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Changes in Healthcare Spending Attributable to High Deductible Health Plan Offer Among Enrollees with Comorbid Substance Use Disorder and Cardiovascular Disease

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Abstract

Background

The rise in prevalence of high deductible health plans (HDHPs) in the United States may raise concerns for high-need, high-utilization populations such as those with comorbid chronic conditions. In this study, we examine changes in total and out-of-pocket (OOP) spending attributable to HDHPs for enrollees with comorbid substance use disorder (SUD) and cardiovascular disease (CVD).

Methods

We used de-identified administrative claims data from 2007 to 2017. SUD and CVD were defined using algorithms of ICD 9 and 10 codes and HEDIS guidelines. The main outcome measures of interest were spending measure for all non-SUD/CVD-related services, SUD-specific services, and CVD-specific services, for all services and medications specifically. We assessed both total and OOP spending. We used an intent-to-treat two-part model approach to model spending and computed the marginal effect of HDHP offer as both the dollar change and percent change in spending attributable to HDHP offer.

Results

Our sample included 33,684 enrollee-years and was predominantly white and male with a mean age of 53 years. The sample had high demonstrated substantial healthcare utilization with 94% using any non-SUD/CVD services, and 84% and 78% using SUD and CVD services, respectively. HDHP offer was associated with a 17.0% (95% CI = [0.07, 0.27] increase in OOP spending for all non-SUD/CVD services, a 21.1% (95% CI = [0.11, 0.31]) increase in OOP spending for all SUD-specific services, and a 13.1% (95% CI = [0.04, 0.23]) increase in OOP spending for all CVD-specific services. HDHP offer was also associated with a significant increase in OOP spending on non-SUD/CVD-specific medications and SUD-specific medications, but not CVD-specific medications.

Conclusions

This study suggests that while HDHPs do not change overall levels of annual spending among enrollees with comorbid CVD and SUD, they may increase the financial burden of healthcare services by raising OOP costs, which could negatively impact this high-need and high-utilization population.

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Data Availability

Data for this study was accessed through a data use agreement with OptumLabs. While the authors are not able to share the underlying data, interested researchers can contact OptumLabs (https://www.optumlabs.com/) to discuss their own data use agreement.

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Funding

Funding for this paper was from R01DA044201 from NIDA, grant number T32MH109436 from NIMH (Hollander), and grant number T32HS000029 from AHRQ (Meiselbach). The content is solely the responsibility of the authors and does not necessarily represent the official views of the grant funding bodies.

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Authors and Affiliations

  1. PhD Program in Health Policy, Harvard University, Cambridge, MA, USA

    Julia C. P. Eddelbuettel BS

  2. Department of Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA

    Alene Kennedy-Hendricks PhD, Mark K. Meiselbach PhD, Cameron Schilling MPH & Matthew D. Eisenberg PhD

  3. Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA

    Elizabeth A. Stuart PhD

  4. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Haiden A. Huskamp PhD

  5. McLean Hospital, Belmont, MA, USA

    Alisa B. Busch MD

  6. Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, NC, USA

    Mara A. G. Hollander PhD

  7. Brooks School of Public Policy, Cornell University, Ithaca, NY, USA

    Colleen L. Barry PhD

  8. Optum Labs, Boston, MA, USA

    Matthew D. Eisenberg PhD

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  1. Julia C. P. Eddelbuettel BS
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Correspondence to Julia C. P. Eddelbuettel BS.

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This paper was presented as a poster at the Annual Society of Health Economists Annual Meeting (ASHEcon) in June 2023.

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Eddelbuettel, J.P., Kennedy-Hendricks, A., Meiselbach, M.K. et al. Changes in Healthcare Spending Attributable to High Deductible Health Plan Offer Among Enrollees with Comorbid Substance Use Disorder and Cardiovascular Disease. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-08700-2

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