Affordability in a mandated environment.

Objectives: To identify insights gained from Hawaii's experience with healthcare costs in an environment of mandated employer-based coverage and implications for other states as implementation of the Affordable Care Act ramps up.

Study Design: Case analysis.

Methods: We reviewed literature on healthcare costs in Hawaii and analyzed descriptive statelevel and national data from a variety of sources, including MEPS and Hawaii's Department of Commerce and Consumer Affairs.

Engaged patients will need comparative physician-level quality data and information about their out-of-pocket costs.

For patients to be engaged, they will need meaningful and comparable information about the quality and cost of health care. We conducted a literature review and key-informant interviews, reviewed selected online reporting tools, and found that quality and cost reporting fell into two categories. One emphasizes public reporting of information, supported by philanthropic or government institutions that aim to improve provider quality and efficiency.

Evidence that consumers are skeptical about evidence-based health care.

We undertook focus groups, interviews, and an online survey with health care consumers as part of a recent project to assist purchasers in communicating more effectively about health care evidence and quality. Most of the consumers were ages 18-64; had health insurance through a current employer; and had taken part in making decisions about health insurance coverage for themselves, their spouse, or someone else. We found many of these consumers' beliefs, values, and knowledge to be at odds with what policy makers prescribe as evidence-based health care.

Connecting the ivory tower to main street: setting research priorities for real-world impact.

Health care decisionmakers face increasing pressure to use health care resources more efficiently, but the information they need to assess policy options often is unavailable or not disseminated in a useful form. Findings from stakeholder meetings and a survey of private-sector health care decisionmakers in California begin to identify high-priority issues, the perceived adequacy of current information, and preferred formats and other desired attributes of research. This is a first step in establishing a systematic approach to linking the information priorities of private-sector decisionmakers with those who fund and conduct research.

Coordinated care in a 'consumer-driven' health system.

High-deductible health plans--with and without spending accounts--are gaining ground. Will these evolving benefit designs complement or undermine the coordination of care for patients with chronic illnesses? Based on an October 2005 roundtable sponsored by the California HealthCare Foundation and Health Affairs, this paper discusses the implications of a changing health insurance market for the chronically ill, capitation payment for medical groups, and consumers navigating the system.

Consumer decision making in the individual health insurance market.

This paper summarizes the results from a study of consumer decision making in California's individual health insurance market. We conclude that price subsidies will have only modest effects on participation and that efforts to reduce nonprice barriers might be just as effective. We also find that there is substantial pooling in the individual market and that it increases over time because people who become sick can continue coverage without new underwriting.

Using contingent choice methods to assess consumer preferences about health plan design.

Introduction: American insurers are designing products to contain health care costs by making consumers financially responsible for their choices. Little is known about how consumers will view these new designs. Our objective is to examine consumer preferences for selected benefit designs.

Public perceptions of cost containment strategies: mixed signals for managed care.

With health care costs, and insurance premiums in particular, escalating rapidly, we may see the reintroduction of utilization management strategies associated with managed care, which seemed destined for oblivion only a short time ago. Results from a survey to assess Americans' views of managed care cost containment strategies indicate mixed support: Despite an overall lack of confidence in managed care, Americans appear to be receptive to specific managed care practices. Those designing cost containment strategies must find a balance between imposing restrictions that moderate use and hold down costs and allowing consumers to retain some control over their own health care.

Trends and variability in individual insurance products in California.

This paper examines recent trends in benefits and premiums for individual health insurance products purchased by Californians. There is much variability in the coverage available in the individual insurance market, with correspondingly wide variability in premiums. Despite concerns about increased consumer cost sharing, the average share of health spending covered by these products has remained constant between 1997 and 2002.

Medical management after managed care.

Health insurers are under conflicting pressures to improve the quality and moderate the costs of health care yet to refrain from interfering with decision making by physicians and patients. This paper examines the contemporary evolution of medical management, drawing on examples from UnitedHealth Group, WellPoint Health Networks, and Active Health Management. It highlights the role of claims data, predictive modeling, notification requirements, and online enrollee self-assessments; the choice between focusing on behavior change among patients or among physicians; and the manner in which medical management is packaged and priced to accommodate the diversity in willingness to pay for quality initiatives in health care.

Setting priorities in medical care through benefit design and medical management.

As health care costs continue to increase, so does the importance of setting priorities in the allocation of medical care resources. Based on a November 2003 roundtable, this paper discusses the potential for benefit design (the definition of covered benefits) and medical management (the criteria by which benefits are applied to specific patients) to contribute to priority setting, particularly in the context of increasing emphasis on evidence-based medicine.

Workers' perspectives on mandated employer health insurance.

There is renewed discussion of using employer mandates as a strategy for decreasing the number of uninsured Americans. California recently passed the Health Insurance Act of 2003, the first state-based "play-or-pay" legislation in nearly a decade. To better understand workers' perceptions, the California HealthCare Foundation commissioned NORC at the University of Chicago to conduct a survey to assess workers' views on mandated employer coverage.

Subsidies and the demand for individual health insurance in California.

Objective: To estimate the effect of changes in premiums for individual insurance on decisions to purchase individual insurance and how this price response varies among subgroups of the population.

Data Source: Survey responses from the Current Population Survey (http://www.bls.

Tiered hospital networks.

As a result of rising health care costs, health plans are experimenting with insurance products that shift greater financial responsibility for medical care to consumers and create incentives for consumers to consider cost differences when choosing among providers. Based on an October 2002 roundtable discussion, this paper discusses insurance product trends, particularly tiered hospital networks. Issues addressed include these product features' potential to reduce system costs, the effect on the hospital-health plan relationship, consumers' ability to consider cost and quality in decision making, and financial barriers to care for the chronically ill.