Show Me My Health Plans: Using a Decision Aid to Improve Decisions in the Federal Health Insurance Marketplace.
Ontology highlight
ABSTRACT:
SUBMITTER: Politi MC
PROVIDER: S-EPMC5550739 | biostudies-literature | 2016 Jul
REPOSITORIES: biostudies-literature
Publications
Show Me My Health Plans: Using a Decision Aid to Improve Decisions in the Federal Health Insurance Marketplace.
Politi Mary C MC Kuzemchak Marie D MD Liu Jingxia J Barker Abigail R AR Peters Ellen E Ubel Peter A PA Kaphingst Kimberly A KA McBride Timothy T Kreuter Matthew W MW Shacham Enbal E Philpott Sydney E SE
MDM policy & practice 20160701
<h4>Introduction</h4>Since the Affordable Care Act was passed, more than 12 million individuals have enrolled in the health insurance marketplace. Without support, many struggle to make an informed plan choice that meets their health and financial needs.<h4>Methods</h4>We designed and evaluated a decision aid, Show Me My Health Plans (SMHP), that provides education, preference assessment, and an annual out-of-pocket cost calculator with plan recommendations produced by a tailored, risk-adjusted ...[more]
Similar Datasets
Project description:BackgroundThe implementation of the ACA has improved access to quality health insurance, a necessary first step to improving health outcomes. However, access must be supplemented by education to help individuals make informed choices for plans that meet their individual financial and health needs.Methods/designDrawing on a model of information processing and on prior research, we developed a health insurance decision support tool called Show Me My Health Plans. Developed with extensive stakeholder input, the current tool (1) simplifies information through plain language and graphics in an educational component; (2) assesses and reviews knowledge interactively to ensure comprehension of key material; (3) incorporates individual and/or family health status to personalize out-of-pocket cost estimates; (4) assesses preferences for plan features; and (5) helps individuals weigh information appropriate to their interests and needs through a summary page with "good fit" plans generated from a tailored algorithm. The current study will evaluate whether the online decision support tool improves health insurance decisions compared to a usual care condition (the healthcare.gov marketplace website). The trial will include 362 individuals (181 in each group) from rural, suburban, and urban settings within a 90 mile radius around St. Louis. Eligibility criteria includes English-speaking individuals 18-64 years old who are eligible for the ACA marketplace plans. They will be computer randomized to view the intervention or usual care condition.DiscussionPresenting individuals with options that they can understand tailored to their needs and preferences could help improve decision quality. By helping individuals narrow down the complexity of health insurance plan options, decision support tools such as this one could prepare individuals to better navigate enrollment in a plan that meets their individual needs. The randomized trial was registered in clinicaltrials.gov (NCT02522624) on August 6, 2015.
| S-EPMC4754978 | biostudies-literature
Project description:ImportanceRecent subsidy enhancements in Affordable Care Act (ACA) Marketplaces made many low-income enrolles (below 150% of the federal poverty level [FPL]) eligible for 2 free silver-tier plans. eligible for 2 free silver-tier plans. However, an unintended consequence of this structure is that the identity of which silver plans are free will often "turn over" between years, requiring that enrollees actively initiate premium payment (or lose coverage). The prevalence of this free-plan turnover is not known.ObjectiveTo measure the prevalence of free-plan turnover in ACA Marketplaces and to estimate how many enrollees below 150% of FPL are likely to be affected.Design setting and participantsThis observational cross-sectional study used data on plan offerings and premiums in 33 state ACA Marketplaces using HealthCare.gov in 2021 and 2022, along with estimates of county-level enrollee characteristics and plan selection patterns. The enrollment-weighted share of county markets affected by free-plan turnover was quantified, along with the association of turnover with enrollee and market characteristics. Estimates of the number of affected low-income enrollees were calculated using the data plus statistics reported in past research. Data were analyzed from November 21, 2021, to February 28, 2022.ResultsThis study found that turnover of zero-premium plans was quite common, with 93% of HealthCare.gov counties (weighted by enrollment) experiencing at least 1 zero-premium plan in 2021 turning over to nonfree in 2022; 84% of counties experienced turnover of all $0 silver plans from 2021 to 2022. This turnover affected an estimated 1.36 million people with incomes below 150% of FPL. Turnover was more common in counties with a higher share of non-White enrollees, in Medicaid nonexpansion states, in counties with more carriers, and in counties with changes in the number of offered plans.Conclusions and relevanceThe findings of this cross-sectional study suggest that owing to the prevalence of zero-premium plan turnover, many low-income ACA enrollees faced elevated risk of disenrollment at the start of 2022. Outreach to affected enrollees and other actions to encourage coverage retention and midyear reenrollment could help mitigate coverage losses.
