Letters: Deductibles are unhealthy for employer-sponsored health plans

Employers originally introduced deductibles to create shared member burden. The hope was people would consume care more carefully if they had to cover all costs out of the gate. The article “Fewer employers offering high-deductible plans as only option” illustrates the growing shift away from deductibles, pointing to rising healthcare costs and lack of engagement with plans as contributors.

The article overlooks that deductibles are problematic at their core, with three fundamental issues: they indiscriminately blunt care; they mask value with no transparency into cost or treatment options; they treat all conditions equally. People aren’t empowered to get the care they need when they need it.

Berkeley researchers analyzed employee spending on a high-deductible health plan—finding that workers did spend less on healthcare, with costs decreasing by 12% compared to a traditional plan. This sounds positive, but researchers concluded the spending reductions were entirely due to lower utilization. Deductibles don’t enable smarter care choices; rather, they force a decision about whether to get care. When people avoid care important to long-term health, that’s a huge problem. Another study on deductibles found women delayed chemotherapy for breast cancer by nearly nine months.

It doesn’t make sense that all conditions are the same in the eyes of a deductible—from toe fungus to cancer. There absolutely shouldn’t be a deductible for treatments like chemotherapy and insulin—when not getting care could be deadly.

Once employees meet their deductibles, care appears free, making all treatment options more appealing. Spikes of unnecessary utilization raise the risk pool, increasing prices the following year.

There’s a better way: Eliminate the deductible. Our data shows companies can save up to 20% on health insurance costs while encouraging employees to use their benefit.

Tony Miller
Founder and CEO
Bind On-Demand Health Insurance

Regarding “The industry strives for ‘zero harm,’ but remains unprepared for today’s challenges,” I agree with Anne Marie Benedicto that eliminating medical errors requires fundamental change at the leadership level. I also agree that it will take a major investment in new solutions and safety culture to stop the epidemic of preventable harm. I would only add that for most categories of harm, evidence-based solutions are already in the field. It’s often just a matter of commitment—of attention, will and yes, capital.

My company is about making bedside care safer by applying advanced video and audio technology and data analytics to solve problems such as falls, self-harm, elopement and violence against staff. On falls, we have been getting to near zero events for patients under direct observation, which is usually less than 10% of patient census, but it also results in housewide reductions of up to 80%. This collateral improvement seems to be a byproduct of leadership engagement in solving a problem.

Recently, we have held meetings with CMS quality leaders, the Agency for Healthcare Research and Quality and the Joint Commission to present our results, which have been published in numerous clinical journals and presented at major conferences. When there are relatively inexpensive solutions that save money (in our case, on sitters and the unreimbursed costs of treating fall injuries), we think that regulatory bodies should back them as standards of care.

The feds have pushed care bundles and meaningful use of electronic health records and tried to use the payment system to steer hospitals away from pointless care and toward value-based treatment. In addition to appealing to the better angels of their nature, maybe it is time to encourage healthcare leaders to invest in patient safety technologies that work—while also reducing costs.

Brad Playford
Founder and CEO
AvaSure