Mental Health Coverage and Payment in Private Health Plans

描述(由申请人提供)：卫生与公众服务部(HHS)已经发布了根据《平价医疗法案》(ACA)创建的交易所的风险调整规则和建议的保费年龄结构，但推迟了其他一些交易所条款的实施。各州已经决定是自主运营交易所，还是与联邦政府合作运营。对于是否扩大ACA下的医疗补助，各州也采取了广泛的政策姿态，目前有20个州宣布反对扩大医疗补助。国家主导的政策将在未来几年设定一个灵活的ACA政策环境。在RO1-MH094290“医疗保健改革中的精神健康保险”一书中，我们的团队评估了针对交换计划的激励措施，以提供针对精神健康和其他慢性病的护理，发现对服务不足的激励措施对癌症和精神卫生保健的激励作用最强。在一个主要的方法论发展中，MH094290确定了对传统风险调整方法的简单修改，即对最小二乘回归施加“约束”，可以解决与风险调整相关的效率问题。到目前为止，我们的工作使用了医疗支出小组调查(MEPS)。在这次竞争性的更新中，我们建议改进和扩展我们的方法，并将它们应用于用于开发实际支付模型的非常大的数据集。我们计划实现两个目标：首先，使用MEPS数据构建一个健康保险交易所的模拟模型，以：a)根据当前的联邦政策，确认交易所中存在对精神健康(和其他慢性病)不利的激励因素；b)在拟议的风险调整政策的框架内，应用约束回归技术来解决选择激励问题。第二，改进现有的风险调整方法：第一，使用大型MarketScan Exchange合格成年人口，该人口使用欧洲议会议员交易所人口进行选择和加权，以代表可能的交易所参与者的支出和疾病分布；第二，考虑影响计划风险和激励措施的支付系统特征(计划设定的保费和再保险)；第三，对与选择患有精神疾病和其他慢性病的人进行选择相关的激励措施应用约束回归修正。除了学术论文外，AIM 2还将为成年人制作一个潜在的可实施的“最佳风险调整”模型，纠正与选择相关的激励因素。

DESCRIPTION (provided by applicant): The Department of Health and Human Services (HHS) has released rules for risk adjustment in Exchanges created by the Affordable Care Act (ACA) and a recommended premium age structure, but is delaying the implementation of some other Exchange provisions. States have decided whether to run Exchanges autonomously or in partnership with the Federal government. States are also taking a wide range of policy postures on whether to expand Medicaid under the ACA, with 20 states currently declaring opposition to Medicaid expansion. State-driven policies will set a fluid ACA policy environment for years to come. In RO1-MH094290, "Mental Health Coverage in Health Care Reform," our team assessed incentives for Exchange plans to supply care for mental health and other chronic conditions, finding that incentives for underservice were strongest for cancer and mental health care. In a major methodological development, MH094290 identified a simple modification of conventional risk adjustment methods, namely, imposing "constraints" on least-squares regressions, that can address efficiency problems associated with risk adjustment. Our work so far has used the Medical Expenditure Panel Survey (MEPS). In this competing renewal we propose to refine and extend our methods and to apply them to the very large data sets used for development of actual payment models. We plan to accomplish two aims: First, construct a simulation model of a Health Insurance Exchange using MEPS data to: a) confirm the presence of adverse incentives for mental health (and other chronic illnesses) in Exchanges based on current federal policy; and b) apply constrained regression techniques to address selection incentives within the framework of proposed risk adjustment policy. Second, improve on existing risk- adjustment methodology by: first, using a large MarketScan Exchange eligible adult population that is selected and weighted using the MEPS Exchange population so as to be representative of the spending and illness distribution of likely Exchange participants; second, accounting for payment system features (plan-set premiums and reinsurance) affecting plan risk and incentives; and third, applying the constrained-regression fix for incentives related to selection against those with mental and other chronic illnesses. In addition to academic papers, Aim 2 will produce a potentially implementable "optimal risk adjustment" model for adults that corrects selection-related incentives.