By Leslie Small

In recent years, high-deductible health plans (HDHPs) have faced increasing scrutiny as evidence emerges that they may not actually cause people to be savvier health care consumers. Now, a new study adds another layer to the debate by finding that access to and uptake of health savings accounts (HSAs) is low among people enrolled in HDHPs. “These findings are concerning given that the proportion of employers offering HDHPs has increased dramatically in the past 15 years,” stated a related commentary piece published by JAMA.

“For HDHPs to realize the goals of motivating patients to shop around for health care, increasing their price sensitivity and minimizing the chance that they forego necessary care, a high proportion of HDHP enrollees must enroll in an HSA and contribute sufficient funds to meet their out-of-pocket expenses,” wrote Matthew L. Maciejewski, Ph.D., and Anna Hung, Ph.D., Pharm.D., both of Duke University.

The study suggested that one policy option to increase HSA uptake in the individual market could be to “allow more flexibility in what types of HDHPs qualify for linkage to an HSA” or even require exchange plans with high deductibles to be linked to an HSA. Another way would be for employers, health plans and health systems to “target messaging to HDHP enrollees to encourage acquisition of an HSA as a strategy to help manage the high cost-sharing of these plans,” the study said.

Jason Karcher, a Milliman, Inc. actuary, says that for plan sponsors, failing to educate consumers about how to get the most benefit out of an HDHP with an HSA is “tempting fate.” That’s because if consumers end up deferring needed care because they’re concerned about upfront costs, “it can compound and result in higher plan costs down the road.”

E. Craig Keohan, chief revenue officer of HealthSavings Administrators — one of the largest HSA providers — says his firm has had success with engaging consumers by tailoring outreach to people in different circumstances. The company developed six different “personas,” and asks new HSA enrollees to pick one, then “we craft all education and communication on them based on that,” Keohan tells AIS Health.