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）已经发布了由《平价医疗法案》（ACA）创建的交易所风险调整规则和推荐的保费年龄结构，但正在推迟实施其他一些交易所规定。各州已经决定是自主经营交易所还是与联邦政府合作经营。各州在是否根据ACA扩大医疗补助方面也采取了广泛的政策立场，目前有20个州宣布反对扩大医疗补助。国家驱动的政策将在未来几年内为ACA政策环境奠定基础。在RO 1-MH 094290“医疗保健改革中的精神健康覆盖率”中，我们的团队评估了Exchange计划为精神健康和其他慢性疾病提供护理的激励措施，发现服务不足的激励措施对癌症和精神健康护理的影响最大。在一个主要的方法学发展中，MH 094290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”，这可以解决与风险调整相关的效率问题。到目前为止，我们的工作一直使用医疗支出小组调查（MEPS）。在这一竞争更新中，我们建议改进和扩展我们的方法，并将其应用于用于开发实际支付模型的非常大的数据集。我们计划完成两个目标：第一，构建一个模拟模型的健康保险交易所使用MEPS数据：a）确认存在不利的激励精神健康（和其他慢性疾病）的交易所根据当前的联邦政策;和B）应用约束回归技术，以解决选择激励的框架内提出的风险调整政策。其次，通过以下方式改进现有的风险调整方法：首先，使用大型MarketScan Exchange合格成年人群，该人群是使用MEPS Exchange人群选择和加权的，以便代表可能的Exchange参与者的支出和疾病分布;其次，考虑支付系统功能（计划设定保费和再保险）影响计划风险和激励;第三，将约束回归修复应用于与精神病和其他慢性疾病患者选择相关的激励。除了学术论文，Aim 2还将为成年人提供一个潜在的可实施的“最佳风险调整”模型，以纠正与选择相关的激励措施。

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.