High-deductible health plans (HDHPs) and out-of-pocket health care spending are rapidly rising. More than one-third of Americans with employer-based insurance have HDHPs, and the most popular bronze plans in the federal marketplaces—those with the lowest monthly premiums—have an average annual deductible of more than $5,000, according to a 2017 survey published in Health Affairs.
Although HDHPs were designed to encourage consumers to shop around for lower-cost providers, some patients simply forego or delay crucial medical care. Lower-income patients experience the financial burden of HDHPs most acutely. “What we believe could be happening is lower-income patients might be trying to save money and therefore not going to see their doctors or seeking advice when they need it and might be ending up sicker,” says Frank Wharam, MD, an internist and founding director of the Division of Health Policy and Insurance Research at Harvard Medical School’s Department of Population Medicine.
Although a patient’s financial well-being may not fall under a clinician’s purview, providers can help patients with HDHPs by using a few simple strategies.
- Encourage patients to use health savings accounts (HSAs). Not all HDHPs offer consumers HSAs, but many do. Providers can make sure patients use an HSA if they have one, says Raj Bhavsar, the chief technology officer at ConnectYourCare, a spending accounts administrator for employers. For example, practice staff can ask about HSAs when verifying insurance information and remind patients to bring their HSA debit card to their next appointment.
- Stay engaged. “Providers have to be engaged with patients who have an HDHP to ensure that they’re doing the right preventive things,” Bhavsar says. Encourage patients who are new to HDHPs and have higher out-of-pocket costs to continue taking preventive medications to avoid potential health issues—and large hospital bills.
- Reconsider what is necessary. “The best first-line approach is for the provider to only recommend care that is necessary for the patient and based on good evidence,” Wharam says. In his urgent care practice, Wharam has noticed that more patients are asking about cost when tests or medications are recommended, which can lead to a discussion of the value (financial and otherwise) of treatment.
For patients with HDHPs facing complicated care, providers can initiate a conversation about the basics of their insurance plan, including whether associated costs would represent a barrier to care. “A provider who develops an understanding of that would have a better understanding of how their patients might react to a given situation,” Wharam says.