The March edition of Health Affairs came out last night. Two studies caught my eye that are seemingly non-related, but they made a good amount of sense to me together. The first by Desai et al looks at how people respond to an ad campaign to use the New Hampshire price transparency tool. The goal of price transparency tools is to provide information to patients who are then able to shop for better prices or quality of services. The research team bought just under $40,000 in ads and then looked at what happened in actual claims.
The average number of visits per week to the website was 265 in the preintervention phase and 1,931 in the intervention phase (exhibit 1). This represents a 629 percent increase in the number of weekly visits. The percentage of total visits that came through Google Ads (“paid visits”), on average, per week in the preintervention and intervention phases was 0 percent and 63 percent, respectively.
The ads drove eye-balls.
The average price paid for each of the three sets of services enrollees in New Hampshire received were not differentially lower during the advertising campaign than before it (exhibit 2). We estimate a 4.4 percent non–statistically significant increase (p=0.07) in the price paid for ED visits associated with the intervention. Our estimates implied no change in the price paid (estimate: 0.3 percent; p=0.26) for imaging services and a non–statistically significant change (18.3 percent increase; p=0.16) for physical therapy services.
Behaviors did not notably change.
The second paper looks at spending in employer sponsored insurance (ESI) after a bunch of employers configured several services as a bundled payment and split some of the potential savings with their employees/patients in the form of lower cost sharing (Whaley et al)
The program we studied negotiates preferred prices for selected providers that cover the procedure and all related care within a thirty-day period after the procedure and waives cost sharing for patients who receive care from these providers. After implementation, episode prices for three selected surgical procedures declined by $4,229, a 10.7 percent relative reduction. Employers captured approximately 85 percent of the savings, or $3,582 per episode (a 9.5 percent relative decrease), and patient cost-sharing payments decreased by $498 per episode (a 27.7 percent relative decrease).
This is real money at stake. It is a major redesign of care delivery and care financing. And it worked.
How do these things go together?
The change in behavior in the second paper was developped as a package and presented to the interested patient as a complete bundle. The bundle reduces cash costs (lower cost-sharing) and search, learning and information costs as well as backside uncertainty costs. The bundle is a whole lot cheaper on both the cash side and cognitive management side. And the information that this choice set was better/easier was actively handed out to them.
The first paper, merely reduced information costs directly and may or may not have reduced cash costs depending on patient cost-sharing structures in their policy. The patient is asked to do a lot more including setting up appointments with an unfamiliar proivder, driving out of area, or trying to figure out how one clinic interacts and transfers data back to their “home” specialist or PCP. There are a lot of friction points in between the provision of information and the change in behavior.
To get behavioral changes, people need to know about options, they need to see the advantages and then they need an easy enough path forward to change. Providing information is often only a small part of the path smoothing needed for change.