We also examined cancer screenings and found that use of these screenings was higher among those who did not meet the age recommendations once deductibles were met. The largest effect was seen for colorectal cancer screenings (Figure 2). We found a 126 percent increase in use of colorectal cancer screenings once individuals reached their deductible among individuals under age 50, whereas screenings increased 60 percent among December 17, 2020, #373 individuals ages 50 and older. Figure 2 Increase in Odds of Having Cancer Screening After Meeting Health Plan Deductible, by Recommended Age of Screening Use of Low-Value Health Care Services Rises 140% 126%*** After People Satisfy Health Plan Deductibles 120% The use of cost sharing, such as deductibles, is an increasingly common strategy to enhance health care consumeris 100% m and lower health care spending. Proponents speculate that high levels of cost sharing enhance consumers’ tendency to discriminate between high- and low-value care. In other words, cost sharing is a tool for teaching members to “choose wisely” throughout the plan year when it comes to the services they use. But does 80% this work? 60%*** 60% In a recent study, “Do People Choose Wisely After Satisfying Health Plan Deductibles? Evidence From the Use of Low-Value Health Care Services,” the Employee Benefit Research Institute (EBRI) examined the extent to 40% 33% which members who satisfy their plan deductible continue to discriminate when it comes to services used. To quantify whether deductibles help patients learn to “choose wisely” and avoid low-value care once deductibles 16%*** 20% have been met, six commonly overutilized imaging, screening, and pre-surgery testing services were compared 11%*** 11%*** among 1.5 million individuals enrolled in commercial health plans with a deductible who had, and had not, satisfied the deductible. 0% Ages 40+ Ages <40 Ages 21+ Ages <21 Ages 50+ Ages <50 The use of the specified low-value health care services was demonstrably higher among patients satisfying their Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening plan deductible when compared with patients who had not met their deductible (Figure 1). The study found that Source: Authors’ analysis of 2015 Truven MarketScan. the likelihood of receiving low-value health care services increased by as much as 83 percent, depending on the *p< 0.05, **p<0.01, ***p<0.001. service, for those who had satisfied their plan’s deductible relative to those who had not. Figure 1 These findings have implications for deductible-level setting specifically and future benefit designs more Increase in Odds of Using Low-Value Health Care Services After generally as they relate to efforts to reduce use of low-value health care services. A lack of nuance in plan design Meeting Health Plan Deductible regarding coverage of low-value services may contribute to the observed patterns for those enrollees who satisfy 90% their deductibles (or expect to). In addition to more nuanced plan designs that effectively discourage low-value 83%*** care, these findings underscore the need to implement provider-facing initiatives to reduce low-value care — and 80% 73%*** ensure that policies are aligned with consumer cost sharing to achieve low-value-care avoidance. 68%*** 70% The EBRI report, “Do People Choose Wisely After Satisfying Health Plan Deductibles? Evidence From the Use 60% of Low-Value Health Care Services,” is published as the October 2020 EBRI Issue Brief, and is available online here. 5 0% 41%*** 40% The Employee Benefit Research Institute is a private, nonpartisan, nonprofit research institute based in 28%*** 28%** Washington, DC, that focuses on health, savings, retirement, and economic security issues. EBRI does not lobby 30% and does not take policy positions. The work of EBRI is made possible by funding from its members 21and %*** 20% sponsors, which include a broad range of public, private, for-profit and nonprofit organizations. For more information go to www.ebri.org or connect with us on Twitter or LinkedIn. 8%** 10% 0% First 6 Weeks First 120 Days First 6 Weeks First 120 Days Baseline Labs Chest X-Rays Vitamin D PSA Testing Testing ### Imaging for Low Back Pain Imaging for Uncomplicated Unneeded Testing Before Screening Contrary to Current Without Red Flags Headache Low-Risk Surgery Evidence Source: Authors’ analysis of 2015 Truven MarketScan. *p< 0.05, **p<0.01, ***p<0.001. EBRI’s on Twitter! @EBRI or http://twitter.com/EBRI EBRI blog: https://ebriorg.wordpress.com/ EBRI on Twitter: @EBRI or http://twitter.com/EBRI Blog: https://ebriorg.wordpress.com/ © 2020, Employee Benefit Research Insti tute, 901 D St. SW, Suite 802, W ashington, DC 20024, 202/659-0670 www.ebri.org 2