| S-EPMC9034407 | biostudies-literature
Project description:The health insurance Marketplaces established by the Affordable Care Act include features designed to simplify the process of choosing a health plan in the individual, or nongroup, insurance market. While most individual health insurance enrollees purchase plans through the federal and state-based Marketplaces, millions also purchase plans directly from an insurance carrier (off Marketplace). This study was a descriptive comparison of the decision-making processes and shopping experiences of consumers in two states who purchased a health insurance plan from the same large insurer in 2017, either through the federal Marketplaces or off Marketplace. In a survey, those who selected plans through the Marketplaces reported less difficulty finding the best or most affordable plan than did those enrolling off Marketplace. Respondents in families with chronic health conditions who enrolled through the Marketplaces reported better overall experiences than those who enrolled off Marketplace. Respondents with low health insurance literacy reported poor experiences in enrolling both through the Marketplaces and off Marketplace. Access to consumer assistance in the individual health insurance market should target off-Marketplace populations as well as all populations with low health insurance literacy.
| S-EPMC7333350 | biostudies-literature
Project description:Objective(s)Birth plans appeared at the end of the twentieth century, enabling women to express their expectations towards childbirth. This reflects a rising demand for patients to take a proactive role in their medical care. This study aimed to collaboratively develop a medical decision aid with expectant mothers to prepare them better for the events surrounding their child's birth.Study designFive topics frequently addressed in birth plans were identified by both patients' associations, using semi-structured interview with representatives of women's associations, and professionals, using an online poll. Initially, work groups with perinatal care professionals drafted items designed to guide expectant mothers in developing their birth plans and actively participating in childbirth decisions. Subsequently, we used a modified Delphi-consensus in three rounds to retain the most relevant items. The first two rounds engaged a multidisciplinary team of professionals, while the third involved expectant mothers from two maternity wards in Lyon, France. Items that received a rating between 3 (good value) and 4 (excellent value) on a 4-point scale by more than 75% of participants were deemed consensual. The study assessed inter-rater agreement using the Fleiss kappa score.ResultsThe professional work groups proposed a total of 124 items distributed across five themes: analgesia during labour, drug administration before and during labour, events in the delivery room, initial neonatal care, and perineal protection. Ultimately, 65.3% of the initial 124 items were deemed relevant by both the experts and the expectant mothers. Notably, the most significant differences in consensus centered around analgesia and the complexity of information. Non-medicinal analgesic methods were favored by mothers-to-be but not by professionals. Conversely, detailed information on delayed cord clamping were favored by experts.ConclusionsA modified Delphi consensus was used to create with expectant mothers a decision aid tool to help them write their birth projects, addressing five main topics that are frequently reported in the literature. We now need to test this tool in clinical practice to assess its relevance in routine obstetrics consultation.
| S-EPMC11916945 | biostudies-literature
Project description:BackgroundMany cancer survivors struggle to choose a health insurance plan that meets their needs because of high costs, limited health insurance literacy, and lack of decision support. We developed a web-based decision aid, Improving Cancer Patients' Insurance Choices (I Can PIC), and evaluated it in a randomized trial.Materials and methodsEligible individuals (18-64 years, diagnosed with cancer for ≤5 years, English-speaking, not Medicaid or Medicare eligible) were randomized to I Can PIC or an attention control health insurance worksheet. Primary outcomes included health insurance knowledge, decisional conflict, and decision self-efficacy after completing I Can PIC or the control. Secondary outcomes included knowledge, decisional conflict, decision self-efficacy, health insurance literacy, financial toxicity, and delayed care at a 3-6-month follow-up.ResultsA total of 263 of 335 eligible participants (79%) consented and were randomized; 206 (73%) completed the initial survey (106 in I Can PIC; 100 in the control), and 180 (87%) completed a 3-6 month follow-up. After viewing I Can PIC or the control, health insurance knowledge and a health insurance literacy item assessing confidence understanding health insurance were higher in the I Can PIC group. At follow-up, the I Can PIC group retained higher knowledge than the control; confidence understanding health insurance was not reassessed. There were no significant differences between groups in other outcomes. Results did not change when controlling for health literacy and employment. Both groups reported having limited health insurance options.ConclusionI Can PIC can improve cancer survivors' health insurance knowledge and confidence using health insurance. System-level interventions are needed to lower financial toxicity and help patients manage care costs.Implications for practiceInadequate health insurance compromises cancer treatment and impacts overall and cancer-specific mortality. Uninsured or underinsured survivors report fewer recommended cancer screenings and may delay or avoid needed follow-up cancer care because of costs. Even those with adequate insurance report difficulty managing care costs. Health insurance decision support and resources to help manage care costs are thus paramount to cancer survivors' health and care management. We developed a web-based decision aid, Improving Cancer Patients' Insurance Choices (I Can PIC), and evaluated it in a randomized trial. I Can PIC provides health insurance information, supports patients through managing care costs, offers a list of financial and emotional support resources, and provides a personalized cost estimate of annual health care expenses across plan types.
