Objectives:

Consumer oriented approaches have become increasingly common in health insurance plans. This report considers three sometimes, but not always, related consumer-oriented strategies: consumer directed health plans (CDHPs), tiered provider networks, and efforts to collect and disseminate information about provider quality. The goals of the report are to provide a framework for assessing the likely effects of CDHPs, tiered networks, and expanded quality data collection and dissemination, to review available published peer reviewed literature on CDHPs, and to provide information about the likely value of further review of the literature on tiered networks and provider quality data collection and dissemination.

Data Sources:

We reviewed the published literature identified in MEDLINE® or Econlit.

Review Methods:

We developed a framework that identifies important factors determining the impacts of these approaches. We also reviewed the published literature that reported original evidence about the prevalence of CDHPs, the impacts of CDHPs on health care utilization or health care costs, or the extent of selection bias in CHDP plan enrollment. We also conducted some inquiries into the literature on tiered networks.

Results:

Among the implications of our framework, perhaps the most important is that the effects of these policies are likely to vary substantially with the context within which they are implemented. For example, some consumers may respond to the financial incentives inherent in CDHPs and tiered networks much more than others. By extension, some firms may have more favorable experiences with these plans than others. The impacts of consumer-oriented strategies may also differ between firms that offer a choice of plans and those that do not due to differences between the firms in the types of people joining the plans.

We found 11 published studies that provided evidence the prevalence or effects of CDHPs. Available evidence is insufficient to draw conclusions about the effects of CDHPs. Perhaps the most consistent point is that CDHPs are subject to selection bias. Evidence on the effects of CDHPs on utilization and spending was mixed and generally of limited strength. We conclude that further evidence synthesis will be most profitable after the literature has had further time to develop.

We also found that the number of studies that appear likely to produce reviewable evidence about the impacts of tiered networks on utilization and costs is small. The literature on the impacts of quality data collection and dissemination is somewhat larger, but is much more diffuse, with little evidence specific to the context of consumer-oriented strategies of the type examined here.

Conclusions:

The effects of CDHPs, tiered provider networks, and efforts to collect and disseminate information about provider quality are likely to vary within the context in which they are implemented. There is insufficient published evidence to draw conclusions about the effectiveness of these CDHPs and tiered provider networks and the literature on the impacts of quality data collection and dissemination is diffuse.