Evaluation of the Effect of a Consumer-Driven Health Plan on Medical Care Expenditures and Utilization

Objective. To compare medical care costs and utilization in a consumer-driven health plan (CDHP) to other health insurance plans.
Study Design. We examine claims and employee demographic data from one large employer that adopted a CDHP in 2001. A quasi-experimental pre–post design is used to assign employees to three cohorts: (1) enrolled in a health maintenance organization (HMO) from 2000 to 2002, (2) enrolled in a preferred provider organization (PPO) from 2000 to 2002, or (3) enrolled in a CDHP in 2001 and 2002, after previously enrolling in either an HMO or PPO in 2000. Using this approach we estimate a difference-in-difference regression model for expenditure and utilization measures to identify the impact of CDHP.
Principal Findings. By 2002, the CDHP cohort experienced lower total expenditures than the PPO cohort but higher expenditures than the HMO cohort. Physician visits and pharmaceutical use and costs were lower in the CDHP cohort compared to the other groups. Hospital costs and admission rates for CDHP enrollees, as well as total physician expenditures, were significantly higher than for enrollees in the HMO and PPO plans.
Conclusions. An early evaluation of CDHP expenditures and utilization reveals that the new health plan is a viable alternative to existing health plan designs. Enrollees in the CDHP have lower total expenditures than PPO enrollees, but higher utilization of resource-intensive hospital admissions after an initially favorable selection.     

Employee Choice of Consumer-Driven Health Insurance in a Multiplan, Multiproduct Setting

Objective. To determine who chooses a Consumer-Driven Health Plan (CDHP) in a multiplan, multiproduct setting, and, specifically, whether the CDHP attracts the sicker employees in a company's risk pool.
Study Design. We estimated a health plan choice equation for employees of the University of Minnesota, who had a choice in 2002 of a CDHP and three other health plans—a traditional health maintenance organization (HMO), a preferred provider organization (PPO), and a tiered network product based on care systems. Data from an employee survey were matched to information from the university's payroll system.
Principal Findings. Chronic illness of the employee or family members had no effect on choice of the CDHP, but such employees tended to choose the PPO. The employee's age was not related to CDHP choice. Higher-income employees chose the CDHP, as well as those who preferred health plans with a national provider panel that includes their physician in the panel. Employees tended to choose plans with lower out-of-pocket premiums, and surprisingly, employees with a chronic health condition themselves or in their family were more price-sensitive.
Conclusions. This study provides the first evidence on who chooses a CDHP in a multiplan, multiproduct setting. The CDHP was not chosen disproportionately by the young and healthy, but it did attract the wealthy and those who found the availability of providers more appealing. Low out-of-pocket premiums are important features of health plans and in this setting, low premiums appeal to those who are less healthy.     

Tales from the New Frontier: Pioneers' Experiences with Consumer-Driven Health Care

Objective. To conduct site visits to study the early experiences of firms offering consumer-driven health care (CDHC) plans to their employees and firms that provide CDHC products.
Data Sources/Study Setting. A convenience sample of three firms offering CDHC products to their employees, one of which is also a large insurer, and one firm offering an early CDHC product to employers.
Study Design. We conducted onsite interviews of four companies during the spring and summer of 2003. These four cases were not selected randomly. We contacted organizations that already had a consumer-driven plan in place by January 2002 so as to provide a complete year's worth of experience with CDHC.
Principal Findings. The experience of the companies we visited indicated that favorable selection tends to result when a CDHC plan is introduced alongside traditional preferred provider organization (PPO) and health maintenance organization (HMO) plan offerings. Two sites demonstrated substantial cost-savings. Our case studies also indicate that the more mundane aspects of health care benefits are still crucial under CDHC. The size of the provider network accessible through the CDHC plan was critical, as was the role of premium contributions in the benefit design. Also, companies highlighted the importance of educating employees about new CDHC products: employees who understood the product were more likely to enroll.
Conclusions. Our site visits suggest the peril (risk selection) and the promise (cost savings) of CDHC. At this point there is still far more that we do not know about CDHC than we do know. Little is known about the extent to which CDHC changes people's behavior, the extent to which quality of care is affected by CDHC, and whether web-based information and tools actually make patients become better consumers.     

Consumer Enrollment and Experiences in the Cash and Counseling Program

Study Context. Consumer direction of Medicaid supportive services raises concerns about who should be permitted to self-direct, whether consumers should be allowed to pay family members, whether a self-directed option increases demand for services, and how to ensure quality. The Cash and Counseling programs contained features designed to address these concerns.
Demonstration Enrollment. Many consumers used representatives to manage the allowance on their behalf and others chose to disenroll, suggesting that beneficiaries were capable of deciding for themselves whether the programs were suitable for them. Participation among eligible beneficiaries during the demonstration was modest, suggesting that consumer direction did not itself substantially increase the demand for services.
Consumer Experiences. Most consumers were able to assume the role of employer without difficulty, many hiring relatives or acquaintances as workers. In each state, more than 85 percent reported they would recommend the program to others seeking more control over their care, and more than half said the program had "improved their lives a great deal."     

Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record

PURPOSE

Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care.

METHODS

We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively.

RESULTS

A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake.

CONCLUSIONS

By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems.     

The Relationship between Health Plan Performance Measures and Physician Network Overlap: Implications for Measuring Plan Quality

ObjectiveTo examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics.ConclusionsStandard health plan performance measures reflect physician practice patterns rather than plans'' effort to improve quality. This implies that more provider-oriented measurement, such as would be possible with accountable care organizations or medical homes, may facilitate patient decision making and provide further incentives to improve performance.     