| S-EPMC7356712 | biostudies-literature
Project description:ImportanceIndividual health insurance marketplaces established through the Affordable Care Act of 2010 (ACA) fill a critical gap for those who lack other coverage options. The high degree of coverage turnover, or churn, has raised concerns about affordability and strategic behavior on the part of individuals to sign up only when they need care.ObjectiveTo assess the role of California's ACA marketplaces in the broader health care landscape by understanding enrollment tenure and churn.Design, setting, and participantsThis cross-sectional study analyzed survey data from a representative, probability-based sample of enrollees in California's ACA marketplace, Covered California, collected immediately after the open enrollment periods in 2018, 2019, and 2021. Administrative data from Covered California from January 1, 2014, to December 31, 2021, were used to analyze marketplace tenure. Survey data included 9571 heads of households aged 18 to 64 years who were newly enrolled or had recently terminated their plan, directly drawn from Covered California's administrative records. Administrative data included individuals up to age 65 years who enrolled in the marketplace during 2014 to 2021.ExposuresNew enrollment in or termination from health care coverage through California's ACA marketplace.Main outcomes and measuresEnrollment tenure in California's ACA marketplace, sources of coverage prior to enrolling and after terminating coverage, and demographic or plan characteristics associated with the decision to go uninsured.ResultsMedian (IQR) length of coverage among 5.4 million enrollees (mean [SD] age, 38 [16] years; 17% Asian American/Native Hawaiian or other Pacific Islander, 2.5% Black or African American, 23% Latino [response options were Hispanic, Spanish, or Latino origin], 29% White, 7.5% categorized as other [including American Indian/Alaskan Native, multiple races, and other], and 21% of unknown race or ethnicity) was 14 (6-35) months, and 41% to 46% of enrollees disenrolled within 1 year, with substantial variation by subgroups. Despite this churn, only 14% (95% CI, 12%-15%) of 6474 terminating members surveyed across 3 years (2018, 2019, and 2021) reported being uninsured after leaving the marketplace, with the rest moving to job-based coverage or Medicaid. Most of those surveyed (mean [SE] percentage, 56% [0.016] individuals) reported having had employer-sponsored insurance or Medicaid prior to enrolling in the marketplace. Among subsidized renewal candidates, Latino candidates were 1.5 percentage points (95% CI, 0.8-2.3 percentage points) more likely to go uninsured compared with White candidates, and those with no expected physician visits in the coming year were 4.8 percentage points (95% CI, 2.4-7.2 percentage points) more likely to go uninsured vs those who expected physician visits.Conclusions and relevanceThe results of this cross-sectional study of coverage churn found that ACA marketplaces served 2 distinct types of individuals, long-term enrollees but, more often, individuals with short-term-coverage needs due to a change in eligibility for other insurance. These results suggest that marketplaces are smoothing coverage disruptions and that policies to reduce gaps in coverage should be designed with this in mind.
| S-EPMC9719048 | biostudies-literature
Project description:BackgroundOver 15.3 million Americans relied on the individual health insurance market for health coverage in 2021. Yet, little is known about the relationships between the organizational characteristics of individual market health insurers and quality of coverage, particularly with respect to clinical outcomes.ObjectiveTo examine variation in marketplace insurers' quality performance and investigate how performance varies by insurer organizational characteristics.DesignRetrospective cohort study.Participants381 insurer products, representing 184 unique insurers in 50 states in 2019 and 2020.Main measuresMarketplace plan clinical quality measures reported in the 2019-2020 CMS Plan Quality Rating System dataset and insurer-product organizational attributes identified from several data sources, including non-profit ownership, Blue Cross Blue Shield Association membership, Medicaid focus and whether or not the insurer product is vertically integrated with a provider organization.Key resultsAmong the 381 insurer products in this study, 35% are part of a provider-sponsored health plan (PSHP) and 70% of these entities received four stars or above for overall quality performance. Overall, PSHPs exhibited higher quality than non-PSHPs for both clinical quality management (0.36 increased on a 5-point scale; 95% CI = 0.11 to 0.62; P = 0.005) and enrollee experience (0.27; 95% CI = 0.03 to 0.50; P = 0.03) summary indicators. Medicaid focused insurers were associated with lower performance on enrollee experience, plan administration, and various outcomes related to clinical quality.ConclusionsProvider-sponsored health plans in the health insurance marketplaces are associated with higher-quality care, as measured by CMS clinical quality measures.
