JMIR Publications

ABSTRACT

Background:

A growing number of Americans are enrolled in high-deductible health plans (HDHPs). Enrollees in HDHPs, particularly those with chronic conditions, face high out-of-pocket (OOP) costs and often delay or forgo needed care due to cost. These challenges could be mitigated by the use of cost-conscious strategies when seeking health care, such as discussing costs with providers, saving for medical expenses, and using online tools to compare prices, but few HDHP enrollees engage in such cost-conscious strategies. A novel behavioral intervention could enable HDHP enrollees with chronic conditions to adopt these strategies, but it is unknown what intervention features would be most valued and used by this patient population.

Objective:

To assess preferences among HDHP enrollees with chronic conditions for a novel behavioral intervention that supports use of cost-conscious strategies when planning for and seeking health care.

Methods:

In an exploratory sequential mixed methods study among HDHP enrollees with chronic conditions, we conducted 20 semi-structured telephone interviews and then surveyed 432 participants in a national internet survey panel. Participants were adult HDHP enrollees with diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, or asthma. The interviews and survey assessed participants’ health care experiences when using HDHPs and their preferences for the content, modality, and frequency of use of a novel intervention that would support their use of cost-conscious strategies when seeking health care.

Results:

Approximately half of interview participants reported barriers to using cost-conscious strategies. These included not knowing where to find information and worrying that use of cost-conscious strategies would be too time-consuming. A majority of interviewees who had discussed costs with providers, saved for medical expenses, or used online price comparison tools found these strategies helpful for managing their health care costs. Most interviewees expressed interest in an intervention delivered through a website or phone app that would help them compare prices for services at different locations. Survey participants were most interested in learning to compare prices and quality, followed by discussing costs with their providers and putting aside money for care, through a website or email-based intervention that they would use a few times a year.

Conclusions:

Regular use of cost-conscious strategies could mitigate financial barriers faced by HDHP enrollees with chronic conditions. Novel behavioral interventions to reduce such barriers and facilitate engagement in cost-conscious strategies should be explored to help HDHP enrollees with chronic conditions better manage their OOP spending.