Decision Making Challenges and Needs for Health Insurance Exchange Enrollees

健康保险交易所参与者的决策挑战和需求

• 批准号: 9322331
• 负责人: Alison A Galbraith
• 金额: $ 39.93万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9322331
• 关键词: Decision; Making; Challenges; Needs; Health

PROJECT SUMMARY/ABSTRACT Navigating health insurance options is daunting, particularly for consumers who must purchase coverage on their own in the non-group market. Much is at stake in these decisions, which determine not only the adequacy of financial risk protection but may also have important consequences for health care access and health, especially for vulnerable populations. Health insurance exchanges can facilitate plan selection by creating a marketplace to choose among qualified health plans and by providing decision support tools to help consumers optimize their choices. The goal of the proposed project is to understand the downstream experiences of enrollees in the non-group market after choosing a plan, and to identify those at highest risk for adverse outcomes so that strategies can be developed to address their needs. The project’s specific aims are to: 1) examine how exchange enrollees differ from those who enroll in non-group plans outside the exchange in terms of socioeconomic and clinical characteristics, decision support tools used, and type of plan chosen; 2) explore whether use of particular tools during enrollment in non-group exchange and non-exchange plans is associated with type of plan chosen and better downstream health care outcomes (e.g. avoiding delayed/forgone care and financial burden due to out-of-pocket costs, and being able to continue to see one’s prior provider); 3) identify enrollees who prove to be at highest risk for adverse downstream outcomes in non- group plans using characteristics that can be measured at enrollment; and 4) understand challenges enrollees face choosing and using insurance benefits and the types of information and tools needed during and after enrollment. We will use a longitudinal design to follow a cohort of individuals and families enrolling in non- group plans from a large insurance carrier in and outside health insurance exchanges during 2017 open enrollment in four New England states. We will gather baseline survey data about enrollee characteristics and decision making tools used to choose the plan. After 12 months of enrollment, we will collect follow-up survey data about downstream outcomes, and obtain claims data on utilization and costs in the plan. The research team’s expertise in health policy, health services research, economics, and clinical medicine will foster a policy-relevant, scientifically rigorous R01 in an environment with a track record of academic research using health plan data and populations. This project provides a unique and timely opportunity to rigorously study the impact of unprecedented changes to the non-group insurance market on health plan decision making, access, and affordability. This project will provide crucial data for policy makers and health plans to inform the design of exchanges and decision support tools to enable consumers to choose high quality health insurance coverage that minimizes costs and promotes use of high-value health care.

项目总结/摘要 浏览健康保险选项是令人生畏的，特别是对于必须购买保险的消费者来说， 在非集团市场上。这些决定关系重大，不仅决定了 金融风险保护的充分性，但也可能对获得医疗保健产生重要影响， 健康，特别是弱势群体。健康保险交易所可以通过以下方式促进计划选择： 创建一个市场来选择合格的健康计划，并提供决策支持工具，以帮助 消费者优化选择。该项目的目标是了解下游 选择计划后，参与者在非团体市场的经验，并确定那些风险最高的人， 因此，我们必须考虑到不利的结果，以便制定战略来满足他们的需求。该项目的具体目标是 目的：1）检查Exchange注册者与在Exchange之外注册非团体计划的注册者有何不同 在社会经济和临床特征、使用的决策支持工具和选择的计划类型方面; 2） 探讨在非团体交换和非交换计划的注册过程中使用特定工具是否 与选择的计划类型和更好的下游医疗保健结果（例如，避免 由于自付费用而延迟/放弃护理和经济负担，并且能够继续看到自己的 先前的提供者）; 3）确定被证明在非医疗保健领域中处于不利下游结果的最高风险的登记者。 使用可以在注册时测量的特征的组计划;以及4）理解注册者的挑战 面对选择和使用保险福利以及期间和之后所需的信息和工具的类型 招生我们将使用纵向设计来跟踪一组在非公立学校注册的个人和家庭。 集团计划从一个大型保险公司在健康保险交易所内外2017年开放 在四个新英格兰州注册。我们将收集有关注册者特征的基线调查数据， 用于选择计划的决策工具。入组12个月后，我们将收集随访调查 下游结果的数据，并获得计划中利用率和成本的索赔数据。研究 团队在卫生政策、卫生服务研究、经济学和临床医学方面的专业知识将促进 政策相关的，科学严谨的R 01在一个环境中与学术研究的跟踪记录，使用 保健计划数据和人口。该项目提供了一个独特而及时的机会， 非团体保险市场前所未有的变化对健康计划决策，准入， 和可负担性。该项目将为决策者和卫生计划提供重要数据， 交易所和决策支持工具，使消费者能够选择高质量的健康保险 最大限度地降低成本和促进高价值医疗保健的使用。