| S-EPMC9585138 | biostudies-literature
Project description:BackgroundDelay in surgical treatment for carpal tunnel syndrome (CTS) may result in long-term decreased functional outcomes. Few investigators have examined the relationship between type of health insurance plan and time to definitive treatment of CTS following diagnosis. We investigated the relationship between insurance type, treatment decision, and the time between diagnosis and surgery across groups.MethodsThis was a retrospective cohort study using the MarketScan Commercial Claims and Encounters Database 2011-2020. We used χ2 tests, linear regression, and logistic regression models to analyze demographic data and the time lag interval between CTS diagnosis and treatment.ResultsOverall, 28% of high-deductible health plan (HDHP) patients underwent carpal tunnel release, compared with 20% of traditional insurance patients (P < 0.001). HDHPs are defined by the internal revenue service as a deductible of $1400 for an individual or $2800 for a family per year. The odds of undergoing surgery versus no treatment for HDHP patients were 47% higher than traditional patients (P < 0.001). Among the patients who underwent surgery, HDHP patients underwent surgery 65 days earlier on average following diagnosis compared with traditional patients (P < 0.001).ConclusionsPatients with HDHPs who receive a diagnosis of CTS are more likely to undergo surgery, with a shorter time lag between diagnosis and surgery. The results from this study call attention to differences in surgical decision-making between patients enrolled in different insurance plans.
| S-EPMC10906623 | biostudies-literature
Project description:OBJECTIVE:To examine variations in premium and cost-sharing across marketplace plans available to eligible families. DATA SOURCES:2011-2012 Medical Expenditure Panel Survey (MEPS), 2014 health plan data from healthcare.gov, and the 2011 Medicare Part D public formulary file. STUDY DESIGN:We identified a nationally representative cohort of individuals in the MEPS who would have been eligible for marketplace coverage. For each family, we simulated the total out-of-pocket payment (premium plus cost-sharing) under each available plan in their county of residence, assuming their premarketplace use. DATA COLLECTION/EXTRACTION METHODS:Confidential state and county of residence identifiers were merged onto MEPS public use files and used to match MEPS families to the plans available in their county as reported in the publicly available data from healthcare.gov. PRINCIPAL FINDINGS:We found substantial variation in total family health care spending, especially premium component, across marketplace plans. This is true even within a plan tier of the same minimum actuarial value, and for families eligible for subsidies. Variation among families with income below 250 percent of the FPL is larger than variation among families with higher income. CONCLUSIONS:Our simulations show substantial variations in net premium and out-of-pocket payments across marketplace plans, even within a plan tier.
| S-EPMC6051972 | biostudies-literature
Project description:Competition in health insurance markets may fail to improve health outcomes if consumers are not able to identify high quality plans. We develop and apply a novel instrumental variables framework to quantify the variation in causal mortality effects across plans and how much consumers attend to this variation. We first document large differences in the observed mortality rates of Medicare Advantage plans within local markets. We then show that when plans with high (low) mortality rates exit these markets, enrollees tend to switch to more typical plans and subsequently experience lower (higher) mortality. We derive and validate a novel "fallback condition" governing the subsequent choices of those affected by plan exits. When the fallback condition is satisfied, plan terminations can be used to estimate the relationship between observed plan mortality rates and causal mortality effects. Applying the framework, we find that mortality rates unbiasedly predict causal mortality effects. We then extend our framework to study other predictors of plan mortality effects and estimate consumer willingness to pay. Higher spending plans tend to reduce enrollee mortality, but existing quality ratings are uncorrelated with plan mortality effects. Consumers place little weight on mortality effects when choosing plans. Good insurance plans dramatically reduce mortality, and redirecting consumers to such plans could improve beneficiary health.
| S-EPMC8409169 | biostudies-literature