Choice and Consequences: Health Care through a Private Health Insurance Exchange

描述（由申请人提供）：这里提出的工作利用来自私人健康保险交易所的详细索赔和登记数据，以了解更多关于选择健康计划的过程，当选择集很大时，以及这种选择如何影响随后的医疗保健需求。My Plan by MedicaSM是单一保险公司私人健康保险交易所的早期例子。我的医疗计划为雇主提供了一套多达20个福利计划的选择，雇员可以从中选择保险，由雇主的固定美元缴款补贴。2013年计划年度增加了一项重要的改进：除了选择因服务点成本分摊而异的计划外，员工现在还可以选择他们的提供商网络，从最初广泛的PPO网络或围绕垂直整合的医院和医生诊所系统建立的四个不同的提供商网络（“Medica ACO”）中选择一个。我们建议开发一个模型，这种复杂的健康计划的选择，并研究如何产生的成本分摊和供应商网络的特点影响医疗保健需求的几年后，选择。由于这种创新的Medica产品结合了提供者网络的差异以及服务点成本分摊，我们相信我们从这种模式中获得的关于健康计划选择及其后果的知识可以告知我们对2010年平价医疗法案下提供的公共交流的理解。 拟议工作的具体目标旨在支持AHRQ价值组合：具体目标1：确定预测2012年登记模式的成员特征，其中选项仅因福利设计而异。具体目标二：确定2013年和2014年入组模式的差异，当Medica ACO选项叠加在受益设计差异之上时。具体目标3：确定福利设计差异对未来护理提供模式的影响。具体目标4：确定Medica ACO注册对未来护理提供模式的影响。 拟议的工作是创新的，在以下几个方面：（1）我们利用访问详细的计划设计，员工成本分摊，注册和索赔数据的保险公司，以评估的影响，私人健康保险交易所推出的早期进入这个新市场。各种各样的雇主群体确保了计划设计和员工成本分摊的变化。(2)员工自付保费的外生变化提供了一种工具来控制计划设计的非随机选择。(3)我们异常丰富的关于提供者网络的数据使我们能够使用个人访问初级保健和专科保健提供者网络的历史来确定成员是否愿意转向新的“常规护理来源”，以节省保费。(4)我们能够纵向跟踪成员，以确定与计划设计相关的护理提供模式的变化。

DESCRIPTION (provided by applicant): The work proposed here leverages detailed claims and enrollment data from a private health insurance exchange to learn more about the process of choosing a health plan when the choice set is large, and how this choice affects subsequent health care demand. My Plan by MedicaSM is an early example of a single-insurer private health insurance exchange. My Plan by Medica offers employers a choice set of up to 20 benefit plans from which employees select coverage, subsidized by the employer's defined-dollar contribution. An important enhancement was added for the 2013 plan year: in addition to selecting plans that vary by point-of-service cost sharing, employees now also select their provider network, choosing from the original broad PPO network or one of four distinct provider networks ("Medica ACOs") built around vertically-integrated hospital and physician clinic systems. We propose to develop a model of this complex health plan choice, and examine how the resulting cost sharing and provider network characteristics impact health care demand in the years after that choice. Because this innovative Medica product incorporates differences in provider networks as well as point-of-service cost sharing, we believe the knowledge we gain from this model about health plan choice and its consequences can inform our understanding of the public exchanges to be offered under Affordable Care Act of 2010. The Specific Aims of the proposed work have been designed to support the AHRQ Value portfolio: Specific Aim 1: To identify the member characteristics that predict 2012 enrollment patterns, where options vary only by benefit design. Specific Aim 2: To identify the differences in 2013 and 2014 enrollment patterns, when Medica ACO options are layered on top of benefit design differences. Specific Aim 3: To identify the impact of benefit design differences on future patterns of care delivery. Specific Aim 4: To identify the impact of Medica ACO enrollment on future patterns of care delivery. The proposed work is innovative in the following ways: (1) We take advantage of access to detailed plan design, employee cost sharing, enrollment and claims data from the insurer to evaluate the impact of a private health insurance exchange put in place by an early entrant into this new market. The wide variety of employer groups assures variation in plan design and employee cost sharing. (2) Exogenous variation in employee out-of-pocket premiums provides an instrument to control for the non-random selection of plan design. (3) Our unusually rich data about provider networks allows us to use individuals' history of accessing primary care and specialty care provider networks to identify members' willingness to switch to a new "usual source of care" in order to save premium dollars. (4) We are able to follow members longitudinally to identify changes in patterns of care delivery associated with plan design.