Mental Health Coverage and Payment in Private Health Plans

私人健康计划中的心理健康承保和付款

• 批准号: 8694370
• 负责人: Thomas G. McGuire
• 金额: $ 61.56万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-09 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8694370
• 关键词: Accounting; Address; Adult; Affect; Age; Caring; Chronic; Chronic Disease; Data; Data Set; Development; District of Columbia; Economics; Ensure; Environment; Equilibrium; Evolution; Expenditure; Federal Government; Foundations; Health; Health Care Reform; Health Insurance; Health Planning; Health Status; Healthcare; Human; Improve Access; Incentives; Income; Insurance; Least-Squares Analysis; Legal; Life; Link; Liquid substance; Malignant Neoplasms; Managed Care; Marketing; Medicaid; Medical; Mental Health; Mental disorders; Methodology; Methods; Modeling; Modification; Paper; Participant; Persons; Policies; Population; Posture; Psyche structure; Quality of Care; Research; Research Personnel; Risk; Risk Adjustment; Role; Running; Services; Solutions; Structure; Substance abuse problem; Surveys; System; Techniques; United States Dept. of Health and Human Services; Weight; Work; base; design; federal policy; financial incentive; improved; models and simulation; parity; payment; public health relevance; risk sharing; success

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.

描述（由申请人提供）：卫生与公众服务部（HHS）发布了由《平价医疗法案》（ACA）和推荐的保费年龄结构创建的保险交易所的风险调整规则，但推迟了其他一些保险交易所条款的实施。各州已经决定是自主经营还是与联邦政府合作经营。在是否根据ACA扩大医疗补助方面，各州也采取了各种各样的政策姿态，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形成一个不稳定的ACA政策环境。在RO1-MH094290“医疗改革中的精神健康覆盖”中，我们的团队评估了为精神健康和其他慢性疾病提供护理的交流计划的动机，发现服务不足的动机在癌症和精神卫生保健方面是最强的。在一项主要的方法发展中，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，我们的工作一直使用医疗支出小组调查（MEPS）。在这种竞争性的更新中，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付费模式的非常大的数据集。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)确认基于当前联邦政策的交易所中存在对心理健康（和其他慢性疾病）的不利激励；b)在建议的风险调整政策框架内应用约束回归技术来解决选择激励问题。其次，改进现有的风险调整方法：首先，使用大型MarketScan Exchange符合条件的成年人口，使用MEPS Exchange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，核算影响计划风险和激励的支付系统特征（计划设定保费和再保险）；第三，对那些患有精神疾病和其他慢性疾病的人，应用约束回归修正与选择有关的激励。除了学术论文之外，目标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。