Report Primary Care Doctors Have Limited Knowledge About Consumer-Driven Health Plans

A large proportion of the nation’s primary care physicians are not prepared to advise patients enrolled in consumer-driven health plans on such issues as coverage limitations and cost considerations, a new survey has found.

In fact, 43 percent of the doctors responding to the survey, which was conducted by the Robert Wood Johnson Foundation Clinical Scholars Program and published Wednesday, October 8, in the American Journal of Managed Care, said they have heard “a little” or “not at all” about consumer-driven health plans, 33 percent reported having heard “somewhat,” and 24 percent reported having heard “much” or “a great deal” about the plans, which generally combine a high deductible with either a health reimbursement arrangement or a health savings account.

Despite their limited knowledge about the plans, 40 percent of the physicians responding to the survey reported having enrollees in such plans on their practice panels, generally comprising about 5 percent of their total patients.

An estimated 5.5 million Americans are enrolled in consumer-driven health plans nationwide, according to the 2008 Employer Benefits Survey released last month by the Henry J. Kaiser Family Foundation and the Health Research & Educational Trust.

Dr. Craig Pollack, a Robert Wood Johnson Foundation clinical scholar at the University of Pennsylvania and a co-author of the study, said physicians’ lack of knowledge about the plans demonstrates that many plan members are receiving little or no guidance from their doctors when making medical purchasing decisions.

The survey, which was conducted anonymously by mail in May and June 2007, asked 528 randomly selected internists, family physicians and general practitioners 65 or younger, about their baseline knowledge and overall impression of consumer-driven health plans; their general readiness to discuss issues of cost, cost-effectiveness and medical budgeting with patients; their ability to advise patients on the costs of commonly prescribed services; their views regarding the effects of the plans on clinical care; and their views on the role of publicly available quality-of-care information in patient decision-making.

Once doctors were provided a brief description of consumer-driven health plans, 46 percent reported a favorable impression, 37 percent were neutral, and 17 percent reported an unfavorable impression. Physicians with patients enrolled in such plans were more likely to have a favorable impression than physicians without these patients, the survey found.

When physicians were asked about their readiness to discuss issues related to cost, cost-effectiveness and budgeting, almost three-quarters said they were prepared to discuss cost (73 percent) and cost-effectiveness (76 percent), but less than half—48 percent—said they were ready to discuss medical budgeting with patients.

Physicians were generally distrustful of quality-of-care information available to members of the plans from government or insurance Web sites, with less than half agreeing that this information should factor into patients’ choice of hospitals or specialists. Less than 21 percent of physicians said patients should trust government Web sites for such information, while less than 8 percent said that insurer Web sites contained reliable health care quality information.

“The AMA is working to better educate America’s physicians about the coverage and cost considerations of consumer-directed health plans,” American Medical Association board chairman Joseph Heyman said in a statement. “A health savings account brochure is available for patients and physicians on the AMA Web site, and we are looking into other ways to better answer physicians’ questions about consumer-directed health plans.”