Decision Making Challenges and Needs for Health Insurance Exchange Enrollees

项目摘要/摘要 导航医疗保险选项是令人望而生畏的，特别是对于必须在 他们自己在非集团市场。这些决定事关重大，不仅决定了 金融风险保护的充分性，但也可能对获得医疗保健和 健康，特别是弱势群体的健康。健康保险交易所可以通过以下方式促进计划选择 创建一个可在合格的健康计划中进行选择的市场，并提供决策支持工具来帮助 消费者优化了他们的选择。拟议项目的目标是了解下游 参保人在选择计划后进入非团体市场的经验，并确定谁是风险最高的人 造成不利后果，以便能够制定战略来满足他们的需求。该项目的具体目标是 至：1)检查交易所参与者与交易所以外的非团体计划的参与者有何不同 就社会经济和临床特征、所使用的决策支持工具和选择的计划类型而言；2) 探讨在非集团交换计划和非交换计划投保期间使用特定工具是否 与选择的计划类型和更好的下游医疗保健结果相关(例如，避免 由于自付费用而延迟/放弃护理和经济负担，并能够继续看到自己的 以前的供应商)；3)确定被证明为在非 使用可在注册时衡量的特征的团体计划；以及4)了解挑战参与者 面对选择和使用保险福利以及在期间和之后需要的信息和工具的类型 招生。我们将使用纵向设计来跟踪参加非 集团计划2017年由一家大型保险公司在国内外医疗保险交易所开业 在新英格兰的四个州注册。我们将收集有关参赛者特征和 用于选择计划的决策工具。在注册12个月后，我们将收集跟踪调查 关于下游结果的数据，并获得计划中关于使用率和成本的索赔数据。这项研究 团队在卫生政策、卫生服务研究、经济学和临床医学方面的专业知识将培养 在具有学术研究记录的环境中使用与政策相关、科学严谨的R01 健康计划数据和人口。这个项目提供了一个独特和及时的机会，让我们认真研究 非团体保险市场发生前所未有的变化对健康计划决策、准入、 和可负担性。该项目将为政策制定者和健康计划提供关键数据，为设计提供参考 交易所和决策支持工具，让消费者选择高质量的医疗保险 将成本降至最低并促进使用高价值医疗保健的覆盖范围。

PROJECT SUMMARY/ABSTRACT Navigating health insurance options is daunting, particularly for consumers who must purchase coverage on their own in the non-group market. Much is at stake in these decisions, which determine not only the adequacy of financial risk protection but may also have important consequences for health care access and health, especially for vulnerable populations. Health insurance exchanges can facilitate plan selection by creating a marketplace to choose among qualified health plans and by providing decision support tools to help consumers optimize their choices. The goal of the proposed project is to understand the downstream experiences of enrollees in the non-group market after choosing a plan, and to identify those at highest risk for adverse outcomes so that strategies can be developed to address their needs. The project’s specific aims are to: 1) examine how exchange enrollees differ from those who enroll in non-group plans outside the exchange in terms of socioeconomic and clinical characteristics, decision support tools used, and type of plan chosen; 2) explore whether use of particular tools during enrollment in non-group exchange and non-exchange plans is associated with type of plan chosen and better downstream health care outcomes (e.g. avoiding delayed/forgone care and financial burden due to out-of-pocket costs, and being able to continue to see one’s prior provider); 3) identify enrollees who prove to be at highest risk for adverse downstream outcomes in non- group plans using characteristics that can be measured at enrollment; and 4) understand challenges enrollees face choosing and using insurance benefits and the types of information and tools needed during and after enrollment. We will use a longitudinal design to follow a cohort of individuals and families enrolling in non- group plans from a large insurance carrier in and outside health insurance exchanges during 2017 open enrollment in four New England states. We will gather baseline survey data about enrollee characteristics and decision making tools used to choose the plan. After 12 months of enrollment, we will collect follow-up survey data about downstream outcomes, and obtain claims data on utilization and costs in the plan. The research team’s expertise in health policy, health services research, economics, and clinical medicine will foster a policy-relevant, scientifically rigorous R01 in an environment with a track record of academic research using health plan data and populations. This project provides a unique and timely opportunity to rigorously study the impact of unprecedented changes to the non-group insurance market on health plan decision making, access, and affordability. This project will provide crucial data for policy makers and health plans to inform the design of exchanges and decision support tools to enable consumers to choose high quality health insurance coverage that minimizes costs and promotes use of high-value health care.