Grant: #73057

Grantee Institution:The Regents of the University of California

Principal Investigator: Patrick Romano, M.D., M.P.H.

Grant Period: October 1, 2015 – September 30, 2017

Budget: $346,028

Project Aim: To explore the opportunities and challenges among individuals newly enrolled in the California insurance marketplace, as compared with those who have had coverage for at least five years.

Key Findings:

  • Participants reported seeking out the information they wanted (such as distance to services, provider reviews, and availability of providers) instead of solely relying on information that health plans provided.
  • Participants and experts had dueling definitions of ‘quality’ causing many participants to doubt the credibility of review sources.
  • To increase credibility, health care providers can show greater transparency of their plan benefits, give accurate information about provider availability, and personalize resources to help consumers understand plan benefits and navigate their network options.

Project Description:

The researchers explored the opportunities and challenges among individuals newly enrolled in the California insurance marketplace, as compared with those who have had coverage for at least five years. They employed focus groups and surveys to (1) identify meaningful attributes of healthcare quality from the perspective of consumers newly insured through America’s largest state marketplace (Covered CA) and consumers with stable employer-related coverage; (2) determine if and how provider choice and potentially costly treatment decisions are influenced by cost-sharing, network design, and related perceptions of quality; (3) identify the quality-related and other resources that consumers trust when seeking information and advice for health plan and provider choice (and why those sources are trusted); and (4) assess differences in consumer perspectives relative to their experience with health insurance and key socio-demographic characteristics. The goal of this project was to improve on ways to provide consumers with the information and tools they need to choose health plans and make treatment decisions that are consistent with their values.

This project was funded as part of the Robert Wood Johnson Foundation’s solicitation “Optimizing Value in Health Care: Consumer-focused Trends from the Field,” which supported studies that addressed consumer perceptions of value in the new and emerging health care landscape.

Publications:

Consumers’ Perceptions And Choices Related To Three Value-Based Insurance Design Approaches
Health Affairs | March 2019