The goal of this study is to address gaps in knowledge about tiered pricing and develop policy options for Minnesota state policymakers regarding the use of quality information. The applicants will conduct an analysis of the Minnesota State Employees Group Health Insurance Plan (SEGIP), which assigns primary care clinics to one of four tiers based on their risk-adjusted total annual per capita cost of care. They will examine consumer and provider perspectives through the following research questions:
To what extent is the two-fold difference in total annual per capita risk-adjusted cost across the four tiers due to unit prices versus quantity of service?
To what degree are differences in total cost across tiers explained by measures of avoidable utilization?
What is the pure tier effect (cost-sharing) on total cost?
How sensitive is the choice of clinic to tier-related cost-sharing differentials?
To what extent does “loyalty” at the clinic and physician level attenuate the price-sensitivity of clinic choice?
How do clinics respond to being placed in cost-sharing tiers?
How should data on clinic quality of care be incorporated into a tiered cost-sharing system?
The State Health Access Data Assistance Center (SHADAC) is a program of the Robert Wood Johnson Foundation and a part of the Health Policy and Management Division of the School of Public Health at the University of Minnesota.