Analysis of a Tiered Clinic Cost-sharing Health Insurance Benefit Design

项目摘要/摘要 与其他发达国家相比，美国的医疗支出和结果之间的差异 这些国家表明，该国的卫生系统持续低效。目前的供应商支付系统通常 无意中惩罚而不是奖励那些以较低成本产生更好健康结果的提供者。一 提高效率的方法是向消费者提供有关更高质量、更低成本的供应商和 选择它们的经济激励措施。分级费用分摊就是这样一种健康保险福利设计，它提供了 为患者提供信息和激励，从而以更大的患者数量回报高效的提供者。 这项研究将考察美国运行时间最长的分级成本分担系统之一- 州雇员团体保险计划明尼苏达州优势健康计划(SEGIP)。SEGIP计划包括 全州13万名州雇员及其家属，包括密集的城市中心和 偏远的农村地区。每年，SEGIP员工都会选择一家初级保健“看门人”诊所，负责 协调他们的整个护理，包括转诊到专家和医院，以及药品。 根据风险调整后的总护理成本对诊所进行评估，并将其归入四个费用分担级别之一。这个 成本分担差异很大，这给了消费者选择成本较低的诊所的强烈动机。 我们已经解决了一些关于消费者对研究资助的分层的反应的初步问题 罗伯特·伍德·约翰逊和多纳格基金会。在这项提案中，我们进入下一步，以 调查诊所领导对纳入分级费用分摊系统的反应。我们将使用这两个数量 并将定性方法作为三角剖分混合方法设计的一部分。我们的研究将评估哪些行动 诊所领导对纳入分级成本分担系统的回应，以及他们如何从战略上思考 关于分级成本分担，以及他们在试图更有效地练习时面临的障碍。

PROJECT SUMMARY/ABSTRACT The discrepancy between health spending and outcomes in the United States compared to other developed countries suggests persistent inefficiency in the nation's health systems. Current provider payment systems often inadvertently penalize, rather than reward, providers who produce better health outcomes at lower cost. One approach to improving efficiency is to give consumers information about higher-quality, lower-cost providers and financial incentives to choose them. Tiered cost-sharing is one such health insurance benefit design that provides information and incentives to patients, thereby rewarding efficient providers with greater patient volume. This study will examine one of the longest-running tiered cost sharing systems in the United States – the State Employee Group Insurance Program Minnesota Advantage health plan (SEGIP). The SEGIP plan covers 130,000 State employees and their dependents across the state, which includes dense urban centers and remote rural areas. Each year SEGIP employees select a primary care “gatekeeper” clinic that is responsible for coordinating the entirety of their care, including referrals to specialists and hospitals, and pharmaceuticals. Clinics are assessed on their risk-adjusted total cost of care and placed into one of four cost-sharing tiers. The cost-sharing differentials are substantial, giving consumers a strong incentive to choose lower-cost clinics. We have addressed some of the initial questions regarding consumer responses to tiering in research funded by the Robert Wood Johnson and Donaghue Foundations. In this proposal, we move to the next step to investigate responses of clinic leaders to inclusion in a tiered cost-sharing system. We will use both quantitative and qualitative methods as part of a triangulation mixed methods design. Our research will assess what actions clinic leaders have taken in response to inclusion in a tiered cost-sharing system, how they think strategically about tiered cost-sharing, and what barriers they face as they try to practice more efficiently.