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Evaluation of a Natural Experiment. Presented by: Jon Gabel, NORC Jeremy Pickreign, NORC Paul Fronstin, EBRI Kaeley Shannon, NORC. A Total Replacement HSA Plan for Company X. Objectives. Examine how the adoption of a full replacement HSA plan affected Claims expenses Use of services

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evaluation of a natural experiment
Evaluation of a Natural Experiment

Presented by:

Jon Gabel, NORC

Jeremy Pickreign, NORC

Paul Fronstin, EBRI

Kaeley Shannon, NORC

A Total Replacement HSA Plan for Company X

objectives
Objectives
  • Examine how the adoption of a full replacement HSA plan affected
    • Claims expenses
    • Use of services
    • Employee out-of-pocket expenses
    • Use of preventive services
  • Major contribution – follow performance for four years of an HSA full replacement plan.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

the natural experiment
The Natural Experiment
  • Company X offered traditional HMO and PPO plans to non-union active workers through 2006, and early retirees through 2007.
  • In 2007, all non-union active workers and their dependents were transferred to an HSA plan.
    • Higher Deducible
    • Higher OOP limit
    • Employer contribution to Savings Account
  • In 2008, all early retirees were transferred to the HSA Plan.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

database
Database
  • Monthly enrollment files for all sponsors and dependents from 2006-2010.
  • Merged enrollment files with medical and pharmacy claims corresponding to all years.
  • Medical claims files include ambulatory and inpatient claims.
  • All beneficiaries enrolled during study years.
    • N= 50,514 actives and 8,571 retirees
    • Includes neo-natal, disabilities and decedents.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

analysis
Analysis
  • Examine active and retiree trends.
  • Use continuously enrolled analytic file.
  • Descriptive
    • Claims expenses per year
    • Utilization per year
      • Use of select preventive services

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

average total allowed charges 2006 2010
Average Total Allowed Charges, 2006-2010

Continuously Enrolled Active Workers and Early Retirees

NOTE: Active Workers changed over to HSA in 2007, Early Retirees changed over in 2008.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

distribution of insurance payments and out of pocket expenses 2006 2010
Distribution of Insurance Payments and Out-of-Pocket Expenses, 2006-2010

Continuously Enrolled Active Workers and Early Retirees

NOTE: Active Workers changed over to HSA in 2007, Early Retirees changed over in 2008.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

average number of inpatient discharges per 1000 beneficiaries 2006 2010
Average Number of Inpatient Discharges Per 1000 Beneficiaries, 2006-2010

Continuously Enrolled Active Workers and Early Retirees

NOTE: Active Workers changed over to HSA in 2007, Early Retirees changed over in 2008.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

average number of outpatient visits per beneficiaries 2006 2010
Average Number of Outpatient Visits Per Beneficiaries, 2006-2010

Continuously Enrolled Active Workers and Early Retirees

NOTE: Active Workers changed over to HSA in 2007, Early Retirees changed over in 2008.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

average number of drug claims per beneficiaries 2006 2010
Average Number of Drug Claims Per Beneficiaries, 2006-2010

Continuously Enrolled Active Workers and Early Retirees

NOTE: Active Workers changed over to HSA in 2007, Early Retirees changed over in 2008.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

percent of female beneficiaries at least age 40 receiving breast cancer screening 2006 2010
Percent of Female Beneficiaries at Least Age 40 Receiving Breast Cancer Screening, 2006-2010

Continuously Enrolled Active Workers and Early Retirees

NOTE: Active Workers changed over to HSA in 2007, Early Retirees changed over in 2008.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

percent of female beneficiaries at least age 18 receiving cervical cancer screening 2006 2010
Percent of Female Beneficiaries at Least Age 18 Receiving Cervical Cancer Screening, 2006-2010

Continuously Enrolled Active Workers and Early Retirees

NOTE: Active Workers changed over to HSA in 2007, Early Retirees changed over in 2008.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

percent of beneficiaries age 50 and older receiving colorectal cancer screening 2006 2010
Percent of Beneficiaries Age 50 and Older Receiving Colorectal Cancer Screening, 2006-2010

Continuously Enrolled Active Workers and Early Retirees

NOTE: Active Workers changed over to HSA in 2007, Early Retirees changed over in 2008.

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment

summary
Summary

Major Findings

  • Allowed charges declined for both actives and retirees following changeover to HSA plan.
  • In subsequent years, increases in allowed charges were substantial.
  • Outpatient visits and drug claims fell in first year of HSA but rose in subsequent years.
    • Inpatient days were volatile during the study period.
  • In first year of HSA use of preventive services generally declined, but rose for some services

A Total Replacement HSA Plan for Company X: Evaluation of a Natural Experiment