for Health Information and Analysis August 14, 2013

1. High-Deductible Health Plans (HDHPs) in Massachusetts: Adoption of HDHPs and Patterns of Health Care Utilization and Spending Funding Source: Center for Health Information and Analysis August 14, 2013 Wen-Chieh Lin, Deborah Gurewich, Robin Clark, and Bruce Barton

2. Acknowledgement • Center for Health Information and Analysis • RFR 2013-003 • The Evolving Marketplace: Exploring the Impact of Uninsurance and Underinsurance on Consumers, Employers, and Communities in Massachusetts • Catherine West, Kevin McAvey, and Matthew Goodridge

3. Project Team • University of Massachusetts Medical School • Investigators: Wen-Chieh Lin, Deborah Gurewich, Robin Clark, and Bruce Barton • Project manager: Beth O’Connell • Project team members: Jianying Zhang, Parag Kunte, Georgia Willis, and Kathy Muhr • Consultants: Bob Seifert and Katharine London

4. High Deductible Health Plan and Consumer Directed Health Plan • High Deductible Health Plan (HDHP) • Typically, a health plan with deductible at least $1,000 for individual and $2,000 for family • Higher deductibles and greater cost sharing in exchange for lower premiums • Cost-conscious decisions about health care • Consumer Directed Health Plan (CDHP) • HDHP coupled with tax-saving options, e.g., health saving account (HSA), health retirement arrangement (HRA), or flexible spending account (FSA), for out-of-pocket payments

5. Existing Studies on HDHPs/CDHPs • Increased enrollment in HDHPs/CDHPs; however, substantial variation across states • HDHP/CDHP enrollees are likely to have higher incomes, high education, and better health status • HDHPs/CDHPs have the potential to reduce health care spending

6. Knowledge Gaps • Most studies are derived from people in large, self-insured employers • Inconclusive results on the effect on quality of care and long-term effects • Limited evidence regarding effects on people with low incomes or chronic conditions

7. Study Objectives • Describe the HDHP adoption across years in MA • Examine differences between HDHP enrollees and non-HDHP enrollees in MA • Assess the availability and adoption of CDHPs (a subset of HDHPs) in MA

8. Overview of Study Approach • Analyze MA All Payer Claims Database (APCD) • Examine changes in HDHP enrollment across years • Compare HDHP enrollees with non-HDHP enrollees • Investigate differential effects of HDHPs on subgroup of enrollees • Environmental Scan and Key Informant Interviews • Understand the market for CDHP products in MA • Understand the factors that facilitate and impede CDHP uptake in MA

9. APCD Data Analysis • MA APCD Data 2009 – 2011 • MA Residents with Private Health Insurance • Employer-sponsored health plans • Individually purchased health plans • HDHP Enrollment • HDHP enrollees (deductible >= $1,000) • Non-HDHP enrollees (deductible < $1,000) • Potentially expanded groups based on the distribution of the deductible amount

10. APCD Data Analysis, contd. • Descriptive Analysis • HDHP enrollment by year • Differences in demographics and disease profiles • Comparative Analysis • Matched comparison group • Health care utilization and expenditures • Preventive care services and quality of care

11. APCD Data Analysis, contd. • Differential Effects of HDHPs • People with high disease burden or chronic conditions • People who live in lower income or lower education attainment neighborhoods • Employees of small employers • Members in the individual market

12. Environmental Scan • Specific Aim, to Understand: • The market for CDHP products in MA • Approach • On-line searches • Health plan websites • The Connector website

13. Key Informant Interviews • Specific Aims, to Understand: • Health plan experience offering CDHP products • Health plan decision-making • Factors that facilitate and impede CDHP uptake • Sample and Approach • Representatives of 8 largest health plans • Semi-structured interviews • Coding and content analysis

14. Anticipated Limitations • Key informant interviews focus on the perspective from health insurance companies • Potentially limited information on the use of tax-saving options (HSA, HRA, and FSA) • Currently unable to track people if they switch health plans or employers • Potentially low statistical power to detect some group differences among HDHP enrollees • Potential selection effects

15. Questions and Discussion • Related studies (past or ongoing) in MA we should know about • Data sources for CDHPs in MA • Reasons for low CDHP uptake in MA

16. Thank You For more information, please contact: Wen-Chieh Lin wen.lin@umassmed.edu