Optum/UHG/UHC Analytics Conference 2019

Research Objective: High deductible health plans (HDHP) combined with health savings accounts (HSA) have increased markedly in the employer-sponsored health insurance market. However, little is known about how enrollees use their health savings for healthcare spending. By combining detailed bank data with health care claims the goals of our research are to examine how HSA saving behavior affects health care purchasing decision and understand what drives HSA balance.

Study Design: We conducted a cross-sectional analysis using a unique dataset containing HSA transactional data, plan coverage, benefit design, medical claims, and demographics data from 2016. We employed two-stage least squares (2SLS) regression models to examine the associations between total HSA balances and health care utilization and cost. We also performed ordinary least square regression models to examine the associations between the 5 Stages consumer journey and health care utilization and cost.

Population Studied: Study population of 357,437 employees aged 18 to 64 who were employed at 987 relatively large companies (number of employees ≥10) and were continuously covered by HSA-eligible health plans offered by their employers for 12 months in 2016. Roughly 80% of the employees opened an HSA.

Principal Findings: We found that around 60% of HSA-eligible members contributed to their HSAs in 2016 and around 70% of HSA-eligible members received employer contributions. Members who made contributions to their accounts were more likely to be male, family subscriber, older, have higher education level, Caucasian, have higher family income, and higher family net worth. Employer contribution had a significant effect on employee’s HSA balance. In multivariable 2SLS regression analysis, increase in total HSA balance was significantly associated with increases in preventive care visits, outpatient events, office visits, and medical spending. Increases in ER visits, urgent care visits, and inpatient admissions were not statistically significant. Among the 5 Stages, Optimizers (people who have investment balances >$0 or HSA balances ≥$10,000) had less utilizations and spending except for the highest preventive care use.

Conclusions: Increase in HSA balance leads to increases in consumption of preventive care visits, outpatient events, office visits, and medical spending. HSA funds could serve as a cushion against high deductibles and help ensure access to care.