Enrollment in consumer-driven health plans or “CDHPs” has skyrocketed during the past 24 months. Now, UnitedHealth Group, the nation’s second-largest health insurance company, has announced membership growth increases of 75% in its CDHP and HRA (Health Reimbursement Account) offerings for the period between June 2005 and June 2006. Membership in UnitedHealth Group consumer-driven health plans has now surpassed 1.75 million people. Moreover, research suggests that even consumers working for employers that still offer more traditional health insurance options like PPOs and HMOs are choosing to enroll in CDHPs.
There is something else that is different about a CDHP-insured consumer: they tend to take a more proactive role in managing their healthcare. A UnitedHealth Group study suggests that individuals in consumer-driven health plans are more likely to be actively engaged in managing their health and making health care decisions, as compared to individuals with traditional health insurance. A joint study between Definity and UnitedHealth Group found that CDHP enrollees supplied with appropriate health care information have higher usage of preventative care services. They also less likely to pursue discretionary acute care services. As a result, they are hospitalized less and have fewer trips to the emergency room.
For clinical laboratories and anatomic pathology group practices, the growing number of consumers insured by a CDHP will be a sword that cuts both ways. On the negative side, laboratories will increasingly be billing consumers directly, often for the entire amount of the laboratory testing services performed. Experts expect that laboratories and pathology groups will see an increase in bad debt, as consumers either refuse to pay, or don’t have the money to pay, for up to 100% of their laboratory charges.
On the positive side, CDHP members will have increased freedom to choose their healthcare providers. Well-informed CDHP members may do research and actively select high-quality laboratories and acknowledged sub-specialist pathologists. The consumer will want a “world class” laboratory or pathologist to diagnose their case or provide a second opinion to their attending physician. Because of this fact, laboratories and pathologists who develop a public brand and increased awareness among consumers will likely have a competitive advantage.
Dark Daily predicts that consumer-driven health plans will have far-reaching consequences to the laboratory industry. Laboratories and pathology groups will need to learn and develop a service organization that can help CDHP members get answers to their questions, monitor the costs of tests and procedures, and research their health issues. Because it will be consumers choosing their providers, and not managed care companies as in past years, the overall trend of growing CDHP enrollment should benefit clinical laboratories and anatomic pathology group practices.