Impact of HSA Cost Sharing Reductions on High-deductible Members with Diabetes

HSA 费用分摊减少对患有糖尿病的高免赔额会员的影响

• 批准号: 9137503
• 负责人: Dennis Ross-Degnan
• 金额: $ 45万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-30 至 2020-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9137503
• 关键词: Impact; HSA; Cost; Sharing; Reductions

 DESCRIPTION (provided by applicant): High deductible health plans (HDHPs) have lower premiums, but require patients to pay the full cost of most medical care until annual deductibles of $1000 to $6000 are met. HDHPs have proliferated rapidly over the last decade. Health Savings Account (HSA)-qualified HDHPs are the most rapidly growing HDHP arrangement, now covering 14% of commercially insured Americans. These plans subject most health care services (including medications) to high annual deductibles but allow pre-tax contributions to accounts that can be used for medical costs. Advocates believe that exposing patients to greater costs will create "activated consumers" who will seek higher-value health care and adopt healthy behaviors, while critics fear that these economic barriers may reduce access to needed care. Our ongoing project in the Natural Experiments in Diabetes Translation (NEXT-D) initiative (5U58DP002719) has determined that diabetes patients with HSA-HDHPs experience the largest reductions in hospital access and adherence to key medications for chronic illness. Although these findings are concerning, federal regulations allow employers to tailor HSA-HDHPs through two mechanisms that could improve access to care: (1) Exempting certain chronic medications from deductible requirements (i.e., medications cost $0 to patients) through "preventive drug lists" ($0-PDs), and (2) Generously funding HSAs so that employees pay less out-of-pocket. Thus, HSA-HDHPs represent both a risk to diabetes patients but also an opportunity for employers to improve care through tailored cost sharing reductions. In this application, we will examine effects of these two important variations in HDHP design on diabetes secondary prevention, high priority care, diabetes complications, and costs, both overall and among vulnerable subgroups (men, low socioeconomic status, Black or Hispanic, severe diabetes, high comorbidity). We will employ a cutting-edge interrupted time series study design that approximates the estimates of randomized controlled trials. We will draw from a 12-year rolling cohort (2005-2017) of >60 million members insured by a large national health plan, with 30,000 diabetes patients who experience employer-mandated transitions to HSA-HDHPs. We will also conduct economic analyses from the employer and member perspectives of the impacts of $0-PDs and generously funded HSAs on total health care and out-of-pocket costs. Our findings will allow policy makers and employers to develop tailored, next-generation health insurance designs that optimize quality and equity for diabetes patients who are most vulnerable under HDHPs.

 描述(由申请人提供)：高免赔额健康计划(HDHP)保费较低，但要求患者支付大部分医疗保健的全额费用，直到达到每年1000至6000美元的免赔额。高密度脂蛋白在过去十年中迅速激增。符合健康储蓄账户(HSA)资格的HDHP是增长最快的HDHP安排，现在覆盖了14%的商业保险美国人。这些计划要求大多数医疗保健服务(包括药物)每年都有很高的免赔额，但允许向可用于医疗费用的账户缴纳税前费用。倡导者认为，让患者承担更大的成本将产生“活跃的消费者”，他们将寻求更高价值的医疗保健，并采取健康的行为，而批评者则担心，这些经济壁垒可能会减少获得所需医疗服务的机会。我们正在进行的糖尿病自然实验转化(NEXT-D)计划(5U58DP002719)中的项目已经确定，患有HSA-HDHPS的糖尿病患者在住院和坚持治疗慢性病的关键药物方面的降幅最大。尽管这些发现令人担忧，但联邦法规允许雇主通过两种机制来定制HSA-HDHP，这两种机制可以改善获得护理的机会：(1)通过“预防性药物清单”(0美元-PD)免除某些慢性药物的免赔额要求(即，药物对患者来说是0美元)，以及(2)慷慨资助HSA，以便员工支付更少的自付费用。因此，HSA-HDHP既是糖尿病患者的风险，也是雇主通过量身定做的成本分担减少来改善护理的机会。在本应用程序中，我们将检查HDHP设计中的这两个重要变化对糖尿病二级预防、高优先级护理、糖尿病并发症和成本的影响，包括总体上和弱势群体(男性、低社会经济地位、黑人或西班牙裔、严重糖尿病、高合并症)的影响。我们将采用接近随机对照试验估计值的尖端中断时间序列研究设计。我们将从一个大型国家健康计划承保的6000万名&gt；成员组成的12年滚动队列(2005-2017)中抽调，其中30,000名糖尿病患者经历了雇主强制过渡到HSA-HDHPS。我们亦会从雇主和会员的角度进行经济分析，分析零元私营医疗保险和慷慨资助的医疗津贴对整体医疗服务和自付成本的影响。我们的发现将使政策制定者和雇主能够开发定制的下一代医疗保险设计，以优化糖尿病患者的质量和公平性，这些患者最容易受到人类健康保险计划的影响。