State Insurance Exchanges Face Challenges In Offering Standardized Choices Alongside Innovative Value-Based Insurance

Corlette, Sabrina; Downs, David H.; Monahan, Christine H.; Yondorf, Barbara

doi:10.1377/hlthaff.2012.1072

Cited by 7 publications

(3 citation statements)

References 5 publications

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“…Thus, this increase in cost‐sharing is less controversial and less complex to employ than in situations where treatments must be authorized by physicians. Some state programmes have tied higher cost‐sharing to preference‐sensitive interventions, a strategy that is trying to orient cost‐sharing to interventions of questionable clinical value.…”

Section: Discussionmentioning

confidence: 99%

Assessing social values for California's efforts to reduce the overuse of unnecessary medical care

Perez

Backman

Ginsburg

2017

Health Expectations

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BackgroundA partnership of large health‐care purchasers created a workgroup to reduce the overuse of harmful and wasteful medical care in California.ObjectiveEmploy a civic engagement process to identify the social values important to the public in considering different strategies to reduce overuse.InterventionUse of deliberation techniques for 3 case examples that explore possible strategies: physician oversight, physician compensation, increased patient cost‐sharing or taking no definitive action.ResultsFive themes were identified, including strong support for physicians’ leadership role to reduce overuse; nuanced enthusiasm for increasing patient cost‐sharing to discourage excessive demand; and marked disapproval of physician compensation as a motivator.ConclusionMost but not all of the perspectives voiced by participants are congruent with efforts to reduce overuse that is being initiated or discussed at the state, provider and health plan level. As health‐care policymakers and leaders consider more targeted approaches to reducing overuse, these findings will inform decision‐making.

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Section: Discussionmentioning

confidence: 99%

Assessing social values for California's efforts to reduce the overuse of unnecessary medical care

Perez

Backman

Ginsburg

2017

Health Expectations

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“…enacting tort reform; and many other strategies. 44,45 Legislation 1. State governments should take steps to make the knowledge of prices for services at various institutions readily available to the public and primary care offices.…”

Section: Insurance Company Administrative Policiesmentioning

confidence: 99%

High-Deductible Health Plans

Long¹,

Berman²,

Brandt³

et al. 2014

Pediatrics

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High-deductible health plans (HDHPs) are insurance policies with higher deductibles than conventional plans. The Medicare Prescription Drug Improvement and Modernization Act of 2003 linked many HDHPs with tax-advantaged spending accounts. The 2010 Patient Protection and Affordable Care Act continues to provide for HDHPs in its lower-level plans on the health insurance marketplace and provides for them in employer-offered plans. HDHPs decrease the premium cost of insurance policies for purchasers and shift the risk of further payments to the individual subscriber. HDHPs reduce utilization and total medical costs, at least in the short term. Because HDHPs require out-of-pocket payment in the initial stages of care, primary care and other outpatient services as well as elective procedures are the services most affected, whereas higher-cost services in the health care system, incurred after the deductible is met, are unaffected. HDHPs promote adverse selection because healthier and wealthier patients tend to opt out of conventional plans in favor of HDHPs. Because the ill pay more than the healthy under HDHPs, families with children with special health care needs bear an increased cost burden in this model. HDHPs discourage use of nonpreventive primary care and thus are at odds with most recommendations for improving the organization of health care, which focus on strengthening primary care.This policy statement provides background information on HDHPs, discusses the implications for families and pediatric care providers, and suggests courses of action.

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“…Minimizing confusion is vital since our research found that persons in this age range do not understand the notion of a premium, or how it is distinguished from a co-payment. Research also suggests that a simulator, in which consumer's responses to hypothetical scenarios are used to steer them towards health insurance options, may be useful (Corlette, Downs, Monahan, & Yondorf, 2013). Ultimately the goal is for young consumers to match their perceived need for health insurance to a health insurance plan and our recommendations are intended to inform the organizations and individuals (e.g., navigators) who facilitate this.…”

Section: Implications For Policymentioning

confidence: 99%

Young Adult's Perspectives on Being Uninsured and Implications for Health Reform

Dauner

Thompson

2014

TQR

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Young adults between the ages of 18-34 are most likely to lack health insurance in the United States. The Affordable Care Act (ACA), a federal statute signed into law in 2010, contains provisions specific to increasing access to health insurance for young adults including the provision that persons under 26 can stay on their parents’ insurance. While the reasons for uninsurance among young adults have been documented, how they operate and are perceived on an individual level have not been explored in great detail. Further, it is poorly understood how the ACA policies and the state health insurance exchanges can serve young adults. Thus, we interviewed uninsured young adults aged 18-35 in northeastern Minnesota and northwestern Wisconsin and used inductive thematic analysis to explore these issues. Findings suggest that young adults don’t feel at risk for health problems and therefore have low levels of health insurance literacy and place little value on health insurance. Multiple barriers to health insurance coverage, including the provision about staying on a parent’s policy, persist despite the ACA. Our findings also suggest valuable lessons for state health insurance exchanges on how to better serve this population.

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State Insurance Exchanges Face Challenges In Offering Standardized Choices Alongside Innovative Value-Based Insurance

Cited by 7 publications

References 5 publications

Assessing social values for California's efforts to reduce the overuse of unnecessary medical care

Assessing social values for California's efforts to reduce the overuse of unnecessary medical care

High-Deductible Health Plans

Young Adult's Perspectives on Being Uninsured and Implications for Health Reform

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