Transcript Consumer Directed Health Plans and Patient Activation

Consumer Directed Health
Plans and Patient Activation
Judith Hibbard
Jessica Greene
Martin Tusler
University of Oregon
Funding Provided by the Robert Wood
Johnson Foundation through the HCFO
Initiative
A Key Assumption is that CDHPs will
activate consumers to become better
managers of their health and health care.
Emerging Evidence Suggests that
Consumers do change Behavior in a
CDHP
Seek out information
Increase use of preventive care
Reduce utilization
Cease chronic disease medications
Specific Research Questions:
Do the more activated choose a CDHP?
Do those in a CDHP become more activated
over time?
Are the more activated more likely to engage in
health promoting behaviors? More likely to adopt
new health promoting behaviors?
Are the more activated less likely to engage in
unproductive behaviors? Less likely to adopt
new unproductive behaviors?
Measuring Activation
Patient Activation Measure assesses
knowledge, skills, and confidence for
managing health and health care
Developed using qualitative methods,
classical test theory, and Rasch analysis.
The resulting metric, is a unidimensional,
interval level, Guttman-style measure with
strong psychometric properties.
Data
Mixed mode survey (2004 and 2005) from
employees offered CDHP and PPO plans in
2004 (n=2104) response rate 79%; 2005
(n=1616) response rate 80%
Collapsed high deductible and low deductible
CDHP in this analysis
Analysis compares the PPO enrollees with those
who opted into the CDHP
Favorable Selection into CDHP
Fewer Chronic Conditions
Lower Medical Claims
Lower Pharmacy Claims
Better Educated
Those who are More Activated More likely to
Enroll in a CDHP
PAM score by plan type
64.5
64
63.5
63
PPO
CDHP
62.5
62
61.5
61
60.5
2004***
Key: *** p < .001
Activation Did Not Change Significantly for
CDHP or PPO enrollees from 2004-05
65
64.5
64
63.5
63
Activation
62.5
Score
62
61.5
61
60.5
60
2004
2005
PPO
CDHP
Key: Differences are not significant, Paired-Samples t-test
Information Seeking by Plan Type
Plan type with higher likelihood of behavior
2004
2005
CDHP***
CDHP**
Used a telephone advice nurse
NS
NS
Was persistent in asking doctor to
explain questions
NS
NS
Behavior
Used any health website
Key: * p < .05, *** p < .001
Behaviors by Plan Type
Plan type with higher likelihood of behavior
Risky Cost Saving Behaviors
2004
2005
Didn't go to doctor to save money
PPO*
PPO*
Took lower dose to save money
NS
NS
Did not fill prescription to save money
NS
NS
Limited fat in diet
CDHP***
NS
Exercised
CDHP***
NS
NS
NS
Healthy Behaviors
Ate 5 daily servings of fruits or
vegetables
Key: * p < .05, *** p < .001
Multivariate Analysis: Information Seeking by PAM
Score in 2004
PPO
CDHP
70
70
65
65
60
60
55
55
50
50
Used any health Used a telephone Was persistent in
website
advice nurse** asking doctor to
explain
questions***
Legend:
Used any health Used a telephone Was persistent in
website*
advice nurse asking doctor to
explain
questions***
Did not do the behavior
Did the behavior
Key: * p < .05, ** p < .01, *** p < .001, Controlling for Education, Income,
Age, Health, job type, gender, and survey mode
Multivariate Analysis:
Risky Cost-Saving Behaviors by PAM score in 2004
PPO
CDHP
70
70
65
65
60
60
55
55
50
50
Didn't go to doctor Took lower dose to
Did not fill
to save money
save money prescription to save
money
Legend:
Didn't go to doctor Took lower dose to
Did not fill
to save money
save money prescription to save
money
Did not do the behavior
Did the behavior
Controlling for Education, Income, Age, Health, job type, gender, and
survey mode
Multivariate Analysis:
Healthy Behaviors by PAM score in 2004
PPO
CDHP
70
70
65
65
60
60
55
55
50
50
Limited fat in diet**
Exercised*
Ate 5 daily servings
of fruits or
vegetables
Legend:
Limited fat in diet***
Exercised***
Ate 5 daily servings
of fruits or
vegetables***
Did not do the behavior
Did the behavior
Key: * p < .05, ** p < .01, *** p < .001 Controlling for Education, Income,
Age, Health, job type, gender, and survey mode
Multivariate Analysis:
New Information Seeking by PAM score in 2005
PPO
CDHP
75
75
70
70
65
65
60
60
55
55
50
286
295
25
50
616
983
67
45
45
Used any health Used a telephone Was persistent in
website***
advice nurse*** asking doctor to
explain questions
Legend:
Used any health Used a telephone Was persistent in
website
advice nurse asking doctor to
explain
questions**
Did not adopt the behavior
Adopted the behavior
Key: * p < .05, ** p < .01, *** p < .001, Controlling for Education, Income,
Age, Health, job type, gender, and survey mode
Multivariate Analysis:
New Risky Cost-saving Behaviors by PAM score in 2005
PPO
CDHP
70
70
65
65
60
60
55
55
322
340
327
1013
1133
1075
50
50
Didn't go to doctor Took lower dose to
Did not fill
to save money
save money prescription to save
money
Legend:
Didn't go to doctor Took lower dose to
Did not fill
to save money
save money prescription to save
money
Did not adopt the behavior
Adopted the behavior
Controlling for Education, Income, Age, Health, job type, gender, and
survey mode
Multivariate Analysis:
New Healthy Behaviors by PAM score in 2005
PPO
CDHP
70
70
65
65
60
60
55
193
186
235
55
586
578
737
Limited fat in diet**
Exercised
Ate 5 daily servings
of fruits or
vegetables*
50
50
Limited fat in diet*
Exercised**
Ate 5 daily servings
of fruits or
vegetables
Legend:
Did not adopt the behavior
Adopted the behavior
Key: * p < .05, ** p < .01 Controlling for Education, Income, Age, Health,
job type, gender, and survey mode
Activation As a Predictor of
Information Seeking Behaviors
Behavior
2004
2005
Used any health website
*
**
***
**
**
***
Used a telephone advice nurse
Was persistent in asking doctor to explain
KEY: Based on Logistic Regressions controlling for Education, Income, Age, Selfreported Health, Gender, Hourly/Salaried, Plan Type, and Survey Mode
Activation as a Predictor of Behavioral
Adoption
2004
2005
Didn't go to doctor to save money
NS
NS
Took lower dose to save money
NS
NS
Did not fill prescription to save money
NS
NS
***
***
***
***
**
**
Risky Cost Saving Behaviors
Healthy Behaviors
Limited fat in diet
Exercised
Ate 5 daily servings of fruits or vegetables
KEY: Based on Logistic Regressions controlling for Education, Income, Age, Selfreported Health, Gender, Hourly/Salaried, Plan Type, and Survey Mode
Summary
Those more activated more likely to enroll
in a CDHP
Experience in a CDHP does not appear to
increase activation
Activation is related to many of the
behaviors encouraged by health plans,
this is true regardless of plan design
CDHP’s good choice for those already
activated