Choice and Consequences: Health Care through a Private Health Insurance Exchange

选择和后果：通过私人健康保险交易所提供医疗保健

• 批准号: 8671303
• 负责人: CAROLINE S CARLIN
• 金额: $ 19.01万
• 依托单位: MEDICA RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8671303
• 关键词: Choice; Consequences; Health; Care; through

DESCRIPTION (provided by applicant): The work proposed here leverages detailed claims and enrollment data from a private health insurance exchange to learn more about the process of choosing a health plan when the choice set is large, and how this choice affects subsequent health care demand. My Plan by MedicaSM is an early example of a single-insurer private health insurance exchange. My Plan by Medica offers employers a choice set of up to 20 benefit plans from which employees select coverage, subsidized by the employer's defined-dollar contribution. An important enhancement was added for the 2013 plan year: in addition to selecting plans that vary by point-of-service cost sharing, employees now also select their provider network, choosing from the original broad PPO network or one of four distinct provider networks ("Medica ACOs") built around vertically-integrated hospital and physician clinic systems. We propose to develop a model of this complex health plan choice, and examine how the resulting cost sharing and provider network characteristics impact health care demand in the years after that choice. Because this innovative Medica product incorporates differences in provider networks as well as point-of-service cost sharing, we believe the knowledge we gain from this model about health plan choice and its consequences can inform our understanding of the public exchanges to be offered under Affordable Care Act of 2010. The Specific Aims of the proposed work have been designed to support the AHRQ Value portfolio: Specific Aim 1: To identify the member characteristics that predict 2012 enrollment patterns, where options vary only by benefit design. Specific Aim 2: To identify the differences in 2013 and 2014 enrollment patterns, when Medica ACO options are layered on top of benefit design differences. Specific Aim 3: To identify the impact of benefit design differences on future patterns of care delivery. Specific Aim 4: To identify the impact of Medica ACO enrollment on future patterns of care delivery. The proposed work is innovative in the following ways: (1) We take advantage of access to detailed plan design, employee cost sharing, enrollment and claims data from the insurer to evaluate the impact of a private health insurance exchange put in place by an early entrant into this new market. The wide variety of employer groups assures variation in plan design and employee cost sharing. (2) Exogenous variation in employee out-of-pocket premiums provides an instrument to control for the non-random selection of plan design. (3) Our unusually rich data about provider networks allows us to use individuals' history of accessing primary care and specialty care provider networks to identify members' willingness to switch to a new "usual source of care" in order to save premium dollars. (4) We are able to follow members longitudinally to identify changes in patterns of care delivery associated with plan design.

描述（由申请人提供）：此处提出的工作利用私人健康保险交换的详细索赔和注册数据，以了解有关选择集合时选择健康计划的更多信息，以及此选择如何影响后续的医疗保健需求。我的Medicasm计划是单身私人健康保险交易所的早期例子。我的Medica计划为雇主提供了最多20个福利计划的选择，从该计划中，员工选择了由雇主定义的美元捐款提供补贴的承保范围。在2013年计划年度添加了重要的增强：除了选择随服务成本分配而异的计划外，员工现在还选择其提供商网络，从原始的广泛PPO网络中选择或围绕垂直综合医院和医师临床系统建立的四个不同的提供商网络（“ Medica acos”）之一。我们建议开发这种复杂的健康计划选择的模型，并检查所得的成本共享和提供商网络特征如何影响该选择后的几年中的医疗保健需求。 Because this innovative Medica product incorporates differences in provider networks as well as point-of-service cost sharing, we believe the knowledge we gain from this model about health plan choice and its consequences can inform our understanding of the public exchanges to be offered under Affordable Care Act of 2010. The Specific Aims of the proposed work have been designed to support the AHRQ Value portfolio: Specific Aim 1: To identify the member characteristics that predict 2012 enrollment patterns, where options vary only by benefit 设计。特定目的2：确定2013年和2014年的入学模式的差异，当Medica ACO选项层叠在收益设计差异之上时。特定目标3：确定福利设计差异对未来护理交付方式的影响。特定目标4：确定医疗ACO入学对未来护理交付方式的影响。 拟议的工作是通过以下方式创新的：（1）我们利用详细的计划设计，员工成本分配，入学率和索赔数据的数据，以评估早期参与者进入这个新市场的私人健康保险交流的影响。各种各样的雇主团体可以确保计划设计和员工成本分享的差异。 （2）员工自付费用的外在变化为控制计划设计的非随机选择提供了一种工具。 （3）我们关于提供商网络的异常丰富的数据使我们能够利用个人访问初级保健和专业护理提供商网络的历史，以确定会员愿意切换到新的“通常的护理来源”以节省高级美元。 （4）我们能够纵向关注成员，以确定与计划设计相关的护理交付方式的变化。