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）：这里提出的工作利用了来自私人健康保险交易所的详细索赔和登记数据，以了解更多关于在选择集很大时选择健康计划的过程，以及这种选择如何影响随后的医疗保健需求。MedicaSM的“我的计划”是单一保险公司私人健康保险交易所的早期例子。“我的医保计划”为雇主提供了多达20种福利计划供雇员选择，由雇主的固定美元供款提供补贴。2013年计划年度增加了一项重要的改进：除了根据服务点成本分担选择不同的计划外，员工现在还可以选择他们的供应商网络，从原始的广泛的PPO网络或围绕垂直整合的医院和医生诊所系统建立的四个不同的供应商网络（“Medica ACOs”）中选择一个。我们建议为这种复杂的健康计划选择开发一个模型，并研究在选择之后的几年里，由此产生的成本分担和提供者网络特征如何影响医疗保健需求。由于这一创新的医疗产品结合了供应商网络和服务点成本分担的差异，我们相信，我们从这一模型中获得的关于健康计划选择及其后果的知识，可以帮助我们理解2010年《平价医疗法案》下提供的公共交换。建议工作的具体目标旨在支持AHRQ价值组合：具体目标1：确定预测2012年注册模式的成员特征，其中选项仅因福利设计而变化。具体目标2：确定2013年和2014年注册模式的差异，当Medica ACO选项在福利设计差异之上分层时。具体目标3：确定福利设计差异对未来护理提供模式的影响。具体目标4：确定Medica ACO注册对未来医疗服务模式的影响。拟议的工作在以下方面是创新的：(1)我们利用从保险公司获得详细的计划设计、员工成本分担、登记和索赔数据的优势，评估早期进入这个新市场的私人健康保险交易所的影响。各种各样的雇主团体保证了计划设计和员工成本分担的变化。(2)员工自付保费的外生变异为计划设计的非随机选择提供了一种控制工具。(3)我们关于医疗服务提供者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保健提供者网络的历史，来确定成员是否愿意转向新的“常规医疗服务来源”，以节省保费。(4)我们能够纵向跟踪会员，以确定与计划设计相关的护理服务模式的变化。