The Implications of Insurance Benefit Design for Health and Disability Among Low Income Adults with Diabetes.

项目摘要/摘要 这个职业发展奖将确立金伯利·纳拉因博士，医学博士，博士，公共卫生硕士的独立 调查人员侧重于评估健康、老龄化和医疗成本对社会、经济和社会的影响 在低社会经济地位(SES)的成年人中，使用准试验性的 和微模拟方法。这个KO8奖将为她提供发展专业知识所需的支持 在3个领域：1)行政索赔分析和纵向数据；2)老龄化、流行病学和社会保障差异 3)微观模拟和成本效益分析。不坚持服药和治疗 由于费用而提出的建议是成年人健康和残疾状况的SES梯度的一个重要驱动因素 使用Diabetes.1基于价值的保险设计(VBID)策略，降低以下项目的自付(OOP)成本 治疗糖尿病及相关疾病(高脂血症和高血压)以及疾病的药物 管理预约(初级保健和内分泌医生就诊)已被证明能改善用药情况。 私人保险个人的依从性和心血管危险因素控制。然而，人们对此知之甚少 关于VBID对低收入成人2型糖尿病的影响。2，3了解VBID的影响 在低收入成年人中很重要，因为他们面临着与2型相关的最高疾病负担 糖尿病，他们可能对VBID特别敏感，因为他们对价格的敏感性比 4然而，他们也可能面临成本之外的障碍，如健康素养低， 这使得VBID在这一人群中的影响不确定。此外，重要的是要知道是否有 VBID反应的异质性，跨越基线用药依从性水平，考虑到先前的研究 在基线服药依从性水平最低的亚组中显示出最大的影响幅度。 最后，VBID对低收入成年人的健康、残疾和医疗费用的长期影响 糖尿病仍未得到调查。Narain博士将通过研究VBID在这些人群中的影响来阐明VBID的影响 由UnitedHealthcare提供的雇主赞助的VBID糖尿病健康计划(DHP)的影响， 在低收入人群(年薪30,000美元)中，成人患有2型糖尿病。该项目将利用现有数据 由200多名雇主组成的集合，位于加州大学洛杉矶分校，以评估 DHP，分别采用准实验方法和微观模拟建模方法。具体的 拟议项目的目的是1)评估DHP对(A)用药依从性的影响，(B) 心血管危险因素(糖化血红蛋白和低密度脂蛋白)和(C)低收入成人2型糖尿病的医疗保健利用 2)比较药物依从性基线水平的DHP治疗效果；3) 估计DHP相对于标准健康保险计划对无残疾生活的长期影响 老年低收入成人2型糖尿病患者的预期和医疗费用。该项目将提供 提供医疗保险福利设计和改善健康公平的关键见解。

Project Summary/Abstract This career development award will establish Dr. Kimberly Narain, MD, PhD, MPH, as an independent investigator focused on evaluating the health, aging and healthcare costs implications of social, economic and health policies/programs, among adults with low socioeconomic status (SES), using both quasi-experimental and microsimulation approaches. This KO8 award will provide her the support she needs to develop expertise in 3 areas 1) analysis of administrative claims and longitudinal data; 2) aging epidemiology and SES disparities in aging; and 3) microsimulation and cost-benefit analysis. Non-adherence to medications and treatment recommendations due to costs is an important driver of the SES gradient in health and disability among adults with diabetes.1 Value Based Insurance Design (VBID) strategies that reduce out-of-pocket (OOP) costs for medications to treat diabetes and associated conditions (hyperlipidemia and hypertension) as well as disease management appointments (primary care and endocrinologist visits) have been shown to improve medication adherence and cardiovascular risk factor control, among privately insured individuals. However, little is known about the effects of VBID among low income adults with Type 2 diabetes. 2,3 Understanding the effect of VBID among low income adults is important because they face the highest disease burden associated with Type 2 diabetes and they may be particularly responsive to VBID given their higher level of price sensitivity, relative to higher income individuals.4 However, they may also face barriers outside of costs such as low health literacy, making the effects of VBID among this population uncertain. Additionally, it is important to know if there is any heterogeneity in response to VBID, across baseline medication adherence levels, given that prior studies have shown the largest effect magnitudes among subgroups with the lowest baseline medication adherence levels. Lastly, the long-term impacts of VBID on the health, disability and healthcare costs of low income adults with diabetes remains uninvestigated. Dr. Narain will clarify the impact of VBID among this population by examining the impact of the Diabetes Health Plan (DHP), an employer-sponsored VBID, offered by Unitedhealthcare, among low income (salaries < $30,000), adults with Type 2 diabetes. This project will leverage an existing data set of more than 200 employers, housed at UCLA, to estimate both the short and long-term impacts of the DHP, using quasi-experimental methods and a microsimulation modeling approach, respectively. The specific aims of the proposed project are to 1) Estimate the impact of the DHP on (A) medication adherence, (B) cardiovascular risk factors (HbA1c and LDL) and (C) healthcare utilization among low income adults with Type 2 diabetes; 2) Compare DHP treatment effects across baseline levels of medication adherence and 3) Estimate the long-term impact of the DHP, relative to standard health insurance plans, on disability-free life expectancy and healthcare costs among aging low income adults with Type 2 diabetes. The project will provide key insight for informing health insurance benefit design and improving health equity.