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Multi-Year Impacts of Offering a “Consumer-Directed” Health Plan: An Intent-to-Treat Design with Varying Take-Up Levels at the Treatment-Cluster Level

Matthew Eisenberg, Carnegie Mellon University 
*Amelia M. Haviland, Carnegie Mellon University 
Peter Huckfeldt, RAND Corporation 
Ateev Mehrotra, RAND Corporation 
Neeraj Sood, University of Southern California 

Keywords: Intent-to-treat, doubly robust, heterogeneous treatment effects, health insurance design

“Consumer-Directed” Health Plans (CDHPs) are of great interest to policy makers as they are a market-based strategy and the main strategy for cost saving that focuses on the demand-side of health care. In addition, they are in full swing, with current offer rates of greater than 50% among large employers and take-up rates over all employer-sponsored insurance of 18%. Literature to date suggests that these plans are associated with reductions in health care costs in the short term but it is unclear if these drops will persist over time and ‘bend the cost curve’. In this work, we use a unique data set with 5 years of enrollment and claims data for 60 large U.S. firms (about 5 million covered lives per year), half of which offered a CDHP over the study period, to study impacts of CDHP offer on health care cost growth. These ‘treatment’ firms had widely varying rates of initial CDHP take-up and take-up rates generally increased, sometimes drastically, in the years after first offer. We present average results of doubly-robust longitudinal intent-to-treat analyses with propensity score weighting at the individual level and discuss implications of the treatment, and take-up, heterogeneity for health policy and methodology.