兰德-The-Impact-of-Health-Reform-on-Purchased-Care-Access_-National-Health-Reform-and-Modernization-of-the-Military-Health-System-Study_93页_8mb

Summary of The Impact of Health Reform on Purchased Care Access

Core Content

This report by the RAND Corporation examines the potential impact of the Affordable Care Act (ACA) coverage expansion on access to purchased care for TRICARE beneficiaries. It focuses on how the increase in insured individuals may influence civilian physicians' decisions to continue or reduce their participation in the TRICARE network.

The study uses a combination of data from the Defense Health Agency (DHA), the Census Bureau's American Community Survey (ACS), and provider data from SK&A. It also incorporates projections from the RAND COMPARE microsimulation model to estimate the changes in health insurance coverage across the U.S. in 2016. These data and models are used to predict how the financial incentives for physicians to accept newly insured patients may affect their interactions with TRICARE enrollees.

The report highlights that approximately 7% of TRICARE visits are delivered by community providers who may be incentivized to replace their current TRICARE patients with newly insured individuals. These providers are termed "at risk" because their financial viability could be threatened by the ACA's coverage expansion.

Main Findings

• Impact on Access: The ACA coverage expansion is expected to increase the demand for health care services, which could lead to a shift in the patient mix for civilian providers.
• Financial Incentives: Physicians may be motivated to replace TRICARE patients with newly insured individuals if the latter offer higher reimbursement rates.
• Specialties and Networks: Primary care physicians are more likely to be affected by the coverage expansion than specialists. Network physicians and those in prime service areas (PSA) are also more at risk than non-network physicians.
• Geographic Variation: Some regions, particularly those with a rapid influx of newly insured individuals and a limited supply of civilian physicians, are more vulnerable to potential access issues.
• Sensitivity to Assumptions: The results of the study are sensitive to assumptions about payment rates, Medicaid policy changes, and the demand for care from newly insured individuals.

Key Information

• Scope of the Study: The research is part of the "National Health Reform and Modernization of the Military Health System" project, sponsored by the Office of the Secretary of Defense.
• Methodology: The study uses empirical data and behavioral modeling to estimate the potential changes in care access for TRICARE beneficiaries.
• Findings:
  • About 19% of TRICARE physicians could potentially replace all of their TRICARE net revenue with revenue from newly insured patients.
  • These physicians account for roughly 7% of all TRICARE visits.
  • Primary care physicians are more likely to be at risk than specialists.
• Policy Implications: The findings suggest that the DoD and TRICARE managed care support contractors should monitor access in specific geographic areas and physician specialties where the risk of reduced TRICARE participation is higher.

Structure of the Report

• Introduction: Overview of the study's purpose and the context of the ACA's impact on the U.S. health care system.
• Affordable Care Act Background: Description of the ACA's coverage expansion provisions and their implementation.
• Physician Responses to the Coverage Expansion: Analysis of how physicians might respond to increased demand and changes in payment structures.
• Overview of Research Approach: Details on the data sources and modeling techniques used in the study.
• Aggregate Effects of ACA Coverage Expansion on Purchased Care Access: Summary of the overall impact on TRICARE access across the U.S.
• Geographic Variation in Impacts on Purchased Care Access: Analysis of how different regions and specialties are affected.
• Sensitivity Analyses: Examination of how different assumptions affect the results.
• Discussion: Interpretation of findings and policy recommendations to mitigate potential access issues.

Policy Recommendations

• Monitoring Access: DHA and TRICARE managed care support contractors should closely monitor access in high-risk regions and specialties.
• Adjusting Payment Rates: Policy options include adjusting TRICARE payment rates or other program features to maintain access.
• Supporting Providers: Strategies to support providers in maintaining their participation in the TRICARE network should be explored.

Conclusion

The study provides a framework for understanding how the ACA's coverage expansion may influence the behavior of civilian providers in relation to TRICARE beneficiaries. It serves as a tool for policymakers to anticipate and address potential access challenges in the military health system. The findings suggest that while the ACA has expanded health insurance coverage, it may also lead to changes in the availability and accessibility of care for TRICARE beneficiaries, particularly in areas with high demand and limited provider capacity.