Consumer-Directed Health Plans and Substance Use Disorder Treatment

以消费者为导向的健康计划和药物滥用障碍治疗

• 批准号: 10208842
• 负责人: Colleen L Barry
• 金额: $ 67.75万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10208842
• 关键词: Affect; Automobile Driving; Cardiovascular Diseases; Caring; Characteristics; Chronic; Clinical; Communities; Continuity of Patient Care; Cost Sharing; Custom; Data; Databases; Decision Making; Deductibles; Diabetes Mellitus; Enrollment; Evidence based treatment; Health; Health Insurance; Healthcare; High Prevalence; Incentives; Individual; Insurance; Logistic Regressions; Medical; Mental Depression; Mental disorders; Morbidity - disease rate; Movement; Nicotine Dependence; Outcome; Public Health; Publishing; Research; Risk; Savings; Source; Substance Use Disorder; Taxes; United States; Vulnerable Populations; base; comorbidity; cost; design; evidence base; health care service; health plan; interest; medication-assisted treatment; member; mortality; opioid epidemic; response; substance use treatment; tool; treatment comparison

ABSTRACT Enrollment in consumer-directed health plans (CDHPs) – plans with high deductibles and tax-advantaged savings accounts – is increasing rapidly. In 2015, 25% of workers with employer-sponsored health insurance were enrolled in CDHPs, and CDHPs are the dominant plan type offered through individual and small group Marketplace plans. When examining the effect of CDHPs on health conditions with both emergent and chronic components, determining the effect a priori can be difficult. Indeed, CDHPs have been shown to reduce health care spending in many contexts but minimal CDHP effects have been found when examining care with inelastic demand. Despite the high prevalence of substance use disorders (SUD) in the U.S., there is little published research analyzing the impact of CDHPs on those with SUD. Previous research on CDHPs suggests that vulnerable populations, including those with chronic health conditions, are at the greatest risk of making poor decisions in response to higher cost sharing. This evidence raises concerns about the potential effects of CDHPs for individuals with SUD since these conditions are most effectively managed as chronic conditions, often co-occur with mental illness and other chronic medical conditions, and can be costly. Furthermore, given that SUD is vastly under-treated and access to evidence-based SUD treatments (e.g., medication-assisted treatment) is severely limited in many communities, the shift toward CDHPs might be creating further barriers to SUD identification, treatment initiation and the continuity of care. Alternatively, CDHPs could drive more value-based health care decision-making, leading to increased use of evidence-based SUD treatments. Using customized commercial insurance data from the Truven Health MarketScan Database (2011-2018) with new claims-derived benefit design information, we propose to study how the shift toward CDHPs affects individuals with SUD. First, we will identify the demographic and care utilization characteristics of individuals with SUD choosing to enroll in CDHPs, and of those with SUD subsequently opting to disenroll from CDHPs (Aim 1). Second, we will compare the effects of the decision to offer a CDHP option to only offering traditional plan choices on SUD treatment utilization, including use of medication-assisted treatment (Aim 2). Third, we will compare the effects of the decision to offer a CDHP option to only offering traditional plan choices on treatment for diabetes, cardiovascular disease, depression and nicotine dependence among enrollees with and without a co-occurring SUD (Aim 3). The proposal's significance lies in our ability to produce new information on whether the movement toward enrollment in CDHPs is exacerbating under-treatment of SUD or driving greater use of value-based care. In the context of the opioid epidemic and broader clinical and societal challenges in connecting individuals with SUD with evidence-based care, it is critical to understand whether and how incentives in the insurance market encouraging enrollment in high deductible plans with savings accounts are affecting initiation of and continuation in evidence-based SUD treatment.

摘要 投保以消费者为导向的健康计划(CDHP)--免赔额高且享受税收优惠的计划 储蓄账户--正在迅速增加。2015年，25%的员工拥有雇主赞助的医疗保险 我们都参加了CDHP，并且CDHP是通过个人和小团体提供的主要计划类型 市场计划。在研究慢性肝炎和急慢性肝炎对健康状况的影响时 组件，先验地确定效果可能是困难的。事实上，CDHPS已被证明会降低健康 在许多情况下的护理支出，但在检查护理时，CDHP的影响最小 缺乏弹性的需求。尽管物质使用障碍(SUD)在美国很普遍，但几乎没有 已发表的研究分析了CDHPS对SUD患者的影响。之前对CDHP的研究表明 脆弱人群，包括那些患有慢性病的人，面临着最大的风险 对更高的成本分担做出糟糕的决定。这一证据引起了人们对以下潜在影响的担忧 CDHP适用于患有SUD的个人，因为这些情况作为慢性病最有效地管理， 通常与精神疾病和其他慢性疾病并存，而且可能代价高昂。此外，在给定的 该SUD严重得不到治疗，并可获得循证的SUD治疗(例如，药物辅助 治疗)在许多社区受到严重限制，向CDHP的转变可能会造成进一步的障碍 对SUD的识别、治疗的启动和护理的连续性。或者，CDHP可以驾驶更多 以价值为基础的卫生保健决策，导致更多地使用循证的SUD治疗。vbl.使用 Truven Health MarketScan数据库中的定制商业保险数据(2011-2018) 索赔衍生的福利设计信息，我们建议研究向CDHP的转变如何影响个人 加了苏德。首先，我们将确定SUD患者的人口统计和护理利用特征 选择参加CDHPS的人，以及后来选择退出CDHPS的SUD患者(目标1)。 其次，我们将比较决定提供CDHP选项和仅提供传统计划的效果 关于SUD治疗利用的选择，包括使用药物辅助治疗(目标2)。第三，我们将 比较决定提供CDHP方案与只提供传统治疗方案的效果 治疗糖尿病、心血管疾病、抑郁症和尼古丁依赖 共同发生的SUD(目标3)。该提案的意义在于我们有能力提供新的信息 加入CDHP的运动正在加剧对SUD的不充分治疗或推动更多的人使用 以价值为基础的护理。在阿片类药物流行以及#年更广泛的临床和社会挑战的背景下 将患有SUD的患者与循证护理联系起来，了解是否以及如何进行至关重要 保险市场鼓励参加有储蓄账户的高免赔额计划的激励措施是 影响循证SUD治疗的开始和持续。

项目成果

The impact of HDHPs on service use and spending for substance use disorders.

• DOI: 10.37765/ajmc.2022.89250
• 发表时间: 2022-10
• 期刊: The American journal of managed care
• 作者: Eisenberg MD;Kennedy-Hendricks A;Schilling C;Busch AB;Huskamp HA;Stuart EA;Meiselbach MK;Barry CL
• 通讯作者: Barry CL