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

项目概要/摘要 这个职业发展奖将建立金伯利纳拉因博士，医学博士，博士，公共卫生硕士，作为一个独立的 研究人员专注于评估健康，老龄化和医疗保健成本的影响，社会，经济和 健康政策/方案，在低社会经济地位的成年人（SES），使用两个准实验 和微观模拟方法。这个KO 8奖项将为她提供发展专业知识所需的支持 在3个领域：1）行政索赔和纵向数据分析; 2）老龄化流行病学和SES差异 3）微观模拟和成本效益分析。不依从药物和治疗 由于成本的建议是成年人健康和残疾的SES梯度的重要驱动力 1基于价值的保险设计（VBID）策略，可降低糖尿病患者的自付（OOP）成本， 治疗糖尿病和相关病症（高脂血症和高血压）以及疾病的药物 管理预约（初级保健和内分泌学家访问）已被证明可以改善药物治疗 坚持和心血管风险因素控制，在私人保险的个人。然而， 关于VBID在低收入成人2型糖尿病患者中的作用。2.3了解VBID的效果 在低收入成年人中，这一点很重要，因为他们面临与2型糖尿病相关的最高疾病负担。 糖尿病，他们可能特别响应VBID鉴于其较高水平的价格敏感性，相对于 4然而，他们也可能面临费用以外的障碍，如健康知识水平低， 使得VBID在该人群中的影响不确定。此外，重要的是要知道是否有任何 考虑到既往研究，在基线药物依从性水平之间，VBID应答的异质性 在基线药物依从性水平最低的亚组中显示了最大的效应幅度。 最后，VBID对低收入成年人的健康，残疾和医疗保健费用的长期影响， 糖尿病尚未得到研究。Narain博士将通过检查VBID在这一人群中的影响， 糖尿病健康计划（DHP）的影响，雇主赞助的VBID，由Unitedhealthcare提供， 低收入人群（工资<30，000美元），2型糖尿病成人。该项目将利用现有数据 一组200多名雇主，住在加州大学洛杉矶分校，以估计短期和长期的影响， DHP，使用准实验方法和微观模拟建模方法，分别。具体 拟议项目的目的是：1）估计DHP对（A）药物依从性的影响，（B） 心血管危险因素（HbA 1c和LDL）和（C）低收入成人中的医疗保健利用 2型糖尿病; 2）比较不同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 2型糖尿病患者的预期寿命和医疗保健费用。该项目将提供 为健康保险福利设计提供信息和改善健康公平性的关键见解。

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.