The results emerging from a year-long
analysis of first-time users of CIGNA
HealthCare's consumer-driven health care
plans indicate that these members are
becoming more cost-conscious, but are
not sacrificing recommended care to save
money and are also benefiting financially.
Key findings from the analysis show that:
- CIGNA Choice Fund is helping
to control costs – Costs
for CIGNA Choice Fund HRA and HSA
members decreased and were about
16 percent lower than costs for those
enrolled in traditional plans;
- Cost-shifting did not occur – Member
out-of-pocket costs decreased for CIGNA
Choice Fund HRA members when compared
to the prior year;
- Members continued to receive
appropriate care – CIGNA
Choice Fund HRA and HSA members increased
their use of preventive care services,
health care quality was maintained
on hundreds of measures of evidence-based
medicine, and use of medications
that support chronic conditions increased,
signaling that members are not foregoing
needed care;
- Consumers are becoming more
engaged – Consumers
report increased awareness and engagement
in managing their health care as
compared to two years ago.
"Our experience illustrates clearly
that when structured and implemented
effectively, consumer-driven health plans
offer a viable approach to addressing
the critical challenges facing our health
care system – improving quality
and managing costs," said H. Edward
Hanway, chairman and chief executive
officer of CIGNA Corporation. Hanway
referenced some of the key findings of
the CIGNA study during a keynote address
today at the Second Annual Consumer-Centric
Healthcare Congress in Washington, D.C.
He also urged health benefits providers
to become "health advocates for
consumers" and called for an industry-wide
commitment to providing quality and cost
information that builds consumer knowledge
and fosters consumer engagement in health
care.
Earlier this year, CIGNA HealthCare
released the first phase of findings
based on six months of data in one of
the largest consumer-driven health care
studies to date. The 
latest
findings based on 12 months of data
show accelerated medical cost savings
with CIGNA Choice Fund – a difference
of about 16 percent – when compared
to the traditional plan population studied,
validating the initial analysis.
Members reduced their share
of health care expenses
The data show that cost-shifting did
not occur. Total out-of-pocket expenses
for CIGNA Choice Fund Health Reimbursement
Arrangement (HRA) plan members fell from
19 percent of total health care costs
to 16 percent, excluding the costs of
premiums, after their switch to a consumer-driven
plan. Premium contributions are typically
10 percent to 20 percent lower for consumer-driven
plans, meaning the overall cost saving
to members is likely somewhat higher
than the study result indicated. Many
members also benefited from the employer-financed
reimbursement account. The average total
cost share of 16 percent would have been
27 percent without the availability of
the reimbursement account.
Member out-of-pocket costs for those
enrolled in the HRA plan are similar
to those of members enrolled in a traditional
plan. Cost savings were seen across varied
levels of health care consumption as
well, with approximately 92 percent of
CIGNA Choice Fund HRA members experiencing
lower out-of-pocket costs than if they
had remained in a traditional plan. At
the lowest spending level (claims less
than $1,000), member share of costs declined
from 39 percent to 16 percent. At the
moderate spending level (claims of $1,001-$7,999),
member share of costs declined from 28
percent to 26 percent. And at the highest
spending level (claims of $8,000 and
higher), member share of costs remained
stable at 11 percent.
"These findings counter the perception
that consumer-driven plans simply move
more costs to consumers or can only benefit
the healthy. The results show that a
thoughtful plan design can remove costs
from the system, not just shift them
elsewhere," said Michael Showalter,
senior vice president of health care
strategy and marketing for CIGNA HealthCare. "And
more importantly, the right plan design
also helps promote quality improvement."
Members continue to receive
recommended care
In an evaluation of compliance with 302
evidence-based measures of health care
quality, for example, women having a
mammogram in the past 24 months or diabetes
patients having a physician visit in
the last six months, CIGNA Choice Fund
members continued to receive recommended
care at the same or higher levels as
those enrolled in traditional plans for
approximately 96 percent of the measures
studied. In addition, preventive care
visits for CIGNA Choice Fund members
increased by eight percent over the prior
period, with these members receiving
preventive care at higher rates than
those enrolled in traditional plans by
12 percent.
