Person: Chernew, Michael
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Chernew
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Michael
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Chernew, Michael
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Publication Adverse Selection into and within the Individual Health Insurance Market in California in 2014Fung, Vicki; Peitzman, Cassandra; shi, Julie; Liang, Catherine; Dow, William; Zaslavsky, Alan; Fireman, Bruce; Derose, Stephen; Chernew, Michael; Newhouse, Joseph; Hsu, JohnPublication Who Uses a Price Transparency Tool? Implications for Increasing Consumer Engagement(SAGE Publications, 2017) Gourevitch, Rebecca; Desai, Sunita; Hicks, Andrew; Hatfield, Laura; Chernew, Michael; Mehrotra, AteevDespite the recent proliferation of price transparency tools, consumer use and awareness of these tools is low. Better strategies to increase the use of price transparency tools are needed. To inform such efforts, we studied who is most likely to use a price transparency tool. We conducted a cross-sectional study of use of the Truven Treatment Cost Calculator among employees at 2 large companies for the 12 months following the introduction of the tool in 2011-2012. We examined frequency of sign-ons and used multivariate logistic regression to identify which demographic and health care factors were associated with greater use of the tool. Among the 70 408 families offered the tool, 7885 (11%) used it at least once and 854 (1%) used it at least 3 times in the study period. Greater use of the tool was associated with younger age, living in a higher income community, and having a higher deductible. Families with moderate annual out-of-pocket medical spending ($1000-$2779) were also more likely to use the tool. Consistent with prior work, we find use of this price transparency tool is low and not sustained over time. Employers and payers need to pursue strategies to increase interest in and engagement with health care price information, particularly among consumers with higher medical spending.Publication Nearly One Third of Enrollees in California's Individual Market Missed Opportunities to Receive Financial Assistance(Health Affairs, 2016) Fung, Vicki; Liang, CY; Donelan, Karen; Peitzman, Cassandra; Dow, William; Zaslavsky, Alan; Fireman, Bruce; Derose, SF; Chernew, Michael; Newhouse, Joseph; Hsu, JohnPublication Potential Consequences of Reforming Medicare Into a Competitive Bidding System(American Medical Association (AMA), 2012) Song, Zirui; Cutler, David; Chernew, MichaelPublication A Controlled Trial of Value-based Insurance Design – The MHealthy: Focus on Diabetes (FOD) Trial(BioMed Central, 2009) Spaulding, Alicen; Fendrick, A Mark; Herman, William H; Stevenson, James G; Smith, Dean G; Chernew, Michael; Parsons, Dawn M; Bruhnsen, Keith; Rosen, Allison B.Background: Diabetes affects over 20 million Americans, resulting in substantial morbidity, mortality, and costs. While medications are the cornerstone of secondary prevention, many evidence-based therapies are underutilized, and patients often cite out-of-pocket costs as the reason. Value-based insurance design (VBID) is a 'clinically sensitive' refinement to benefit design which links patient cost-sharing to therapy value; the more clinically beneficial (and valuable) a therapy is for a patient, the lower that patient's cost-sharing should be. We describe the design and implementation of MHealthy: Focus on Diabetes (FOD), a prospective, controlled trial of targeted c o-payment reductions for high value, underutilized therapies for individuals with diabetes. Methods: The FOD trial includes 2,507 employees and dependents with diabetes insured by one large employer. Approximately 81% are enrolled in a single independent-practice association model health maintenance organization. The control group includes 8,637 patients with diabetes covered by other employers and enrolled in the same managed care organization. Both groups received written materials about the importance of adherence to secondary prevention therapies, while only the intervention group received targeted co-payment reductions for glycemic agents, antihypertensives, lipid-lowering agents, antidepressants, and diabetic eye exams. Primary outcomes include medication uptake and adherence. Secondary outcomes include health care utilization and expenditures. An interrupted time series, control group design will allow rigorous assessment of the intervention's impact, while controlling for unrelated temporal trends. Individual patient-level baseline data are presented. Discussion: To our knowledge, this is the first prospective controlled trial of co-payment reductions targeted to high-value services for high-risk patients. It will provide important information on feasibility of implementation and effectiveness of VBID in a real-world setting. This program has the potential for broad dissemination to other employers and insurers wishing to improve the value of their health care spending.Publication Value-Based Insurance Design: A “Clinically Sensitive, Fiscally Responsible” Approach to Mitigate the Adverse Clinical Effects of High-Deductible Consumer-Directed Health Plans(Springer-Verlag, 2007) Fendrick, A. Mark; Chernew, MichaelPublication Potential Effects Of Eliminating The Individual Mandate Penalty In California(Health Affairs (Project Hope), 2019-01) Fung, Vicki; Liang, Catherine Y.; Shi, Ju; Seo, Veri; Overhage, Lindsay; Zaslavsky, Alan; Fireman, Bruce; Derose, Stephen F.; Newhouse, Joseph; Hsu, John; Chernew, MichaelThe federal government eliminated the tax penalty for non-compliance with the Affordable Care Act’s individual mandate starting with the 2019 enrollment year. Using interviews with individual market enrollees in California in 2017, we found that 19 percent reported that they would not have purchased insurance had there been no penalty. We estimate premiums would have increased by four to seven percent if these enrollees were not in the risk pool. Moreover, the effects of eliminating the penalty were more concentrated in vulnerable subgroups, including those with lower income or educational attainment, Hispanic enrollees, and those who were uninsured in the prior year. Younger enrollees and those without chronic conditions were also more likely to say they would not have purchased insurance if there was no penalty. Eliminating the mandate penalty alone is unlikely to destabilize the individual market in California, but could erode coverage gains, especially among groups who have historically been less likely to be insured.