At the Margins

Wondering if your patients price shop? Ask if they have a health savings account.

by Robin Brand and Rachel Matthews

When first introduced, high deductible health plans (HDHPs) were viewed by many as a silver bullet. Cost-sharing promotes consumerism, so the story goes, and so once patients bear responsibility for their health spending, they'll price shop their way to low-cost, high-quality providers. But studies show that individuals with HDHPs are actually more likely to decrease care utilization across health services, including utilization of medication, imaging, and preventative care. HDHP consumers aren't savvy—they're scared.

What patients want along their financial journey

Our recent research indicates the presence of health savings accounts (HSAs), a common component of many HDHPs, may be a more effective gauge to measure the extent of a patient's consumeristic behavior. Revenue cycle leaders should use this finding to ensure HSA patients are put in the best position to deliver quick and full payment. 

Background on HSAs

Congress created HSAs to allow HDHP individuals to conveniently save for their medical expenditures. However, not all HDHPs are qualified to offer HSAs. The IRS requires HSA-compatible HDHPs to meet minimum deductible and maximum out-of-pocket standards. HSA-compatible HDHPs also may not cover any non-preventative service before the deductible is met. These requirements mean most individuals with an HSA receive health care coverage from their employer.

Individuals with an HSA are most likely to price shop

We recently conducted a consumer survey of 1,000 adult patients who had undergone a non-emergency surgery in the previous 18 months. We asked respondents if they compared prices at two or more providers before scheduling care. Twelve percent of respondents who reported a HDHP without an HSA shopped for care. In comparison, respondents with an HSA price shopped at 35%.

HSA patients are informed and dependable

A 2018 Allegus survey found that HSA participants report a clearer understanding of health care concepts than the general public and express more confidence in their ability to interpret their plan details. Our consumer survey also indicates HSAers' financial fluency directly translates to your bottom-line. We found that when compared with non-HSA HDHP patients, HDHP patients with HSAs are less likely to be turned over to collections and more likely to pay their hospital bill in full within one month of arrival.

What this means for you

As a revenue cycle leader, know that HSA patients are likely to request a price estimate before scheduling their care. It's important to prioritize infrastructure that allows these patients to receive accurate price estimates, such as an online cost estimator or financial call center. Overlooking these tools means HSAers may evaluate your hospital via inaccurate price quotes from an uninformed physician, family friend, or internet search.

Once they receive care, HSAers are dependable patient accounts. These patients likely don't need billing reminder calls or mailings. We recommend redirecting those resources to patients who are in greater need of financial support.

Patient financial preferences, charted

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Want to know more about patient consumerism? Download our consumer profiles to learn how a patient's payer type influences their preferences along the patient financial journey.

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