Consistent with study findings published
earlier this year, CIGNA Choice Fund
members are also more compliant with
medications that manage ongoing conditions,
and more likely to engage in preventive
care when compared to traditional plan
members.
Changing consumer attitudes
highlight ongoing need for information
and support.
In addition to examining claims data
to study behavioral changes after enrollment
in a consumer-driven plan, CIGNA HealthCare
also conducted a member survey to examine
consumer engagement in health care and
attitudes and behaviors related to use
of health care information and health
care costs.
The survey showed that members polled
are more engaged in their health care
than they were two years ago, regardless
of the type of plan in which they were
enrolled. For example,
- More than two-thirds (68 percent)
of respondents reported they are more
actively working to maintain or improve
their health than they were two years
ago.
- Fifty-eight percent said they are
more personally involved in making
decisions about their health than they
were two years ago.
- More than half of respondents agreed
they are more able to make informed
decisions about their health care (54
percent) or ask the right questions
when they talked to their doctor (60
percent) than they were two years ago.
CIGNA Choice Fund members were more
likely than those enrolled in traditional
plans (37 percent v. 28 percent) to agree
that they used their health plan's programs,
such as a discount program or health
coaching, to help them improve or maintain
health.
While many consumers reported that their
awareness of the costs and quality of
care had increased compared to two years
ago, only about four in ten surveyed
agreed that they are usually aware of
the actual costs of the health care services
they get or have an easy way to find
out how much health care services would
cost. About six in ten (59 percent) respondents
agreed they have an easy way to find
information on health care quality.
Consumers of both plan types expressed
a clear preference for quality information,
rather than cost information, to help
them choose doctors or facilities for
care. This was true for all types of
service, including selecting a facility
for inpatient, outpatient or high-tech
radiology services, selecting a physician
for an office visit or a lab for lab
tests. For example, about three-fourths
(76 percent) of members indicated they
would use quality comparison information
to select a hospital for an inpatient
procedure, such as heart surgery. By
contrast, only half indicated they would
use cost comparison information to do
so.
"This finding reaffirms that quality
comparisons are more meaningful to consumers
as they make decisions on where to seek
care," Showalter said. "It
also tells us that our continued strategy
of providing consumers first with information
on the quality of care and then information
on the cost of that care will be the
approach most valued by consumers."
"Consumer-focused approaches in
health care have awakened the need for
more information and support that helps
consumers make informed decisions and
helps them to better interact with the
health care system," said Showalter. "Though
we are encouraged by the progress that's
been made, we also recognize we must
continue our work to address the issues
that consumers tell us would improve
their experience."
About the Study
This study examined claims and clinical
data of approximately 38,200 continuously
enrolled members who switched from
a traditional HMO or PPO plan to one
of CIGNA HealthCare's HRA or HSA plans
in 2005. The analysis compared this
group's claims for the 12-month period
January 2005 through December 2005
to their claims from the same period
in 2004. To examine pharmacy costs
and utilization, the study reviewed
the claims experience of 2,300 CIGNA
Choice Fund members who had a combined
medical and pharmacy deductible through
CIGNA HealthCare. In addition, the
study also compared this group's health
care costs and utilization patterns
to those of 231,600 members enrolled
in a traditional HMO or PPO plan from
the same employer groups during the
same January-December 2005 time period.
Pharmacy analysis for the traditional
population was based upon 109,000 members.
The study drew upon data from 44 different
employer groups offering CIGNA HealthCare's
consumer-driven health care plans to
employees. The consumer survey was based
on a telephone survey of 807 CIGNA HealthCare
members, 406 enrolled in CIGNA Choice
Fund plans and 401 enrolled in traditional
plans from among these same employer
groups, fielded from August 8 to September
6, 2006. This survey has a margin of
error of +/- 4.9 percent.
