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High-deductible plans do not raise out-of-pocket costs for autism care

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Study raises important questions about autism coverage

The analysis by Barry et al. takes a deep dive into the impact of different payment models on a family’s access to autism spectrum disorder–related services, commented David Keller, MD, and Ann Reynolds, MD.

The work emphasizes the reason that “we must continue to study how interventions in behavioral economics, such as mandates and high-deductible health plans, impact access to care for our most vulnerable children,” they wrote.

These data were from 2008 to 2012, before the Affordable Care Act was implemented. As the definition of “high deductible” has changed from $3,000 annually to $10,000 annually, “have families made different choices regarding care?” they asked.

“With the implementation of value-based payments, we will be creating competing forces through the application of behavioral economics. We need to understand how the interplay of economic forces affects families and their access to essential services,” Dr. Keller and Dr. Reynolds continued.

“We need to understand how to help families make informed decisions that balance the needs of their children with the financial realities of our complex care system so that we can support them in that process,” they wrote. “Understanding the impact of behavioral economics on consumer behavior is essential to assuring that children get the right care at the right time for the right diagnosis.”

Dr. Keller is a professor and Dr. Reynolds is an associate professor at the University of Colorado at Denver, Aurora. This is an excerpt of their editorial that accompanies the study by Barry et al. (Pediatrics. 2019 May 13. doi: 10.1542/peds.2019-0926). Dr. Keller reported no relevant financial disclosures. Dr. Reynolds reported providing consultation to Ovid Therapeutics regarding evaluation of sleep severity and improvement in clinical trials.



In states that mandate coverage for autism spectrum disorder (ASD) health services, families in high-deductible health plans (HDHPs) access ASD-related services without paying more out-of-pocket expenses than traditional plan enrollees, an analysis found.

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Lead author Colleen L. Barry, PhD, of Johns Hopkins University, Baltimore, and colleagues examined insurance claims between 2008 and 2012 for children covered by three large U.S. insurers (United Healthcare, Aetna, and Humana) to compare the effects of ASD-related coverage mandates on health spending. At least 47 states and Washington, D.C., have enacted mandates that require insurers to cover ASD-related health services, such as diagnostic and assessment services and behavioral and functional therapies. The final study sample included 98,639 children aged 0-21 years with at least two ASD-related service claims on different days during the study period.

The investigators found that, among HDHP enrollees, coverage mandates were associated with marked increases in average monthly spending across all service categories, but not among traditional plan enrollees. Specifically for HDHP patients, ASD coverage mandates were linked to a $98 greater increase in average monthly spending for insurers on ASD-specific outpatient services, a $142 greater increase in average monthly insurer spending on all outpatient services, and a $142 greater increase in average monthly insurer spending on all health services, according to the study published in Pediatrics. Out-of-pocket spending by patients however, was not significantly different between HDHP and traditional plan enrollees in states that mandate ASD-related coverage, the study found.

Dr. Barry and associates concluded that patients in both HDHP and traditional insurance plans spend large sums on ASD-related care in coverage mandate states, but because costs likely exceed HDHP deductibles, insurers absorb any increases. They suggested that families with regularly high health care expenditures related to ASD services consider high-deductible plans in the context of mandate laws.

“Future research is needed to better understand how features of HDHPs, such as deductible size and health savings account structure, influence the ability of families to make wise choices in obtaining care, and to examine plan premiums and financial strain associated with these plans, particularly for families with children with ASD and high expenditures,” Dr. Barry and associates wrote.

The authors reported no relevant financial disclosures. The study was supported by a National Institute of Mental Health grant and funded by the National Institutes of Health.

SOURCE: Barry CL et al. Pediatrics. 2019 May 13. doi: 10.1542/peds.2018-2391.

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