Optimizing Choice of Health Insurance for Diabetes (OrCHID)
- Agency for Healthcare Research and Quality (AHRQ)
Project Summary
Optimizing Choice of Health Insurance for Diabetes study is a study about health insurance plan choice. Health economic stated preference methods like discrete choice experiments ask patients to weigh trade-offs between multiple product features and can quantify which features influence respondent decisions the most. In this observational natural experiment study, we will use stated preference surveys to quantify patient preferences for health plans that adequately cover diabetes care and assess the relationship between preference-aligned plan enrollment and health and health care utilization outcomes.
Findings from this study can be used to help consumers identify plans with financial and non-financial attributes that are meaningful to them and most likely to improve their health, health care costs, and satisfaction. This information can be used by health plan navigators or brokers to help consumers choose a plan, and/or can be integrated into health plan decision support tools. Findings from this project can be applied to other contexts, including other chronic conditions and other settings such as the ACA Marketplace and Medicare.
Specific Aims
We will conduct individual interviews in English and Spanish with patients with type 2 diabetes (n = 30) enrolled in employer-sponsored and non-group market plans from a commercial carrier. A thematic qualitative data analysis will explore relevant plan characteristics, trade-offs consumers make when choosing a plan (e.g. premium vs. network), consideration of plan choice on a family level, and plan choice constraints (e.g. willingness to pay, coverage for particular devices), especially as these issues pertain to diabetes care.
Using qualitative data from Aim 1, we will design a discrete choice experiment survey to assess how consumers value attributes of health plans. We will administer the survey in English and Spanish to health plan enrollees with diabetes prior to the start of a new plan year. We will apply preference weights elicited in the DCE to consumers’ offered plan and determine the difference between the utility for the offered plan and the utility for the patient’s ideal plan assessed using a DCE-derived utility function.
Our primary outcome will be a claims-based measure of adverse diabetes outcomes among patients from Aim 2 who remain enrolled in a plan for the subsequent year. We will also assess receipt of appropriate diabetes care and health care costs (including out of pocket costs) and utilization from claims data. Plan satisfaction, financial burden, and cost-related under use of care will be assessed via patient surveys administered in English and Spanish.