Predicting Health Plan Member Retention from Satisfaction Surveys: The Moderating Role of Intention and Complaint Voicing

Many health plans have tried to increase member retention by improving their scores on customer satisfaction surveys. However, prior research has demonstrated weak relationships between member satisfaction and retention, suggesting that other variables are needed to understand how satisfaction impacts member retention. In a longitudinal study 4,806 health plan members who completed satisfaction surveys were re-assessed three years later; we compared measures of satisfaction, intention, and complaining behavior from voluntary disenrollees and retained members. The relationship between satisfaction and retention was moderated by members' intentions to disenroll. The findings suggest that health plans can enhance the predictive validity of their satisfaction surveys by including measures of both satisfaction and intentions.     

上海市浦东新区科教兴医的3年策略行动方案研究思路

文章主要介绍上海市浦东新区科教兴医3年策略行动方案的研究背景、研究框架、研究方法与研究经验。作者提出科教兴医策略行动方案的研究需在明确科教兴医目的与内外环境分析的基础上。确定科教兴医策略行动方案的目标，然后再制定策略行动方案；作者还讨论了制定科教兴医行动方案的成功关键因素。     

Generational Cohorts Hold the Key to Understanding Patients and Health Care Providers: Coming-of-Age Experiences Influence Health Care Behaviors for a Lifetime

The health care landscape is ever changing. Medical groups are experiencing challenges in recruiting staff, dealing with managing effective clinical teams, and tempering the growing tensions among partnerships and medical groups. Additionally, all clinicians report many patients are now approaching them differently than in the past. They come armed with medical information from the Internet and a more questioning attitude toward the clinician's directive for care. What accounts for these behavioral changes and management challenges within health care organizations? These issues may be best understood and addressed through generational cohort analysis.     

The Web and Electronic Information in Canadian Consumer Health Libraries

Abstract

Recent Canadian health care reform has its origins in the consumer and patient movements observed worldwide, with system renewal relying heavily on current, accurate information. The advent of accessible electronic information on the Web has made the modern consumer health movements information intensive and its participants well informed. Thirty-three Canadian consumer health librarians were surveyed about electronic information and Web trends, with twenty (61%) responding with personal observations and perceptions regarding use, impact, and value. Qualitative survey data are introduced within the context of other consumer health papers in the literature from other jurisdictions, especially the United States. The investigators relate global trends to what is happening in Canada, always with an eye to reporting librarian concerns of available search tools, unreliable consumer-level information, and the need to improve online appraisal skills, as well as other timely relevant electronic information topics.     

学校食堂卫生监控的几点设想

尝试学校食堂卫生管理的新思路,提出实施危险性关键控制点分析(HACCP)管理,从卫生的控制与管理、烹制加工过程的危害控制、从业人员个人卫生、加工操作卫生要求分别做出了规定。     

上海市浦东新区医疗卫生专业人才培养的3年策略行动方案研究

医疗卫生服务的竞争就是人才的竞争,医疗卫生机构要想获得长远的发展,就必须高度重视人力资源的开发与培养.根据对浦东新区38所医疗卫生机构目前培训状况和未来培训需求的研究结果,作者提出了浦东新区医疗卫生专业人才培养的3年策略行动方案.     

Consumer Price Sensitivity and Social Health Insurer Choice in Germany and the Netherlands

In this paper, we examine the effects of the introduction of free choice and price competition in social health insurance in Germany and the Netherlands. Using panel data at the sickness fund level we estimate the price elasticity of sickness fund choice in both countries. We find that the price elasticity in Germany is high and rapidly increasing. Consistent with findings of other studies on health plan choice, the price elasticity is much lower for elderly than for non-elderly. In the Netherlands, by contrast, the price elasticity of fund choice is negligible. Only when people were forced to choose a sickness fund, they were quite sensitive to premium differences. Key factors in explaining the observed differences in switching behavior between both countries are the degree of financial risk for sickness funds, the features of the risk-adjustment mechanism and the role of employers.     

医疗卫生人员的工作满意度现况调查和比较研究

目的描述不同机构医疗卫生人员工作满意度现状及其差异。方法结构问卷调查,样本机构是上海市某区所有卫生机构、医院和社区卫生服务中心,抽样方法为20%比例系统抽样,计划调查1 047人,实际回收问卷937份,问卷回收率为89.5%。调查内容为人际关系、工作前景、工作条件、医院管理、相对报酬、工作压力、工作强度、社会地位和职业风险。采用因子分析和百分折算法进行数据分析。结果医疗卫生人员对人际关系满意程度最高,为88分;对相对报酬满意程度最低,为60分。这个结果在3类机构之间有一致性。此外,医院医疗卫生人员对各方面的满意程度明显低于社区卫生服务中心和卫生机构,尤其是社会地位。结论应当全面提高医疗卫生人员的薪酬待遇,同时改善医院医疗卫生人员的社会地位。     

Health Status and Health Care Experiences among Homeless Patients in Federally Supported Health Centers: Findings from the 2009 Patient Survey

Objective

To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts.

Data Sources/Study Setting

Nationally representative data from the 2009 Health Center Patient Survey.

Study Design

Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients'' health care experiences.

Data Collection

Computer-assisted personal interviews were conducted with health center patients.

Principal Findings

Homeless patients had worse health status—lifetime burden of chronic conditions, mental health problems, and substance use problems—compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24–3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37–2.92).

Conclusions

There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use.