Analysis of a Tiered Clinic Cost-sharing Health Insurance Benefit Design

项目概要/摘要 美国与其他发达国家相比， 这些国家表明，该国的卫生系统一直效率低下。目前的供应商支付系统通常 无意中惩罚而不是奖励以较低成本产生更好健康结果的提供者。一 提高效率的方法是让消费者了解更高质量，更低成本的供应商， 选择他们的经济激励。分层费用分摊就是这样一种医疗保险福利设计， 信息和激励措施，从而奖励更大的病人数量的有效提供者。 这项研究将探讨美国运行时间最长的分层成本分摊系统之一-- 州雇员团体保险计划明尼苏达州优势健康计划（SEGIP）。SEGIP计划涵盖 全州有13万名州政府雇员及其家属，其中包括密集的城市中心， 偏远的农村地区。每年，SEGIP员工都会选择一家初级保健“看门人”诊所， 协调他们的整体护理，包括转诊到专家和医院，以及药物。 诊所根据其风险调整后的护理总成本进行评估，并被置于四个成本分摊等级之一。的 费用分摊差别很大，使消费者有强烈的动机选择费用较低的诊所。 我们已经解决了一些关于消费者对研究资助的分层反应的初步问题， 罗伯特·伍德约翰逊和多纳休基金会。在本提案中，我们将进入下一步， 调查诊所负责人对纳入分层费用分摊制度的反应。我们将使用两个定量 和定性方法作为三角测量混合方法设计的一部分。我们的研究将评估 诊所领导人在应对纳入分层成本分摊系统时，他们如何从战略上思考 关于分层成本分担，以及他们在试图更有效地实践时面临的障碍。

PROJECT SUMMARY/ABSTRACT The discrepancy between health spending and outcomes in the United States compared to other developed countries suggests persistent inefficiency in the nation's health systems. Current provider payment systems often inadvertently penalize, rather than reward, providers who produce better health outcomes at lower cost. One approach to improving efficiency is to give consumers information about higher-quality, lower-cost providers and financial incentives to choose them. Tiered cost-sharing is one such health insurance benefit design that provides information and incentives to patients, thereby rewarding efficient providers with greater patient volume. This study will examine one of the longest-running tiered cost sharing systems in the United States – the State Employee Group Insurance Program Minnesota Advantage health plan (SEGIP). The SEGIP plan covers 130,000 State employees and their dependents across the state, which includes dense urban centers and remote rural areas. Each year SEGIP employees select a primary care “gatekeeper” clinic that is responsible for coordinating the entirety of their care, including referrals to specialists and hospitals, and pharmaceuticals. Clinics are assessed on their risk-adjusted total cost of care and placed into one of four cost-sharing tiers. The cost-sharing differentials are substantial, giving consumers a strong incentive to choose lower-cost clinics. We have addressed some of the initial questions regarding consumer responses to tiering in research funded by the Robert Wood Johnson and Donaghue Foundations. In this proposal, we move to the next step to investigate responses of clinic leaders to inclusion in a tiered cost-sharing system. We will use both quantitative and qualitative methods as part of a triangulation mixed methods design. Our research will assess what actions clinic leaders have taken in response to inclusion in a tiered cost-sharing system, how they think strategically about tiered cost-sharing, and what barriers they face as they try to practice more efficiently.